Uraemic calciphylaxis is a rare disease characterized by subcutaneous vessel thrombosis and ulcerative skin necrosis that predominantly affects patients with kidney failure. The disease results in substantial morbidity and mortality, but the pathogenesis is unclear and no curative therapies are available. Now, a new study reports a pathogenic role of IL-6–tissue factor (TF) signalling in uraemic calciphylaxis

The administration of anti-inflammatory macrophages has been proposed as an approach to reduce tissue injury in response to inflammation; however, this approach is limited by the instability of macrophages and their potential to switch to a pro-inflammatory phenotype. To overcome these limitations, researchers have now developed a chimeric antigen receptor (CAR) macrophage (CAR-M) that demonstrates

Progression of chronic kidney disease (CKD) is generally faster in cisgender men than cisgender women, suggesting a protective effect of female sex. An observational study in 44 transgender individuals who initiated either feminizing (estradiol and antiandrogens) or masculinizing (testosterone) hormone therapy provides new insights into the effects of sex hormones on the kidney. “This population provides

IgA nephropathy (IgAN) is a common form of glomerulonephritis. Its pathogenesis has been linked to aberrant O-glycosylation of the IgA1 hinge region, which is thought to underlie the formation of IgA1-containing immune complexes that deposit in glomeruli. New insights suggest that IgA O-glycosylation may also affect additional processes, including mucosal immunity and B cell homing to mucosal and non-mucosal

Artificial intelligence approaches that link patient data with chemical-induced kidney injury patterns are revolutionizing nephrotoxicity risk assessment. Substantial progress has been made in the development of integrated approaches that leverage big data, molecular profiles and toxicological understanding to identify at-risk patients, provide insights into molecular mechanisms and advance predictive

Social and environmental exposures are strong drivers of health inequity and adverse health outcomes. However, data from studies that examine the longitudinal effect of social and environmental exposure burdens on kidney disease outcomes are limited. The environmental justice index–social environmental ranking, although imperfect, provides an important tool to address this gap in knowledge.

African American kidney transplant recipients exhibit a higher risk of graft failure than other racial and ethnic groups even after accounting for HLA mismatches and socioeconomic status, which suggests a role for other risk factors. Now, researchers have identified a cluster of four consecutive missense single-nucleotide polymorphisms (SNPs) within leukocyte immunoglobulin-like receptor B3 (LILRB3)

Cardiovascular–kidney–metabolic (CKM) syndrome is categorized into 5 stages that range from stage 0 (no risk factors) to stage 4 (clinical cardiovascular disease in CKM syndrome). A new study by Sophie Claudel, Ashish Verma and coauthors validates this staging system by demonstrating that the risk of cardiovascular and all-cause mortality increases with CKM syndrome stage. “CKM syndrome stages 1 to

Mexico faces a high burden of chronic kidney disease, which is worsened by fragmented health care and a lack of universal coverage for kidney replacement therapy. The Mexico City CKD Project has improved access for uninsured patients through policy reforms, workforce expansion and infrastructure development, demonstrating a scalable model to reduce kidney health disparities.

Advanced instrumentation and rapid computation are generating ever more data on human genetics, epigenetics, transcriptomics, proteomics and metabolomics, posing challenges of integration and interpretation. New research has applied rigorous statistical analyses to genetic variations identified in patients with kidney disease to find drivers of (patho)physiological differences in urine and plasma metabolomes

The prohibitive costs of new pharmacological agents, particularly biologicals, have largely limited their use to high-income countries, resulting in widening of health disparities. Urgent action from the pharmaceutical industry, governments and healthcare organizations is needed to improve access to treatment and address these inequities.

The inclusion of individuals with disabilities and patients as partners in biomedical research is critical for driving innovation. Equally important are patient–researchers, who are instrumental in identifying key research problems and driving research towards areas of direct benefit. We call for institutions to actively work towards accommodating patient–researchers.

Transdermal detection of fluorescent markers has potential to provide point-of-care measurement of glomerular filtration rate. However, validation of proposed approaches and confirmation of their clinical utility should be required ahead of their adoption in the clinic.

Awareness of chronic kidney disease (CKD) and uptake of evidence-based interventions (EBIs) that increase awareness and/or slow progression to kidney failure remain alarmingly low. The global rise in immigration might exacerbate CKD prevalence among minoritized groups, which underscores the need for the nephrology community to acknowledge the diverse contexts that influence EBI implementation and to

A growing burden of diabetic kidney disease in Fiji threatens to overwhelm newly established nephrology services. Greater attention to early detection and intervention, incorporation of kidney health into national strategic plans, and international support to prioritize chronic kidney disease as a global priority is imperative.

Effective gene delivery to the kidneys is complicated by the intricacies of kidney anatomy and physiology, and cross-species differences create further barriers in the translation of preclinical research. A study by Aravind Asokan and colleagues now demonstrates the potential of adeno-associated virus (AAV) library evolution for the development of human kidney gene therapies. Delivery of AAV.k13 and

Despite the emergence of immune-based therapies, patients who undergo nephrectomy for clear cell renal cell carcinoma (ccRCC) remain at high risk of cancer recurrence, highlighting an unmet clinical need to improve outcomes for these patients. Personalized cancer vaccines (PCVs) aimed at neoantigens derived from tumour-specific mutations have demonstrated benefits in patients with tumours having high

Correction to: Nature Reviews Nephrology https://doi.org/10.1038/s41581-024-00926-x, published online 15 January 2025.

The late diagnosis of chronic kidney disease (CKD) is a global problem that limits the opportunity to initiate disease-modifying therapies. Artificial intelligence approaches using imaging or laboratory-based models can facilitate the early detection and risk stratification of CKD and thereby enable optimal treatment to reduce the burden of the disease.

A new study provides evidence of an antibiotic-responsive kidney microbiota that may influence the formation of kidney stones. Jose Agudelo and colleagues identified bacteria in mouse kidney samples, with a higher density in the medulla than in the cortex. Using RNA fluorescence in situ hybridization analysis, they also found bacterial DNA in human kidney samples; species richness was greater in the

The mechanisms that drive impaired immunity in people with kidney disease remain unclear. A study by Partha Biswas and colleagues now links a uraemic toxin to defective germinal centre (GC) B cell responses in mice. Gene-expression analysis and cell staining suggested reduced proliferation and increased apoptosis in GC B cells from KD mice compared with controls. In vitro, exposing plasmablasts to

Chronic kidney disease of undetermined cause (CKDu) is a progressive form of chronic kidney disease (CKD) that is not associated with common risk factors for CKD and mainly affects adults in low- and middle-income countries (LMICs). Researchers from the disadvantaged populations estimated glomerular filtration rate (eGFR) epidemiology (DEGREE) study now report initial insights into the burden of CKDu

Premature birth and low birth weight disrupt kidney development substantially, which leads to an increased risk of acute kidney injury, chronic kidney disease and hypertension. Broader awareness of these risks, implementation of preventive strategies and optimization of neonatal care are key to safeguarding kidney health and ensuring better long-term outcomes.

The high global burden of kidney disease highlights an urgent need for early diagnosis and the implementation of interventions to prevent disease progression. Such an approach requires the identification and management of risk factors and equitable access to quality care.

Chronic kidney disease (CKD) satisfies established criteria for screening. Although the economic burden of screening is substantial, many countries have adopted screening initiatives into their existing national programmes. Recognition of CKD as a major non-communicable disease by international bodies will help to improve global kidney care overall.

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.