Volume 15 Issue 10, October 2019

In a collaborative effort, researchers have identified unusual protein deposits of exostosin 1 and exostosin 2 in patients with PLA2R and THSD7A-negative membranous nephropathy, many of whom had systemic lupus erythematosus, lupus nephritis or other forms of autoimmunity. Although serum exostosin antibodies were not detected, the findings suggest that these proteins could define a distinct subtype of membranous nephropathy.

Understanding of the cardinal role of the kidneys in maintaining fluid and electrolyte homeostasis is deeply rooted in nephrology. However, the fact that the kidney regulates protein and energy homeostasis similarly to the liver has long been overlooked. Comprehensive whole-body metabolomics studies now shed light on this important aspect of kidney function.

Acute kidney injury (AKI) is diagnosed by the serum concentration of creatinine (SCr), an insensitive marker of kidney function. The authors of this Review discuss the properties of ideal biomarkers of tubular damage and how they can be combined with SCr-based AKI definitions to provide greater insights into the processes underlying acute tubular injury.

Kidney organoids have the potential to advance the field of nephrology. Here, the author discusses progress in the development of kidney organoids and describes remaining challenges to the use of these cultures for the study of kidney physiology and disease.

Immunological ageing has profound effects on the immune system and its ability to protect the host against infection, cancer and autoimmunity. In this Review, the authors discuss how the processes of immunosenescence and inflammageing drive these age-related changes, and their effects on the ageing kidney.

Therapeutic modulation of hypoxia-inducible factors, which transduce adaptive transcriptional responses to hypoxia, is an emerging theme in kidney disease. This Review summarizes the hypoxia signalling mechanisms underpinning these novel treatments and highlights key remaining questions relevant to their clinical use.