Nature Reviews Nephrology最新文献

{"title":"Next-generation kidney tissue analysis — spatial omics and digital pathology","authors":"Takahisa Yoshikawa, Roman D. Bülow, Peter Boor, Motoko Yanagita","doi":"10.1038/s41581-026-01102-z","DOIUrl":"10.1038/s41581-026-01102-z","url":null,"abstract":"Understanding pathological processes is crucial for the diagnosis, prediction and prognostication of kidney diseases. Although progress has been made in non-invasive diagnostic approaches, many pathological processes and diseases mainly manifest in the kidney tissue, necessitating comprehensive analyses of kidney samples. Cellular and molecular analyses of the kidney, including single-cell omics approaches, have identified novel disease mechanisms. However, these non-spatial methods lack information on cellular localization and tissue organization, which is crucial for understanding cell–cell interactions. Such information is particularly important for the kidney, which has many different cell types and intricate architecture. Developments in spatial omics technologies address this challenge by enabling the simultaneous analysis of molecular profiles and spatial context. Advances in three-dimensional imaging technologies, including non-destructive approaches, may provide additional layers of structural information. Integration of spatial omics technologies, such as transcriptomics, epigenomics and metabolomics, with imaging and computational pathology approaches, such as pathomics, has the potential to further advance understanding of the pathophysiology of kidney diseases. In the future, such approaches could become part of the diagnostic workflow in pathology. In the meantime, they hold great promise to aid the identification of diagnostic, prognostic and predictive biomarkers as well as novel therapeutic targets, and thereby facilitate drug discovery. In this Review, the authors discuss the advantages, limitations and applications of spatial omics technologies in kidney research. They also discuss novel imaging methods that may extend 2D spatial analyses into 3D modelling, and the complementary applicability of deep-learning-based computational pathology.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 9","pages":"603-621"},"PeriodicalIF":46.7,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148432048","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":"Metabolic determinants of autoimmune kidney diseases","authors":"Yogesh Scindia, Laurence Morel","doi":"10.1038/s41581-026-01096-8","DOIUrl":"10.1038/s41581-026-01096-8","url":null,"abstract":"Autoantibody-driven autoimmune diseases, such as systemic lupus erythematosus, frequently affect organs such as the kidney. The differentiation and function of pathogenic immune cells that drive these diseases are in part controlled by their metabolic programming. For diseases that affect the kidney, the response of kidney cells to immune-mediated injury is also in part controlled by metabolic changes. Immune cells that promote the production of autoantibodies and/or infiltrate the kidney in lupus nephritis are sustained by enhanced glycolysis and mitochondrial oxidation. These metabolic processes are also enhanced in the mesangial and glomerular endothelial cells of patients with lupus nephritis and animal models of lupus nephritis, which may contribute to tissue injury. Similar alterations in metabolic processes might be involved in other autoimmune diseases that affect the kidney, including IgA nephropathy and ANCA-associated vasculitis. Insights into metabolic changes that occur in the context of autoimmune-mediated kidney diseases might have therapeutic implications. Despite the complexity of metabolic alterations presented by specific immune and renal cells in these autoimmune diseases, targeting of glycolysis, mitochondrial oxidation or iron metabolism could offer novel opportunities to enhance existing treatments for autoimmune-mediated kidney injury. The differentiation and function of pathogenic immune cells that drive autoimmune diseases are in part controlled by their metabolic programming. This Review describes alterations in cellular metabolism associated with autoimmune diseases that affect the kidney, with a focus on lupus nephritis. The potential of therapies that target immunometabolism in autoimmune-induced kidney diseases is also discussed.