Volume 17 Issue 12, December 2021

To quote Nelson Mandela, “education is the most powerful weapon which you can use to change the world”. Education and training have changed the world of nephrology in Africa for many patients and their physicians, but most low- and middle-income countries still lack access to affordable therapies for kidney disease.

Kidney transplant recipients receive therapeutic immunosuppression that impairs their immune responses to the COVID-19 mRNA vaccine. For this reason, this vulnerable patient population is insufficiently protected by the standard two-dose COVID-19 vaccination programme and requires a specific follow-up to guide personalization of an intensified vaccination approach.

Patients receiving dialysis are at high risk of contracting SARS-CoV-2 and developing severe COVID-19. Established SARS-CoV-2 vaccination schemes might lack efficacy in these patients and a personalized approach is therefore necessary. Importantly, given the enhanced infection risks associated with dialysis, current vaccines do not replace non-pharmacological measures to prevent infection.

Vaccination against SARS-CoV-2 seems to be safe in patients with immunity-mediated kidney disease, although their immunological responses to vaccination are impaired. Further strategies, including the administration of additional vaccine doses and passive immunization with long-acting monoclonal antibodies, might increase protection in this vulnerable patient group.

Kidney involvement is common in patients with acute SARS-CoV-2 infection, and subclinical inflammation and injury may persist for many months, resulting in a progressive decline in kidney function that leads to chronic kidney disease. Continued research is imperative to understand these long-term sequelae and identify interventions to mitigate them.

This Review examines the unique biological characteristics of unconventional T cells, including γδ T cells, mucosal-associated invariant T cells and natural killer T cells, and their roles in kidney injury, glomerulopathies and fibrosis. The authors also discuss the potential clinical applications of these cells, including in patients with kidney failure treated with dialysis or transplantation.

CircRNAs have been implicated in the pathogenesis of kidney diseases, cardiovascular complications of chronic kidney disease and kidney cancer. This Review describes the roles of circRNAs in the pathophysiology of these diseases and highlights their potential as therapeutic targets and prognostic or diagnostic biomarkers.

Here, the authors provide an overview of the evolutionary processes that have implications for our understanding of kidney disease development and progression. They describe data derived from studies of ancient and archaic genomes and how population migration and genetic admixture have shaped the current landscape of human kidney-associated diseases, as well as the potential impact of environmental influences on evolutionary genetics and the adaptation of kidneys.

The apelin system is a broad regulator of physiology that has beneficial cardiovascular and renal effects. This Review focuses on the role of this system in kidney and cardiovascular health and disease and its potential as a therapeutic target.

Mesangial cells are stromal cells that are important for kidney glomerular homeostasis and the glomerular response to injury. This Perspective reviews advances in our understanding of mesenchymal stromal cell function and describes how these insights can inform our understanding of mesangial cells and their role in disease.