Sodium–glucose co-transporter 2 inhibitors have revolutionized the management of chronic kidney disease. However, long-term data regarding their use are lacking. The post-trial follow-up study to EMPA-KIDNEY provides several insights into how the effects of these powerful medications might be optimized, but several key questions remain unanswered.

New data demonstrate that in people with HIV infection, transplantation outcomes with HIV-positive donor kidneys are not inferior to those with HIV-negative donor kidneys and donor-derived HIV strains do not persist in the recipients. This approach should be standard of care for kidney transplantation in people living with HIV.

A turning point in the treatment of IgA nephropathy has been marked by several new publications that describe promising outcomes associated with the targeting of key pathogenic disease processes, including the production of galactose-deficient IgA1 and IgA-containing immune complexes, complement and endothelin system activation.

Correction to: Nature Reviews Nephrology https://doi.org/10.1038/s41581-019-0129-4, published online 11 March 2019.

The G1 and G2 APOL1 risk alleles are important risk factors for chronic kidney disease (CKD) among Black Americans; however, the genetic risk of CKD associated with APOL1 variants among individuals living in West Africa — the ancestral origin of most Black Americans — has not been thoroughly investigated. New findings from the H3Africa Kidney Disease Research Network and presented at ASN Kidney Week

Recognition that allograft microvascular inflammation can occur in the absence of circulating donor-specific anti-HLA antibodies (DSAs) led to the inclusion of two new categories in the diagnostic framework of the 2022 Banff Classification of Renal Allograft Pathology: ‘microvascular inflammation or injury (MVI), DSA-negative, and C4d-negative’, which includes cases of allograft rejection with no evidence

Women living with kidney disease are exposed to several sex and gender gaps in the clinical practice of standard hemodialysis treatment. Drawing on lived experience, we offer opportunities for improvement and call on nephrology clinicians and researchers to advance gender equity and improve health outcomes for women.

Fibrosis results from the continuous deposition of extracellular matrix (ECM) by fibroblasts in response to injurious stimuli; however, the exact roles of fibroblasts in this process are unclear. New findings demonstrate a key role for the protease ADAMTS12 in driving fibrosis through the remodelling of ECM and activation of profibrotic fibroblasts. “On the basis of these observations, we hypothesize

Glucocorticoids are currently used to induce remission in patients with antineutrophil cytoplasmic antibody glomerulonephritis (ANCA-GN), but these drugs carry a high risk of adverse effects and infection. Targeting T cells through cytokine inhibition might represent an alternative therapeutic approach, according to a new study by Christian Krebs, Ulf Panzer and colleagues. A digital pharmacology analysis

Several mechanisms prevent the ascent of uropathogenic bacteria from the bladder to the kidney, which can lead to pyelonephritis. A new study by Menna Clatworthy and colleagues clarifies the role of neutrophil extracellular traps (NETs) in this protection. Noting the presence of neutrophils in urine from individuals with a negative leukocyte esterase urine dipstick test (which is typically thought

Gene therapy is increasingly used in the clinic, but specific delivery to kidney cells remains an important obstacle to broader implementation in nephrology. In a new study, Tobias Huber and colleagues describe a new adeno-associated virus (AAV) vector that specifically targets glomerular cells. To test the therapeutic potential of AAV2-GEC, the researchers used it to carry the gene encoding IdeS,

Monogenic alterations cause a variety of paediatric kidney diseases; however, insights into their association with clinical outcomes are limited. New analyses of three cohorts demonstrate that monogenic kidney disorders are associated with an increased risk of kidney failure. “These data suggest that recognition of genetic kidney disorders will be important for clinical evaluation, understanding prognosis

Improved understanding of the cellular changes and interactions that occur in the kidney following injury may help to elucidate the mechanisms that govern the transition from acute kidney injury (AKI) to chronic kidney disease (CKD) and aid the development of therapeutic interventions. In new research, Michal Polonsky, Louisa Gerhardt and colleagues use single-cell spatial transcriptomics to uncover

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