A recent study has characterized the early immune response to xenotransplantation. The researchers used a multimodal approach to phenotype two α-1,3-galactosyltransferase-knockout pig kidney xenografts that were transplanted into brain-dead human recipients. The xenografts remained functional and produced urine throughout the 54-h study period, with no evidence of hyperacute rejection.

Mutations in NPHS2 — which encodes the slit diaphragm protein, podocin — are the most common genetic cause of steroid-resistant nephrotic syndrome. Using genetic models of nephrotic syndrome, Ding et al. now demonstrate that adeno-associated virus (AAV)-mediated delivery of podocin can rescue defects in NPHS2.

Transplantation of kidneys from donors with detectable SARS-CoV-2 RNA is generally deemed safe. In a new study, Miklos Molnar and colleagues investigated whether transplanting organs from deceased infected donors, including those who died from COVID-19, can affect transplant outcomes.

Digital transformation offers unprecedented opportunities for advancing healthcare, but also raises complex ethical and legal challenges. Emerging drivers of health disparity termed ‘digital determinants of health’ call for purposeful, equity-focused strategies to ensure that technological innovation benefits all without exacerbating disparities.

New data from a phase 1 clinical trial suggest that the small-interfering RNA (siRNA) therapeutic zilebesiran could be beneficial in patients with hypertension. Zilebesiran is designed to specifically inhibit the hepatic production of angiotensinogen, which is the precursor of all angiotensin peptides.

IL-1 receptor antagonist (IL-1Ra) secreted by macrophages might be a therapeutic target in invasive fungal sepsis, according to a study by Stefan Freigang and colleagues.

The diagnosis of glomerular disease relies largely on meticulous histological and laboratory investigations that continue to improve with technological advances. However, low-income countries such as Uganda lack this investigatory armamentarium and patients are often treated on the basis of suboptimal evidence.

Among global destabilizing events, natural disasters often receive widespread attention whereas protracted conflicts and economic crises fade into the background. Low- and middle-income countries bear the brunt of this indifference, resulting in severely weakened health systems. People who require dialysis are particularly vulnerable, necessitating urgent collaboration to ensure equitable and sustainable

Acute kidney injury (AKI) triggers remodelling of the tubule epithelium; however, insights into the dynamics of this process are limited. Using serial intravital two-photon microscopy to track tissue remodelling in a model of partial ischaemia–reperfusion injury, Luca Bordoni and colleagues now show that injury propagates along the nephron and can predict tubule atrophy.

Acute kidney injury (AKI) is a global concern that affects patient outcomes and resource utilization. An effective educational programme aimed at improving early AKI identification, triaging and treatment, using risk scores and care bundles coupled with access to point-of-care diagnostics, can help to prevent AKI-related deaths in regions with limited resources.

Autosomal dominant polycystic kidney disease (ADPKD) is associated with innate and adaptive immune alterations. Now, Katharina Hopp and colleagues suggest that immune-checkpoint inhibition could slow the progression of ADPKD.

Early identification of acute interstitial nephritis (AIN) can enable withdrawal of the causative drug or initiation of therapy; however, methods to differentiate AIN from other forms of acute kidney injury (AKI) are limited and often requires a kidney biopsy. In new research, Dennis Moledina and colleagues identify and validate CXCL9 as a diagnostic biomarker for AIN, which they say may reduce the

Kevin Nguyen and colleagues investigated the association between residence in historically redlined areas and kidney failure in 2012–2019. They report a significantly higher incidence of kidney failure in redlined areas (Home Owners Loan Corporation (HOLC) grade D; 740.7 per million) than in areas with the best HOLC grade (HOLC grade A; 326.5 per million). Among Black adults, the kidney failure incidence

Kidney injury can induce organ fibrosis through the proliferation and activation of GLI1-expressing mesenchymal cells; however, the mechanism that links injury to GLI1 activation is unclear. Now, researchers show that leukocyte-derived TNF promotes GLI1+ cell proliferation and fibrosis through the induction and release of Indian Hedgehog (IHH) from tubule epithelial cells.

