Nature Reviews Nephrology最新文献

{"title":"Microbiota and kidney disease: the road ahead","authors":"Patricia P. Bloom, Wendy S. Garrett, Kristina L. Penniston, Mari-Karoliina H. Winkler, Stanley L. Hazen, Jose Agudelo, Mangesh Suryavanshi, Ahmed Babiker, Dylan Dodd, Michael A. Fischbach, Kerwyn Casey Huang, Curtis Huttenhower, Bina Joe, Kamyar Kalantar-Zadeh, Rob Knight, Aaron W. Miller, Hamid Rabb, Anvesha Srivastava, W. H. Wilson Tang, Peter J. Turnbaugh, Alan W. Walker, Nicola Wilck, Jiaojiao Xu, Tao Yang \u0000 (, ), Jonathan Himmelfarb, Matthew R. Redinbo, Gary D. Wu, Michael H. Woodworth, A. Lenore Ackerman, Sebastian Winter, Markus M. Rinschen, Hatim A. Hassan, Annabel Biruete, Amanda H. Anderson, Jennifer L. Pluznick","doi":"10.1038/s41581-025-00988-5","DOIUrl":"10.1038/s41581-025-00988-5","url":null,"abstract":"More than 850 million individuals worldwide, accounting for 10–15% of the adult population, are estimated to have chronic kidney disease. Each of these individuals is host to tens of trillions of microorganisms that are collectively referred to as microbiota — a dynamic ecosystem that both influences host health and is itself influenced by changes in the host. Available evidence supports the existence of functional connections between resident microorganisms and kidney health that are altered in the context of specific kidney diseases, including acute kidney injury, chronic kidney disease and renal stone disease. Moreover, promising data from preclinical studies suggest that targeting of gut microbial pathways may provide new therapeutic opportunities for the treatment of kidney disease. This Roadmap describes current understanding of the mechanisms by which microorganisms regulate host organ function, the effects of kidney disease on the gut microbiome, and how these insights may contribute to the development of microbe-targeted therapeutics. We highlight key knowledge gaps that remain to be addressed and strategies for addressing these, outlining both the promise and the potential pitfalls of leveraging our understanding of the gut microbiota to better understand and treat kidney disease. Available evidence supports the existence of functional connections between resident microorganisms and the kidney that are altered in the context of specific kidney diseases. This Roadmap article describes current understanding of the mechanisms by which microorganisms regulate host organ function, highlighting key knowledge gaps that remain to be addressed and opportunities for future research.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"21 10","pages":"702-716"},"PeriodicalIF":39.8,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719393","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":"YAP–TAZ overactivation promotes glomerular epithelial proliferative disease","authors":"Monica Wang","doi":"10.1038/s41581-025-00991-w","DOIUrl":"10.1038/s41581-025-00991-w","url":null,"abstract":"","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"21 9","pages":"583-583"},"PeriodicalIF":39.8,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144715290","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":"Complex interplay between uraemic toxins, gut microbiota and diet","authors":"Monica Wang","doi":"10.1038/s41581-025-00992-9","DOIUrl":"10.1038/s41581-025-00992-9","url":null,"abstract":"","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"21 9","pages":"583-583"},"PeriodicalIF":39.8,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144719384","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":"Immunological features of clear-cell renal-cell carcinoma and resistance to immune checkpoint inhibitors","authors":"Femke H. Burgers, Johannes C. K. van der Mijn, Tom T. P. Seijkens, Inge Jedema, Axel Bex, John B. A. G. Haanen","doi":"10.1038/s41581-025-00983-w","DOIUrl":"10.1038/s41581-025-00983-w","url":null,"abstract":"The advent of immunotherapy has yielded great improvements in survival outcomes of people with clear-cell renal-cell carcinoma (ccRCC). Currently, immune checkpoint inhibitors (ICIs) are the cornerstone of treatment regimens for metastatic ccRCC. Yet a substantial group of patients do not respond to ICIs and few achieve long-term remission, indicating the presence of intrinsic and acquired resistance. The mechanisms underlying ICI resistance in ccRCC remain poorly understood, potentially owing to its unique immunological landscape compared with other immunotherapy-responsive cancers. Specifically, ccRCC is characterized by one of the highest levels of T cell infiltration across different tumours; however, high T cell infiltration does not correlate consistently with improved ICI outcomes. Moreover, the tumour mutational burden in ccRCC is relatively low, compared with that of other immunotherapy-responsive cancers, and fails to predict ICI efficacy. The limited predictive value of these commonly used markers for ICI response underscores the need for deeper exploration of the immunological mechanisms driving the antitumour immune response in ccRCC. Investigating commonalities and disparities with other immunotherapy-responsive cancer types might improve understanding of ICI resistance in ccRCC and inform the development of strategies to enhance the clinical benefits of immunotherapy. Although immune checkpoint inhibitors can prolong survival in people with clear-cell renal-cell carcinoma, disease progression is frequent. Here, the authors explore potential mechanisms that might drive intrinsic or acquired resistance to immune checkpoint inhibitors in clear-cell renal-cell carcinoma, including malignant cell-intrinsic and immune-cell factors.