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Rationing of scarce health-care resources is distressing. Clinicians therefore require clear guidance, which should be developed systematically and transparently through multi-stakeholder engagement. Rationing is seldom required in high-income settings but is often necessary in low-income settings. Global solidarity and health system strengthening are required to reduce the need for rationing.
Glucocorticoids have, for decades, been an enduring component of treatment regimens for anti-neutrophil cytoplasm autoantibody (ANCA)-associated vasculitis. However, a growing number of studies have encouraged a move towards reduced glucocorticoid usage. Findings of the ADVOCATE trial suggest that complement blockade may pave the way for complete glucocorticoid avoidance.
The adult kidney vasculature comprises diverse populations of endothelial cells that support specific functions according to their microenvironment. This Review summarizes our current understanding of the phenotypic, molecular and metabolic heterogeneity of renal endothelial cells in relation to their microenvironment and the potential application of targeting renal endothelial cell metabolism as a therapeutic strategy for kidney diseases or kidney regeneration.
Immune cells have important roles in many kidney diseases and their phenotypes are intricately connected to their metabolic profiles. Here, the authors explore the metabolic programs of different kidney immune cells and their phenotypes, and the potential of targeting immunometabolism in the kidney.
The renin–angiotensin system is essential for the regulation of blood pressure and extracellular fluid volume and composition. This Review describes mechanisms that regulate the production of renin in the collecting duct and the local interactions that underlie the contributions of the distal nephron renin–angiotensin system to the pathogenesis of hypertension and kidney injury.
The concepts of kidney damage and dysfunction, including subclinical damage and loss of renal functional reserve, are relevant to the detection of acute kidney injury (AKI). Here, the authors examine these concepts, as well as AKI duration and relapse, and discuss potential changes to AKI classification criteria.
