Volume 11 Issue 11, November 2015

In the past decade, major advances have been made in defining the antigens and pathogenesis of immune complex diseases such as membranous nephropathy and IgA nephropathy. Probing of rare genetic diseases has revealed new pathways of injury in proteinuric conditions, including channel abnormalities in the podocyte and complement dysregulation underlying proliferative glomerular lesions.

Advances in genome sequencing and genetic manipulation techniques over the last decade have helped identify numerous single-gene causes of early-onset kidney diseases and risk alleles for complex, polygenic traits. Subsequent studies regarding the underlying disease mechanisms will help lead to personal genetic diagnoses and unique therapeutic interventions in the future.

The past decade has seen developments in several aspects of acute kidney injury (AKI), including the discovery of an array of biomarkers, assessment of the optimal dose intensity for renal replacement therapy, and the impact of fluid administration. Furthermore, AKI has emerged as an important risk factor for chronic kidney disease.

Autosomal dominant polycystic kidney disease is a challenging disorder to diagnose and treat effectively. Promising research over the past decade has, however, provided novel interventions, modifications to clinical practice and new areas to investigate with the aim of identifying approaches to slow disease progression.

Although the first 50 years of renal transplantation were marked by great advances in immunosuppressive therapies, the past decade has been marked by an unprecedented increase in technology. This progress has spurred investigators to challenge old paradigms and investigate how best to utilize these technologies to further improve patient care.

Urinary tract infections (UTIs), including pyelonephritis, are among the most common and serious infections encountered by nephrologists. Emerging evidence suggests a fundamental role for the innate immune system in protecting the urothelium from bacterial challenge. This Review provides an overview of UTI pathogenesis in the upper and lower urinary tract. The authors describe the role of intercalated cells and the innate immune response in preventing UTI, focusing on the role of antimicrobial peptides in maintaining urinary tract sterility.

Dysregulated phosphate metabolism is a common consequence of kidney disease and renal transplantation. In this Review, Martin H. de Borst and colleagues outline the pathophysiology of dysregulated phosphate metabolism in renal transplant recipients and discuss the effect of this dysregulation on the cardiovascular system, bone, and the kidney graft. They also propose possible strategies to correct phosphate abnormalities in these patients.

Albuminuria is used as a marker of kidney disease progression, but whether it has a role in the pathogenesis of kidney disease and the reasons for its association with cardiovascular disease are unclear. In this Review, Rabelink and de Zeeuw propose that degradation of the glycocalyx leads to albuminuria and that the filtered protein contributes to kidney disease pathogenesis. Furthermore, they discuss how systemic degradation of the gylcocalyx can lead to cardiovascular disease, providing an explanation for the association between these diseases and albuminuria.

In this Viewpoint, five members of theNature Reviews Nephrologyadvisory board reflect on the progress and frustrations of the past decade in basic and clinical nephrology research. They comment on areas where effort and money should be invested and the challenges that remain to be overcome, as well as give their predictions for progress in the next decade.

November 2015 marks the 10th anniversary of Nature Reviews Nephrology. To celebrate this milestone, we present a special anniversary issue. These specially commissioned articles, together with a special infographic summarize the major advances in translational and clinical nephrology over the past decade and provide insights into how the field might progress over the next 10 years.