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"21 10","pages":"687-701"},"PeriodicalIF":39.8,"publicationDate":"2025-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677541","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 link between dementia and kidney disease demands changes in patient care","authors":"","doi":"10.1038/s41581-025-00984-9","DOIUrl":"10.1038/s41581-025-00984-9","url":null,"abstract":"The risk of cognitive impairment and dementia in people with chronic kidney disease is under-recognized. Better awareness and early intervention are crucial to improving patient outcomes.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"21 8","pages":"517-517"},"PeriodicalIF":39.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41581-025-00984-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144669703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antigens in membranous nephropathy: discovery and clinical implications","authors":"Sanjeev Sethi, Fernando C. Fervenza","doi":"10.1038/s41581-025-00980-z","DOIUrl":"10.1038/s41581-025-00980-z","url":null,"abstract":"Membranous nephropathy is an autoimmune disease that results in an accumulation of antigen–antibody (IgG) immune complexes along the subepithelial region of the glomerular basement membrane and is the most common cause of nephrotic syndrome in adults. The diagnosis of membranous nephropathy is based on the presence of granular IgG on immunofluorescence microscopy and subepithelial electron dense deposits along the glomerular basement membrane on electron microscopy. Prior to 2009, the target antigen within the immune complexes was unknown. However, in the past 15 years, and in particular the past 5 years, several target antigens have been identified. These target antigens include PLA2R, THSD7A, EXT1 and EXT2, NELL1, SEMA3B, NCAM1, CNTN1, HTRA1, FAT1, PCDH7, NTNG1, PCSK6, NDNF and MPO. Several rare putative antigens have also been reported. These findings have transformed our understanding of membranous nephropathy from that of an idiopathic disease, which results from an autoimmune response to an unknown target antigen, to a disease in which a target antigen can be identified in ~80% of cases. Improved understanding of the distinctive clinical association, pathology and prognostic findings of each target antigen will have implications for clinical evaluation and therapeutic targeting in patients with membranous nephropathy. Since the discovery of PLA2R, several target antigens associated with membranous nephropathy have been identified. This Review describes the distinct clinical associations, pathology and prognostic findings associated with each of the identified target antigens and implications for the reclassification of membranous nephropathy.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"21 10","pages":"653-670"},"PeriodicalIF":39.8,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144677640","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":"Pregnancy-associated acute kidney injury — consensus report of the 32nd Acute Disease Quality Initiative workgroup","authors":"Cathy Nelson-Piercy, Nattachai Srisawat, Kianoush Kashani, Nuttha Lumlertgul, Raghavan Murugan, Harin Rhee, Raj Chakravarthi, Tarakeswari Surapaneni, Anjali Acharya, Ghada Ankawi, Kate Bramham, Jorge Cerda, Katherine Clark, Rolando Claure-Del Granado, Swarnalata Gowrishankar, Valerie Luyckx, Shina Menon, Carlos E. Poli-de-Figueiredo, Raja Ramachandran, Manisha Sahay, Srinivas Samavedam, Rasha Shemies, Manjunath S. Shetty, Kate Wiles, Lizemarie Wium, Vin-Cent Wu, Manjusha Yadla, Claudio Ronco, Ravindra L. Mehta, Marlies Ostermann","doi":"10.1038/s41581-025-00979-6","DOIUrl":"10.1038/s41581-025-00979-6","url":null,"abstract":"Acute kidney injury (AKI) during pregnancy and the postpartum period, known as pregnancy-associated AKI (PrAKI), is an important health concern and driver of health inequity worldwide. Causes of PrAKI include sepsis, autoimmune disorders and pregnancy-specific pathologies such as hypertensive disorders. Common risk factors include maternal comorbidities and use of nephrotoxic medications. PrAKI accounts for a substantial proportion of maternal mortality and morbidity, particularly in low-income and middle-income countries, and may also adversely affect the fetus, resulting in death, premature birth and small for gestational age. In this Consensus Statement, we present recommendations on the causes, diagnosis, management and follow-up of PrAKI from the 32nd Acute Disease Quality Initiative meeting, which involved international experts in obstetrics, midwifery, obstetric medicine, paediatrics, internal medicine, anaesthesiology, nephrology and critical care. We