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The promise of digital twins as a tool for personalized approaches in nephrology 数字双胞胎作为肾病学个性化治疗工具的前景。
IF 39.8 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-10-17 DOI: 10.1038/s41581-025-01021-5
Reinhard Laubenbacher, Parta Hatamizadeh
Digital twins are a key computational technology for the implementation of personalized approaches to medical care. They are based on computational models that have been calibrated to an individual patient and can be used to identify personalized treatment approaches. Nephrology offers several promising potential applications for this technology.
数字孪生是实现个性化医疗护理方法的关键计算技术。它们是基于针对个体患者进行校准的计算模型,可用于确定个性化治疗方法。肾脏病学为这项技术提供了几个有前景的潜在应用。
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引用次数: 0
Global landscape of kidney health across Indigenous populations 全球土著居民肾脏健康状况。
IF 39.8 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-10-16 DOI: 10.1038/s41581-025-01016-2
Somkanya Tungsanga, Ikechi G. Okpechi, Maria Eugenia V. Bianchi, Swasti Chaturvedi, David Collister, Harley Crowshoe, Giselle M. Rodriguez de Sosa, Habibu A. Galadanci, Erin Hedin, Kwaifa S. Ibrahim, Arsh K. Jain, Irene L. Noronha, Robin L. Erickson, Jaquelyne T. Hughes, Paul Komenda, Win Kulvichit, Roberto Pecoits-Filho, Kalani L. Raphael, Vallabh O. Shah, Malama Tafuna’i, Caroline Tait, Catherine Turner, Curtis Walker, Robert Walker, Cathy Woods, Adeera Levin, Aminu K. Bello
Approximately 480 million individuals worldwide (~6% of the global population) are Indigenous peoples. Despite their diverse cultures and histories, the shared legacy of colonialism has profoundly shaped their health and socioeconomic status. This legacy is deeply intertwined with poverty, systemic racism and historical trauma, contributing to significant health disparities compared with non-Indigenous populations. Among the many chronic diseases disproportionately affecting Indigenous peoples, chronic kidney disease (CKD) stands out as a major public health concern. Indigenous peoples experience higher rates of CKD, yet they often face barriers to accessing responsive and culturally safe health-care services. Factors such as geographic isolation, socioeconomic disadvantages and systemic discrimination limit their access to preventive care, early disease detection and kidney replacement therapy, leading to worse health outcomes and higher mortality rates. Exposure to environmental and occupational risks and inadequate infrastructure further exacerbate CKD risk for Indigenous peoples. Here, we examine determinants of kidney disease and health among major Indigenous populations in Africa, Asia, Australia, Canada, Latin America, Aotearoa–New Zealand, the Pacific Islands and the USA. We discuss culturally safe and responsive strategies that can improve the delivery of kidney care and make policy recommendations for multiple levels of government to ensure health-care systems are equipped to meet the needs of Indigenous communities. By addressing these gaps and promoting cultural competence in kidney care, health-care providers can have a crucial role in reducing health disparities and improving Indigenous peoples’ kidney health worldwide. Indigenous peoples are disproportionally affected by poor kidney health outcomes globally. Here, a group of Indigenous and non-Indigenous authors provide a global overview of kidney health among Indigenous populations across different regions and its key determinants, including structural factors, and make actionable policy recommendations for addressing these health inequities.
全世界约有4.8亿人(约占全球人口的6%)是土著人民。尽管他们的文化和历史各不相同,但殖民主义的共同遗产深刻地影响了他们的健康和社会经济地位。这一遗产与贫困、系统性种族主义和历史创伤深深交织在一起,导致与非土著人口相比存在巨大的健康差距。在影响土著人民的许多慢性病中,慢性肾病(CKD)作为一个主要的公共卫生问题脱颖而出。土著人民患慢性肾病的比率较高,但他们在获得反应迅速且文化上安全的保健服务方面往往面临障碍。地理隔离、社会经济劣势和系统性歧视等因素限制了他们获得预防保健、早期疾病检测和肾脏替代治疗的机会,导致健康结果更差,死亡率更高。暴露于环境和职业风险以及基础设施不足进一步加剧了土著人民的慢性肾病风险。在这里,我们研究了在非洲、亚洲、澳大利亚、加拿大、拉丁美洲、新西兰、太平洋岛屿和美国的主要土著人口中肾脏疾病和健康的决定因素。我们讨论了文化上安全和响应性的策略,这些策略可以改善肾脏护理的提供,并为各级政府提出政策建议,以确保医疗保健系统能够满足土著社区的需求。通过解决这些差距和促进肾脏护理方面的文化能力,保健提供者可以在缩小健康差距和改善全世界土著人民肾脏健康方面发挥关键作用。
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引用次数: 0
20 years of Nature Reviews Nephrology 《自然评论》肾病学20年。
IF 39.8 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-10-16 DOI: 10.1038/s41581-025-01010-8
The November 2025 issue of Nature Reviews Nephrology marks the 20th anniversary of the journal. It is a time to reflect on advances in the field and the role of the journal in a time of change.
2025年11月出版的《自然肾脏病评论》标志着该杂志成立20周年。这是一个反思该领域的进步和期刊在变革时期的作用的时候。
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引用次数: 0
Harms of terminating NIH grants for kidney disease 终止NIH对肾脏疾病资助的危害。
IF 39.8 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-10-15 DOI: 10.1038/s41581-025-01015-3
Glenda V. Roberts, Thelma Barber, Nichole M. Jefferson, Quenton Turner-Gee, Denay Richards, Robert Sanchez, David Rush, Ololade A. Williams, Dinushika Mohottige
In early 2025, nearly 2,100 research projects funded by the US National Institutes of Health (NIH) were terminated. Numerous calls for depoliticization of the NIH’s scientific mission culminated in the Bethesda declaration, which has now been signed by over 32,000 individuals. However, little attention has been given to the effect of these terminations on people who stand to benefit most from scientific discoveries: the patients, care partners and community leaders.
