Nature Reviews Nephrology最新文献

{"title":"Kidney research at an inflection point: why the next decade must be different","authors":"David Crosby, Gaia Cantelli, Samantha Lawes, Tracey Murray","doi":"10.1038/s41581-026-01124-7","DOIUrl":"10.1038/s41581-026-01124-7","url":null,"abstract":"Kidney disease is a growing global health challenge, yet research remains fragmented and under-resourced. To realize advances from emerging technologies, kidney research must become more collaborative, data-driven and interdisciplinary. A connected ecosystem from discovery to implementation with equity at its core is essential to translate scientific opportunity into kidney health impact.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 11","pages":"753-754"},"PeriodicalIF":46.7,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906689","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inflammation as a therapeutic target to improve kidney and cardiovascular outcomes","authors":"Katherine R. Tuttle, Mehmet Kanbay, Radica Z. Alicic, Juan Jesus Carrero, Sidar Copur, Ann Marie Navar, Brendon L. Neuen, Vlado Perkovic, Peter Rossing, Nikolaus Marx, Paul M. Ridker","doi":"10.1038/s41581-026-01117-6","DOIUrl":"10.1038/s41581-026-01117-6","url":null,"abstract":"Chronic kidney disease (CKD) is a leading cause of premature death due to the loss of kidney function and development of kidney failure, and because of attendant major adverse cardiovascular events. High-sensitivity C-reactive protein (hsCRP), a biomarker of systemic inflammation, is associated with increased risks of cardiovascular events and CKD progression. CKD is characterized by a pro-inflammatory state with upregulation of inflammatory pathways and disruption of anti-inflammatory mechanisms. The resulting systemic inflammation, along with local tissue-based inflammatory mechanisms, are key contributors to kidney damage, atherosclerosis and cardiac dysfunction. As a result, a series of inflammatory pathways and mediators have emerged as potential therapeutic targets for CKD and its major cardiovascular complications. Investigational treatments that have targeted inflammation include inhibition of apoptosis signal-regulating kinase-1 (ASK1) by selonsertib, Janus kinase (JAK) 1/2 inhibition with baricitinib, protein kinase C-β (PKCβ) inhibition with ruboxistaurin, nuclear factor erythroid 2-related factor 2 (Nrf2) activation with bardoxolone, phosphodiesterase inhibition with pentoxifylline and monoclonal antibodies against IL-1β and IL-6. Furthermore, proven therapies for CKD, including renin–angiotensin–aldosterone system inhibitors, sodium–glucose cotransporter-2 inhibitors, glucagon-like peptide-1 receptor agonists and non-steroidal mineralocorticoid antagonists, possess anti-inflammatory properties that might contribute to their previously established clinical benefits. Chronic kidney disease (CKD) is characterized by a pro-inflammatory state that contributes to kidney damage, atherosclerosis and cardiac dysfunction. This Review describes the epidemiology and pathogenesis of inflammation in CKD and outlines the therapeutic rationale for targeting inflammation to improve kidney and cardiovascular outcomes in patients with CKD.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 11","pages":"784-802"},"PeriodicalIF":46.7,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148892017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nucleic acid sensing pathways in kidney disease development","authors":"Magaiver Andrade-Silva, Chaelin Kang, Yena Jang, Katalin Susztak","doi":"10.1038/s41581-026-01120-x","DOIUrl":"10.1038/s41581-026-01120-x","url":null,"abstract":"Sterile inflammation triggered by mislocalized self-nucleic acids has emerged as an important mechanism linking cellular injury to progressive kidney dysfunction. Among the key molecular pathways implicated in this response, those underlying nucleic acid sensing represent a central signalling mechanism, particularly the cytosolic DNA sensor cyclic GMP-AMP synthase (cGAS) and its downstream effector stimulator of interferon genes (STING). In both glomerular and tubular compartments, mitochondrial dysfunction, genotoxic stress and epigenetic dysregulation lead to the accumulation of cytosolic nucleic acids, including mitochondrial DNA and RNA, nuclear DNA fragments and reactivated endogenous retroelements. These signals converge on nucleic acid sensors, including STING, absent in melanoma 2 (AIM2) and endosomal Toll-like receptors (TLRs), activating proinflammatory cascades, cell death programmes and fibrotic remodelling. The latest research highlights the context-dependent engagement of these pathways across human kidney disease and in experimental models of acute kidney injury and chronic kidney disease, linking cellular damage to immune activation and fibrosis. Here, we synthesize emerging insights into the molecular programming of nucleic acid sensing in kidney disease and evaluate the therapeutic landscape, outlining opportunities and challenges for clinical translation. Nucleic acid sensing is emerging as an important contributor to inflammation and tissue injury in the kidney. Here, the authors provide an overview of key DNA and RNA sensors, discuss evidence of their involvement in kidney pathology and consider the potential of these pathways as therapeutic targets.