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 10","pages":"704-720"},"PeriodicalIF":46.7,"publicationDate":"2026-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148393848","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":"Beyond consent: community engagement, benefit sharing and reciprocity in kidney genomics research","authors":"June Fabian, Michèle Ramsay","doi":"10.1038/s41581-026-01101-0","DOIUrl":"10.1038/s41581-026-01101-0","url":null,"abstract":"The emergence of precision therapies for genetically mediated kidney diseases highlights a growing paradox — populations of African ancestry contribute essential genomic diversity but remain among the least likely to benefit from innovations that result from genomic research. Embedding equitable benefit sharing within kidney genomics is an ethical imperative and a scientific necessity.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 9","pages":"595-597"},"PeriodicalIF":46.7,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148361721","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 social needs of patients with kidney failure","authors":"Karine Manera, Amanda Sluiter","doi":"10.1038/s41581-026-01100-1","DOIUrl":"10.1038/s41581-026-01100-1","url":null,"abstract":"People with kidney failure experience high rates of loneliness and social isolation, yet social health remains underrecognized in care. Greater integration of social health into clinical practice, workforce investment and innovative care models are urgently needed to improve well-being and outcomes for patients.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 9","pages":"598-599"},"PeriodicalIF":46.7,"publicationDate":"2026-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148336074","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":"Long-term kidney protection in IgA nephropathy with atrasentan","authors":"Monica Wang","doi":"10.1038/s41581-026-01097-7","DOIUrl":"10.1038/s41581-026-01097-7","url":null,"abstract":"","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 8","pages":"520-520"},"PeriodicalIF":46.7,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148313419","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":"Benefits of finerenone treatment across chronic kidney disease aetiologies","authors":"Monica Wang","doi":"10.1038/s41581-026-01098-6","DOIUrl":"10.1038/s41581-026-01098-6","url":null,"abstract":"","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 8","pages":"521-521"},"PeriodicalIF":46.7,"publicationDate":"2026-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148305256","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 versatile roles of long non-coding RNAs in kidney disease","authors":"Wai Han Yiu, Sydney C. W. Tang","doi":"10.1038/s41581-026-01094-w","DOIUrl":"10.1038/s41581-026-01094-w","url":null,"abstract":"Long non-coding RNAs (lncRNAs) have emerged as critical regulators of kidney homeostasis, and their dysregulation has been implicated in a wide range of kidney diseases including acute kidney injury, chronic kidney disease and renal cell carcinoma, as well as in age-related kidney dysfunction. Increasing evidence indicates that lncRNAs have roles in key cellular processes including inflammation, autophagy, cell proliferation, senescence, apoptosis, mitochondrial dysfunction, angiogenesis, epithelial–mesenchymal transition and interstitial fibrosis. LncRNAs interact with RNA, DNA and protein to regulate gene expression via multiple mechanisms, including RNA modifications, scaffold assembly, chromatin remodelling, transcription and post-transcriptional control. Beyond their non-coding functions, some lncRNAs can be translated into bioactive micropeptides that further modulate cellular activity. Given their tissue-specific expression and high stability in body fluids, lncRNAs hold promise as biomarkers for early detection and monitoring of kidney diseases. Furthermore, lncRNA-based therapies offer novel opportunities to halt disease progression in chronic kidney disease and overcome drug resistance in renal cell carcinoma. Improved understanding of lncRNA-mediated disease mechanisms could therefore lead to improvements in the diagnosis and treatment of kidney pathologies. In this Review, the authors discuss the roles of long non-coding RNAs in acute kidney injury, chronic kidney disease, renal cell carcinoma and kidney ageing, focusing on their involvement in shared pathogenic pathways. They also discuss the potential utility of long non-coding RNAs as biomarkers and therapeutic targets.