Reviews & Analysis

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.

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.

Diabetic kidney disease (DKD), the most common cause of chronic kidney disease, is primarily caused by metabolic dysfunction, likely due to mitochondrial abnormalities. In 2024, several studies made important strides towards defining the molecular mechanisms that underlie the development of DKD.

Inter-organ interactions are critical for homeostasis and proper organ functioning. Several studies published in 2024 have provided insights into the mechanisms underlying reciprocal interactions of the kidney with the brain, gut and liver.

Periodontal disease is very common and might represent a non-traditional risk factor for chronic kidney disease (CKD), independently of shared risk factors. Here, the authors discuss the interplay between these two non-communicable diseases, including the potential mechanisms underlying this bidirectional relationship.

Glomerular injury and damage to the glomerular filtration barrier can promote the development of tubulointerstitial fibrosis. Here, the authors discuss potential mechanisms underlying this effect, as well as the emerging evidence of the tubule–glomerulus crosstalk that promotes glomerular damage following tubular injury.

Endothelin-1 (ET-1) is a potent vasoactive peptide that is produced by various cell types of the kidney and regulates a variety of physiological processes. This Review describes the role of ET-1 in the kidney and in the development of chronic kidney disease, and the kidney-protective effects of endothelin-receptor antagonists in preclinical and clinical studies.

Integrins are heterodimeric transmembrane receptors that mediate crucial interactions between cells and extracellular matrix to regulate cellular functions such as intracellular signalling and organization of the actin cytoskeleton. This Review highlights the roles of integrins and integrin-binding proteins in the control of kidney-cell morphology and functions as well as their role in kidney diseases

New studies have revealed a novel homeostatic clearance function for medullary macrophages, unveiled roles for innate lymphoid cells and epithelial cells in orchestrating inflammation and fibrosis, and shown that clonal haematopoiesis influences the magnitude of inflammation in response to injury. These discoveries suggest therapeutic strategies to prevent kidney dysfunction associated with ageing and injury.

Collagens are ubiquitously expressed and have been linked to a broad spectrum of disorders. Here, the authors discuss collagen subtypes and provide a summary of collagen disorders, fibrotic process and therapies, with an emphasis on kidney diseases.

The authors review the effect of chronic kidney disease (CKD) on female and male fertility and pregnancy outcomes. They also discuss the risk of pregnancy-associated CKD progression and the potential effect of maternal or paternal CKD on the offspring.

The catalogue of genetic factors that have been implicated in kidney disease continues to grow. In this guide to gene–disease relationships, the authors discuss the crucial process whereby genetic and experimental data are critically evaluated to determine whether a genetic variant has a role in kidney disease, which can affect patient diagnosis, prognosis and management.

Congenital nephrogenic diabetes insipidus is a rare but potentially life-threatening condition. This Consensus Statement provides clinical practice recommendations developed by the European Reference Network on Rare Kidney Diseases, the European Society for Paediatric Nephrology and patient advocates to support clinicians in the diagnosis, treatment and genetic counselling of children and adults with nephrogenic diabetes insipidus.

Here, the authors describe approaches to investigating 3D genome architecture and dynamics. They discuss the physical organization and dynamic regulation of the genome and highlight studies that have provided insights into the roles of genome structure and regulation in kidney health and disease.

Here, the authors discuss the roles of renal nerves and the effects of renal denervation in hypertension, chronic kidney disease, heart failure and arrhythmias. They suggest that interruption of afferent pathways that modulate sympathetic nervous system activity are likely to underlie some of the beneficial effects of renal denervation.

Kidney fibrosis is a key pathological process in chronic kidney disease. Here, the authors examine how the metabolic reprogramming of kidney immune and non-immune cells in response to injury can promote fibrosis and consider the potential of metabolism-targeted therapies for preventing the development and progression of kidney fibrosis.

Polygenic scores model the combined risk of multiple variants across the genome to identify individuals at inherited risk of complex diseases. This Review discusses evolving methods for developing polygenic scores and describes examples across a spectrum of disease traits.

IgA nephropathy (IgAN) is thought to result from multiple hits that culminate in immune complex deposition in the kidney. Here, the authors describe the latest insights into the pathogenesis of IgAN and how they have revealed novel therapeutic targets and approaches to this disease.

The kidney has an important role in the handling of amino acids, facilitated by a complex network of kidney transporters and enzymes. This Review provides an overview of the role of the kidney in the synthesis, degradation, filtration, reabsorption and excretion of different amino acids and the relevance of these functions in the context of kidney physiology and disease.