In patients with liver disease, sodium and fluid retention is often attributed to reduced effective blood volume, which stimulates the renin–angiotensin–aldosterone system (RAAS). However, not all patients show RAAS activation. New data suggest a potential aldosterone-independent mechanism of sodium and fluid retention in liver disease. The researchers conclude that activation of ENaC by bile acids

Randomized controlled trials (RCT) are often regarded as the ‘gold standard’ of clinical evidence. However, their strict eligibility criteria can impact cohort diversity and limit the inclusion of some subgroups, including patients with comorbidities, older individuals or those from minority ethnic groups. Observational data, including data from electronic health records, can be used to bridge the

For women with kidney disease of childbearing age, kidney care should feature discussions of pregnancy, including informed counseling and support. Health disparities between regions with different levels of income are undeniable, but special care programs aimed at the early identification and management of patients at risk can greatly decrease the magnitude of the problem.

Lupus nephritis (LN) is a common clinical complication in patients with systemic lupus erythematosus (SLE). A report by Mark J. Shlomchik and colleagues reveals an interplay between NADPH oxidase 2 (NOX2) and Toll-like receptor 7 (TLR7) in B cells that can modulate SLE severity, including its kidney manifestations. The researchers propose that this protection might result from NOX2-mediated inhibition

Cognitive decline is common in patients with chronic kidney disease (CKD); however, the mechanisms linking these two conditions is unclear. New research suggests that disruption of the blood–brain barrier (BBB) by uraemic toxins may lead to microglial activation and subsequent IL-1 receptor (IL-1R)-mediated neuronal impairment. Exposure of neurons to plasma from patients with CKD did not induce their

Population ageing will exacerbate the burden of ageing-related diseases, including chronic kidney disease. Mitigating the effects of this burden will require coordinated, multinational efforts.

Reproductive health is an acknowledged right, yet women with chronic kidney disease (CKD) not only face reduced fertility but also higher risks of adverse pregnancy outcomes for mother and baby. These risks are higher in underserved populations, but they can be minimized through empowerment, education and adequate health-care support. In Mexico, nearly 37% of the population lives in poverty, with ~8%

Advance care planning (ACP) has evolved from a narrow focus on end-of-life preference, such as resuscitation, to a continuum of care planning across the life course. Older adults with kidney disease have high morbidity and mortality, and easy-to-use tools can make ACP easier for patients and clinicians.

Tertiary lymphoid organs (TLOs) are ectopic lymphoid structures with immunomodulatory effects that develop in chronic inflammatory conditions, including transplantation, cancer, autoimmune diseases and infections. Now, Martin Oberbarnscheidt and coauthors report that TLOs contribute to rejection of kidney allografts. In recipients with normal secondary lymphoid tissues, the allograft survival of F1-RIP-LTα

Glucagon-like peptide 1 receptor agonists improve glucose control, promote weight loss and reduce the risk of major cardiovascular events in people with type 2 diabetes mellitus. The FLOW study now provides unequivocal evidence of kidney protective effects with semaglutide in adults with type 2 diabetes mellitus and chronic kidney disease.

Paradoxically, obesity is a risk factor for cancer but is also associated with a survival advantage in patients treated with immune-checkpoint inhibitors. Macrophage expression of programmed cell death protein 1 (PD1) might link these two findings, according to a new study by Jeffrey Rathmell and colleagues. In vitro, upregulation of PD1 expression on macrophages depended on inflammation-induced glycolysis;

Ketogenic diets (KDs) aim to induce the production of ketone bodies and are being investigated as a dietary therapy for multiple conditions, including kidney diseases. A randomized-controlled trial conducted by Simone Kreth and colleagues suggests potential kidney benefits in sepsis. Compared with the control group, patients receiving a KD required insulin for significantly less time, had lower levels

Deep Learning (DL) holds great promise to improve patient outcomes by improving the precision and speed of disease diagnosis and treatment recommendations. Given the efficacy of DL in image analysis, pathology will likely be one of the first medical fields transformed by DL. However, several challenges must be overcome before we can expect to see the use of DL transform the digital future of pathology

A new study reports a beneficial effect of avenciguat — a novel, nitric oxide (NO)-independent, soluble guanylate cyclase (sGC) activator — on albuminuria in patients with chronic kidney disease (CKD). These findings were presented at the 61st European Renal Association Congress in Stockholm. In patients with CKD, insufficient production of NO leads to impairment of NO–sGC–cyclic guanosine monophosphate