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 9","pages":"635-650"},"PeriodicalIF":46.7,"publicationDate":"2026-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148278194","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":"Sequential therapeutic approach for the management of osteoporosis in people with chronic kidney disease","authors":"Pieter Evenepoel, Hanne Skou Jørgensen, Thomas L. Nickolas","doi":"10.1038/s41581-026-01095-9","DOIUrl":"10.1038/s41581-026-01095-9","url":null,"abstract":"Osteoporosis in chronic kidney disease (CKD) grade 4–5D constitutes a profound burden and the treatment gap remains unacceptably wide. People with advanced CKD and osteoporosis should receive comprehensive treatment based on available data, and there is an urgent need to expand the evidence base through inclusion in osteoporosis clinical trials.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 8","pages":"518-519"},"PeriodicalIF":46.7,"publicationDate":"2026-06-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265224","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":"Clinical practice recommendations for the diagnosis and management of nephropathic cystinosis","authors":"Katharina Hohenfellner, Elke Wühl, Dieter Haffner, Cystinosis Guideline Group, Vera Koch, Rachel Bishop, Khalid Alhasan, Atif Awan, Justine Bacchetta, Susanne Bechtold-Dalla Pozza, Susmito Biswas, Majorlein Bos, Friederike Bürger, Mira Choi, Ewa Elenberg, Judith Erler, Sonja Froschauer, Paul C. Grimm, Helge Hebestreit, Nadine Herzig, Laura Inhestern, Christian Köppl, Elena Levtchenko, Graham Lipkin, Theresia Muth, Lars Pape, Claudia Priglinger, Julia Quitmann, Gitta Reuner, Julia Rohayem, Berit Schilling, Aude Servais, Neveen A. Soliman, Anna Sollacher, Claudia Sproedt, Rezan Topaloglu, Burkhard Tönshoff, Doris Trauner, Stefanie Witt, Paul Goodyer, Jess Thoene, Francesco Emma","doi":"10.1038/s41581-026-01089-7","DOIUrl":"10.1038/s41581-026-01089-7","url":null,"abstract":"Cystinosis is a rare autosomal recessive lysosomal storage disorder caused by pathogenic variants in CTNS, which encodes cystinosin, a H+/cystine symporter that mediates cystine efflux from lysosomes. Defective cystinosin leads to accumulation of cystine in lysosomes and the formation of cystine crystals in most tissues. In its more severe and frequent form, infantile nephropathic cystinosis, patients present with renal Fanconi syndrome in the first 2 years of life, which progresses to chronic kidney disease. Since the 1970s, cysteamine therapy and improvements in dialysis and transplantation have substantially improved patient outcomes, and currently most patients survive into adulthood. Consequently, the diagnosis and management of extra-renal complications that develop later in life have become increasingly important. In addition to the kidneys, commonly affected organs include the eyes, the musculoskeletal system, the central nervous system, exocrine glands and endocrine organs. Cystinosis therefore requires integrated care that involves multiple medical specialties and a structured transition plan from paediatric to adult care. Herein, we present evidence-based and expert opinion-based clinical practice recommendations, developed by a team of international specialists and patient representatives following the GRADE methodology, to improve the diagnosis and management of cystinosis in children and adults. In this Consensus Statement, the authors provide clinical practice recommendations for the diagnosis and long-term care of people with cystinosis. In addition to cystinosis-associated kidney complications, they also provide recommendations for the management of extra-renal manifestations, including bone, gastrointestinal, endocrine and neurological disease.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 9","pages":"651-670"},"PeriodicalIF":46.7,"publicationDate":"2026-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41581-026-01089-7.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148258921","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":"Connecting ocean, sky, humanity and planetary health and well-being","authors":"Melissa R. Haswell, Katherine A. Barraclough, Anne Poelina","doi":"10.1038/s41581-026-01092-y","DOIUrl":"10.1038/s41581-026-01092-y","url":null,"abstract":"Healthy oceans are essential for the stability of Earth’s climate and weather patterns, biodiversity and freshwater systems. Despite their vastness, waste from human activities has fundamentally changed oceanic physical, chemical and biological characteristics, threatening human health and well-being. Urgent protective action is required, especially eliminating the extraction and burning of fossil fuels.","PeriodicalId":19059,"journal":{"name":"Nature Reviews Nephrology","volume":"22 8","pages":"516-517"},"PeriodicalIF":46.7,"publicationDate":"2026-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148176363","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}