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Inter-organ interactions are critical for maintaining homeostasis in the body but can contribute to multi-organ dysfunction. Clinical evidence indicates that kidney dysfunction contributes to remote organ dysfunction, but little is known of the underlying mechanisms. Several reports published in 2022 identified critical mediators of kidney crosstalk with distant organs.
Acute kidney injury (AKI) is a multifactorial syndrome with a complex pathophysiology including different inflammatory cells and mediators. Current research focuses on identifying key contributing pathways, determining high-risk groups, characterizing AKI sub-phenotypes and investigating strategies for therapeutic interventions.
Studies in 2022 have advanced knowledge of pregnancy outcomes in kidney donors and transplant recipients as well as the long-term risks associated with hypertensive disorders of pregnancy. These findings should be used to support shared decision-making and appropriate care of women with or at risk of kidney disease.
Over the past year, trial data have emerged on therapeutic interventions in IgA nephropathy and lupus nephritis, including the effects of different doses of glucocorticoids and several novel targeted therapies. These data, in combination with the discovery of autoantibodies targeting nephrin in minimal change disease, can inform the management of immune-mediated glomerular diseases.
Kidney transplantation is the best therapy for kidney failure, but is limited by donor organ availability and the risks associated with immunosuppression. Studies in 2022 provided encouraging data about the outcomes of COVID-19 among transplant recipients, the effects of changes to organ allocation policy in the US and progress in xenotransplantation, raising hope that the organ shortage can be solved.
More than three-quarters of cases of chronic kidney disease are caused by glomerular diseases with glomerulosclerosis, including diabetic kidney disease, hypertensive nephropathy and glomerulonephritis. Studies in 2022 provided insights into the molecular mechanisms that maintain dynamic glomerular structures and the responses of specific glomerular cell types during glomerular disease.
Gut microbiome studies have potential to provide novel therapeutic targets in chronic kidney disease. Here, the authors not only examine the current state of the field and discuss potential gut-related therapies for targeting uraemic metabolites, but also provide guidelines for improving microbiome study design, and data collection and analysis.
This Review discusses the mTORC1 and AMPK nutrient sensing pathways, their downstream effects in kidney cells, their roles in the development of kidney disease and the therapeutic potential of approaches that target these pathways in various chronic kidney diseases.
Disruptions in oxalate homeostasis can lead to kidney disease and cardiovascular complications. Here, the authors review the pathways that regulate oxalogenesis and the excretion of both exogenous and endogenous oxalate, consider the pathological effects of excess oxalate, and examine the latest therapeutic options for addressing oxalate dysregulation.