Autoreactive T cell function is an important therapeutic target in autoimmunity and a study by Nicholas Jones and colleagues now suggests that the sodium–glucose co-transporter 2 (SGLT2) inhibitor canagliflozin (cana) could be used to modulate T cell activation.

New data from the CONVINCE open-label, randomized controlled trial show a lower risk of death among patients with kidney failure who were receiving high-dose haemodiafiltration than among those who were receiving conventional high-flux haemodialysis. These results were presented at the 60th ERA congress in Milan and published in the New England Journal of Medicine.

Podocyte injury in membranous nephritis (MN) is associated with induction of the ubiquitin proteasome system. Meyer-Schwesinger and colleagues previously reported de novo expression of ubiquitin C-terminal hydrolase-L1 (UCH-L1) in MN and now show a link between dysfunctional UCH-L1 and impaired podocyte proteostasis.

Zhang and colleagues found that infusion of metformin compared with saline reduced food intake and weight gain upon refeeding in male rats fed a high-fat diet (HFD). In addition, metformin increased the plasma levels of growth/differentiation factor 15 (GDF15) and upregulated kidney GDF15 expression in these rats. Kidney-specific knockdown of GDF15 in HFD-fed rats significantly reduced the metformin-induced

The endocrine hormone erythropoietin (Epo) is produced in the kidney under hypoxic conditions; following its secretion it binds to erythroid progenitors in the bone marrow to induce erythropoiesis. However, the cells responsible for Epo production have not been characterized. New findings identify a distinct population of kidney stromal cells, termed Norn cells, as the major source of Epo production

Aberrant glycosylation has been implicated in autoimmune diseases, and high expression of mannose in the kidney might contribute to lupus nephritis (LN) by promoting γδ T cell infiltration, according to a study by Salomé Pinho and colleagues.

Fabry disease is an X-linked lysosomal storage disorder caused by mutations in the GLA gene. These mutations result in impaired activity of the encoded enzyme, α-galactosidase A, and subsequent intracellular accumulation of its substrate globotriaosylceramide (Gb3). However, the mechanisms that underlie Fabry nephropathy are not well understood. Now, Tobias Huber and coauthors report that accumulation

APOL1 risk variants are associated with an increased risk of chronic kidney disease. Findings from a new study demonstrate that a small molecule, inaxaplin, inhibits APOL1 channel function; furthermore, inaxaplin reduced proteinuria in patients with focal segmental glomerulosclerosis and two APOL1 risk variants.

Patients with IgA nephropathy (IgAN) and proteinuria of 1 g per day or greater are at risk of kidney disease progression. New findings from a prespecified interim analysis of the PROTECT trial, presented at the World Congress of Nephrology 2023 and published in the Lancet, demonstrate that the dual endothelin and angiotensin receptor antagonist, sparsentan, has greater antiproteinuric effects than

Individuals who are members of multiple marginalized populations experience multiple axes of oppression and discrimination. Such intersectional discrimination can have interactive, negative effects on all aspects of life, including health. To achieve health equity, intersectional-discrimination-induced kidney harms must be examined, measured and mitigated.

Mentoring is an essential component of scientific leadership and can have a profound impact on the development and life course of the mentee. Isi Ero-Tolliver, Dean of the School of Science at Hampton University, describes the life-changing and long-lasting effects of mentorship and why it is important to invest time and effort in mentoring.

The importance of incorporating factors related to sex and gender in all aspects of research is increasingly recognized. Kidney disease pathophysiology, presentation, response to therapy and outcomes differ by sex and gender, but these factors are often not considered in basic and clinical studies. It is time for nephrology to catch up.

Transgender persons can face a number of barriers in accessing primary and specialist care that is equitable, inclusive and appropriate for their needs. In this Viewpoint, commissioned to recognize Pride, five researchers with expertise across different disciplines, including nephrology, endocrinology, public health, psychology and sociology, provide their perspectives on key considerations that are