suggest that pregnant and postpartum women at a high risk of PrAKI should be identified to enable prevention, surveillance and timely diagnosis. The multidisciplinary management of these patients should be tailored to treat their specific causes of PrAKI to optimize short-term and long-term neonatal and maternal outcomes. Further observational and interventional studies are needed to address existing gaps in knowledge of PrAKI and improve maternal and fetal outcomes. Pregnancy-associated acute kidney injury is a risk factor for maternal and fetal morbidity and mortality and a driver of health inequity worldwide. This Consensus Statement from the Acute Disease Quality Initiative provides recommendations on the causes, diagnosis, management and follow-up of pregnancy-associated acute kidney injury.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"21 9","pages":"633-646"},"PeriodicalIF":39.8,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41581-025-00979-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Kidney health outcomes of hypertensive disorders of pregnancy","authors":"Giorgina Barbara Piccoli, Massimo Torreggiani, Nora Schwotzer, Gianfranca Cabiddu, Rossella Attini, Alejandra Orozco, Rasha Shemies, Shilpanjali Jesudason, Fadi Fakhouri, Vesna D. Garovic","doi":"10.1038/s41581-025-00977-8","DOIUrl":"10.1038/s41581-025-00977-8","url":null,"abstract":"Hypertensive disorders of pregnancy (HDPs), including pre-eclampsia (PE), are frequent, affecting 8–10% and 2–4% of all pregnancies, respectively. Among HDPs, PE is the best characterized and most frequently studied — it is a heterogeneous disease with different clinical phenotypes reflecting distinct underlying mechanisms that ultimately result in widespread endothelial dysfunction and systemic damage. HDP clinical remission is common after delivery, but the long-term health of women with a history of HDP is adversely affected compared with that of women with normotensive pregnancies. The relationship between HDP and kidney health is bidirectional: chronic kidney disease (CKD) increases the risk of HDP, and HDP raises the risk of future CKD. To what extent this increased risk of CKD after HDP is due to pre-existing CKD that is unmasked by pregnancy and/or whether HDP is a causal factor in CKD remains unclear. CKD is diagnosed in up to 20% of women after PE, and the lifetime risk of kidney failure after one episode of PE is 4–8 times higher than that of the general population, increasing further with PE recurrence. These risks are cross generational, as women born prematurely from pregnancies complicated by PE and fetal growth restriction can have low nephron mass, which would not only increase their lifetime risk of CKD but also their risk of developing PE in their own pregnancies. This Review examines the bidirectional relationship between hypertensive disorders of pregnancy and kidney disease, which is currently underrecognized, with potential long-term implications for kidney health in both mothers and their offspring. The authors also discuss prevention and management of hypertensive disorders of pregnancy, including kidney health follow-up, and current research gaps.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"21 10","pages":"671-686"},"PeriodicalIF":39.8,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144652280","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":"Patient involvement in nephrology research","authors":"Nicole Scholes-Robertson, Allison Jaure","doi":"10.1038/s41581-025-00987-6","DOIUrl":"10.1038/s41581-025-00987-6","url":null,"abstract":"The involvement of patients with lived experience of kidney disease in nephrology research can strengthen the relevance and uptake of evidence to achieve better outcomes. The past two decades have seen increased efforts to involve patients and caregivers, particularly in research priority setting, study design and dissemination. However, further efforts are needed to improve the transparency and diversity of patient involvement in research.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"21 11","pages":"718-719"},"PeriodicalIF":39.8,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629470","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 catastrophic costs of chronic kidney disease","authors":"Priya Pais, Valerie Luyckx, Susmita Chatterjee, Beverley M. Essue","doi":"10.1038/s41581-025-00978-7","DOIUrl":"10.1038/s41581-025-00978-7","url":null,"abstract":"Chronic kidney disease (CKD) is associated with the highest occurrence of catastrophic healthcare expenditure (CHE) both globally and across all diseases. However, CHE alone does not provide a complete measure of the financial burdens of CKD on a household, especially for those with very low incomes or who forego therapy altogether. A more comprehensive assessment of direct, indirect and long-term costs is crucial to advancing equitable and effective universal health coverage.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"21 9","pages":"580-581"},"PeriodicalIF":39.8,"publicationDate":"2025-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144533663","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}