Innate lymphoid cells (ILCs) are lymphocytes that regulate immune responses. Little is known about these cells in the kidney. New findings now reveal a role for group 3 ILCs (ILC3s) in regulating kidney fibrosis, following their migration from the intestine via a CXCR6–CXCL16 signalling axis. Using single-cell RNA sequencing of genetic models combined with structural predictions of molecular interactions

Recent data from a pre-specified analysis of the SELECT trial show a beneficial effect of the glucagon-like peptide-1 receptor agonist (GLP1RA) semaglutide on kidney outcomes in patients with cardiovascular disease and overweight or obesity without diabetes. These findings were presented at the 61st European Renal Association Congress in Stockholm. The SELECT trial, which included 17,604 participants

Kidneys from older donors might improve the quality of life and survival of patients with kidney failure, yet these organs are often underutilized. Re-framing discussions of organ acceptance from older donors and its benefits over dialysis, especially for older patients and those who cannot tolerate prolonged waiting for transplantation, is urgently needed.

Known risk factors, such as smoking, obesity and hypertension, do not explain variations in the incidence of clear cell renal cell carcinoma (ccRCC) between different geographical regions. A new study reports that the somatic mutation profiles of ccRCC differ between countries, which indicates substantial geographical variations in mutagenic exposures. To investigate mutational signatures in ccRCC

VHL loss is common in clear cell renal cell carcinoma (ccRCC) and triggers a pseudohypoxic state in mutated cells. A study by Jeffrey Rathmell and colleagues now suggests that Vhl deletion also affects the tumour immune-cell infiltrate in RCC. The myeloid cells that infiltrated Vhl−/− tumours were also functionally distinct from those in control tumours, as they were more phagocytic ex vivo and had

Cells of the macula densa (MD) sense changes in tubular fluid to control functions such as renal blood flow and renin release. New findings identify a broader role for MD cells in the remodelling of kidney tissue. “The identified cell … features … suggest that the MD is a much more complex and key sensory and regulatory cell type in the nephron than previously thought,” say the researchers. To study

Kidney disease is strongly linked with cardiovascular diseases, hypertension, diabetes, infections and other health conditions, as well as social determinants of health and climate change. Consequently, a holistic approach to promote well-being, protect individual health and improve access to quality primary care will support kidney health.

Chronic kidney disease is a life-changing diagnosis for millions of people worldwide, as the risk of disease progression and kidney failure creates unbearable uncertainty and limits lifestyle. The devastating impact of advanced kidney disease must be acknowledged in the public health agenda to pave way for improved outcomes for patients at all stages of disease.

The microbiome can modulate immune responses and has an important effect on human health, but its potential causal role in acquired autoimmune diseases remains to be determined. Now, James Gleeson, Renato Monteiro and colleagues report a mechanism by which gut microbial dysbiosis could contribute to the pathogenesis of IgA nephropathy (IgAN). As the mucin layer on the luminal side of the gut wall contains

To describe kidney and patient outcomes for individuals with rare diseases in the UK, Gale and colleagues analysed data from 27,285 patients with 28 different types of rare kidney disease in RaDaR. Over a median follow-up of 9.6 years, RaDaR participants had a significantly higher 5-year cumulative incidence of kidney failure than that of 2.81 million patients with all-cause CKD (28% versus 1%; P < 0

Clinical algorithms that are used to guide medical decision-making often include sex as a variable. However, binary considerations of sex and/or gender might introduce bias due to potentially inaccurate assumptions about sex and gender-specific physiology, hormones and exposures. An equity-focused approach to sex and gender is essential when using clinical algorithms to ensure health equity across

The prevalence of kidney disease and its associated morbidity and mortality continue to rise. This crisis cannot be tackled unless kidney disease is made a global public health priority.

Notable progress in basic, translational and clinical nephrology research has been made over the past five decades. Nonetheless, many challenges remain, including obstacles to the early detection of kidney disease, disparities in access to care and variability in responses to existing and emerging therapies. Innovations in drug development, research technologies, tissue engineering and regenerative

Diabetic kidney disease (DKD), defined as co-existing diabetes and chronic kidney disease in the absence of other clear causes of kidney injury, occurs in approximately 20–40% of patients with diabetes mellitus. As the global prevalence of diabetes has increased, DKD has become highly prevalent and a leading cause of kidney failure, accelerated cardiovascular disease, premature mortality and global