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 11","pages":"821-839"},"PeriodicalIF":46.7,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148874557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A podocyte-specific damage score to enable mapping of disease progression","authors":"Susan J. Allison","doi":"10.1038/s41581-026-01122-9","DOIUrl":"10.1038/s41581-026-01122-9","url":null,"abstract":"","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 10","pages":"683-683"},"PeriodicalIF":46.7,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Creatine supplementation and the young kidney","authors":"Guido Filler","doi":"10.1038/s41581-026-01121-w","DOIUrl":"10.1038/s41581-026-01121-w","url":null,"abstract":"Creatine supplementation is unlikely to harm healthy kidneys, but a normal estimated glomerular filtration rate does not guarantee low risk. Adolescents and young adults with reduced nephron endowment, previous kidney disease or additional nephrotoxic exposures require targeted assessment and pragmatic harm reduction, including avoidance of loading and excessive protein intake.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 11","pages":"758-759"},"PeriodicalIF":46.7,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missed acute interstitial nephritis diagnoses without a biopsy","authors":"Monica Wang","doi":"10.1038/s41581-026-01119-4","DOIUrl":"10.1038/s41581-026-01119-4","url":null,"abstract":"","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 10","pages":"682-682"},"PeriodicalIF":46.7,"publicationDate":"2026-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demystifying palliative care to improve patient symptom management and quality of life","authors":"Emily Rademacher, Samantha Gelfand","doi":"10.1038/s41581-026-01118-5","DOIUrl":"10.1038/s41581-026-01118-5","url":null,"abstract":"People with advanced kidney disease manage a heavy symptom burden in addition to the emotional, mental and social toll of chronic illness and kidney replacement therapy. Addressing misconceptions surrounding palliative care in nephrology might increase incorporation of palliative approaches, thereby improving symptom management and quality of life.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 10","pages":"680-681"},"PeriodicalIF":46.7,"publicationDate":"2026-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148795888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leave no one behind: optimizing kidney protection in type 1 diabetes","authors":"Peter Rossing, Hiddo J. L. Heerspink","doi":"10.1038/s41581-026-01116-7","DOIUrl":"10.1038/s41581-026-01116-7","url":null,"abstract":"Despite unprecedented advances in the treatment of non-diabetic chronic kidney disease (CKD) and CKD in type 2 diabetes mellitus in the past decade, no new drugs have been approved for CKD in type 1 diabetes mellitus. Urgent action is needed to develop new therapies and improve outcomes for this population.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 10","pages":"673-674"},"PeriodicalIF":46.7,"publicationDate":"2026-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148758666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The therapeutic approach to cardiovascular-kidney-metabolic syndrome.","authors":"Janani Rangaswami, Kevin Bryan Lo, Chiadi E Ndumele","doi":"10.1038/s41581-026-01109-6","DOIUrl":"https://doi.org/10.1038/s41581-026-01109-6","url":null,"abstract":"<p><p>Obesity, type 2 diabetes mellitus and chronic kidney disease (CKD) are highly prevalent conditions that frequently coexist and result in an excess burden of cardiovascular disease (CVD), premature death and health-care resource utilization. The concept of cardiovascular-kidney-metabolic (CKM) syndrome highlights the overlap of pathophysiological mechanisms that underlie obesity, diabetes mellitus and CKD and, together with adverse socioecological factors, amplify CVD risk. This framework encourages a holistic approach that recognizes the interconnectedness between metabolic factors, CKD and CVD, and the importance of screening for these factors at a population level to identify windows for CVD prevention across the lifespan. CKD is a key risk factor, mediator and therapeutic target to reduce CVD burden. The approach to using guideline-directed medical therapies for CKM syndrome is facilitated by assessment of absolute risk using validated CVD calculators, enabling therapy to be tailored to match absolute risk for maximal net benefit. In addition, screening for adverse social drivers of health is necessary to identify structural barriers to optimal care and move towards a multidisciplinary approach to ensure alignment between healthy lifestyle, risk factor control and guideline-directed medical therapies for all individuals living with CKM syndrome.</p>","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":" ","pages":""},"PeriodicalIF":46.7,"publicationDate":"2026-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148679441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Addressing the high burden of kidney disease: lessons from Taiwan","authors":"I-Wen Wu,&nbsp;Mai-Szu Wu","doi":"10.1038/s41581-026-01112-x","DOIUrl":"10.1038/s41581-026-01112-x","url":null,"abstract":"Taiwan carries one of the world’s heaviest kidney disease burdens globally; however, its single-payer universal health-care system has enabled policy-driven transformation of kidney care through population-level screening, multidisciplinary pay-for-performance programmes, data-driven surveillance and digital innovation. These strategies have reduced disease incidence and improved outcomes, and provide a replicable model for health systems elsewhere.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 10","pages":"677-679"},"PeriodicalIF":46.7,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148631074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}