2025年初,美国国立卫生研究院(NIH)资助的近2100个研究项目被终止。许多人呼吁将美国国立卫生研究院的科学使命非政治化,这在贝塞斯达宣言中达到高潮,该宣言目前已有32,000多人签署。然而,很少有人注意到这些终止对那些从科学发现中获益最多的人的影响:病人、护理伙伴和社区领袖。
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引用次数: 0
RNA-based therapeutic opportunities for the treatment of kidney diseases 基于rna的治疗肾病的机会。
IF 39.8 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-10-09 DOI: 10.1038/s41581-025-01011-7
Jurriën Prins, Annabelle Biscans, Anton Jan van Zonneveld, Kendall S. Frazier, Eric P. van der Veer
In the past decade, RNA-based therapeutic strategies have transitioned from drugs of promise to transformative treatments for a range of previously untreatable diseases. This transition has largely been driven by a growing comprehension of individual cell types and corresponding transcriptomes in healthy and diseased tissues. However, despite their natural and abundant distribution to the kidney, successful RNA-based therapeutics for kidney diseases are scarce, as the overwhelming majority of administered drugs are either rapidly excreted, localize to non-targeted cells or are unproductive owing to endolysosomal compartmentalization. The limited success in developing RNA-based therapies for this vital organ have led to considerable doubt regarding the targetability and suitability of splice modulation, small interfering or activating RNAs, microRNA mimics or antagonists, aptamers or editing strategies for the treatment of kidney diseases. Strategies to target specific cell types within the kidney and improve the productive uptake of RNA-based drugs are needed to improve the therapeutic efficacy and safety of RNA-based therapies. Despite these challenges, a number of RNA-based therapeutic approaches are being explored for a variety of kidney diseases and hold promise for future validation. Progress in the development of RNA-based therapeutics has been accelerated by the identification of organ-enriching carriers and cell-specific targeting conjugates, leading to their approval for a range of indications. However, attempts to develop RNA-based therapeutics for kidney diseases have proved challenging. This Review describes the physiological, technological and pharmacological hurdles that need to be overcome to realize the potential of RNA therapeutic approaches to kidney diseases.
在过去的十年中,基于rna的治疗策略已经从有希望的药物转变为一系列以前无法治愈的疾病的变革性治疗。这种转变在很大程度上是由对健康和病变组织中个体细胞类型和相应转录组的日益理解所驱动的。然而,尽管它们在肾脏中自然而丰富地分布,但成功的基于rna的肾脏疾病治疗方法很少,因为绝大多数给药药物要么迅速排泄,定位于非靶向细胞,要么由于内溶酶体区隔化而无效。在为这一重要器官开发基于rna的疗法方面取得的有限成功,导致人们对剪接调节、小干扰或激活rna、microRNA模拟物或拮抗剂、适体或编辑策略用于治疗肾脏疾病的靶向性和适用性产生了相当大的怀疑。为了提高基于rna的治疗的疗效和安全性,需要针对肾脏内的特定细胞类型和提高基于rna的药物的有效摄取的策略。尽管存在这些挑战,许多基于rna的治疗方法正在探索用于各种肾脏疾病,并有望在未来得到验证。
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引用次数: 0
Spatial metabolomics and multiomics integration for breakthroughs in precision medicine for kidney disease 空间代谢组学与多组学的整合,为肾脏疾病的精准医学带来突破。
IF 39.8 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-10-09 DOI: 10.1038/s41581-025-01007-3
Kumar Sharma, Jens Hansen, Katalin Susztak, Livia Eberlin, Christopher R. Anderton, Theodore Alexandrov, Ravi Iyengar
Precision medicine is now a feasible prospect for nephrologists as numerous therapeutic options are available for various forms of kidney disease. However, implementation of this strategy will require high-dimensional diagnostic approaches to identify patients who will respond to an intervention and monitor mechanisms of action relevant to the underlying disease process. With the advent of spatial omics, comprehensive and thorough molecular analysis of biological samples is now possible. In particular, spatial metabolomics analysis of kidney biopsy samples could have an important role in facilitating precision medicine for kidney diseases. Spatial metabolomics can be used to monitor changes in the functional outcomes of genes and proteins in specific anatomical compartments such as the glomeruli, tubules, blood vessels and interstitial spaces. Spatial metabolomics studies have identified adenine in regions of interstitial fibrosis and arteriosclerosis in diabetic kidney disease, provided new insights into the regulation of N-glycans in glomeruli from patients with diabetes, and enabled a new metabolomic classification of kidney cancer subtypes. Use of computational informatic platforms to integrate genomics, transcriptomics, proteomics and epigenomics with metabolomics will further enhance the value of spatial metabolomics for clinical applications. Here, the authors discuss how spatial metabolomics could contribute to better understanding of cellular mechanisms in kidney health and disease, as well as the discovery of blood and urine biomarkers and drug targets for new therapies to halt kidney disease progression.
精密医学现在是一个可行的前景,肾病学家有许多治疗方案可用于各种形式的肾脏疾病。然而,这一战略的实施将需要高维诊断方法,以确定将对干预作出反应的患者,并监测与潜在疾病进程相关的行动机制。随着空间组学的出现,对生物样本进行全面彻底的分子分析成为可能。特别是,肾活检样本的空间代谢组学分析可以在促进肾脏疾病的精准医学方面发挥重要作用。空间代谢组学可用于监测特定解剖区室(如肾小球、小管、血管和间质空间)中基因和蛋白质功能结果的变化。空间代谢组学研究已经在糖尿病肾病的间质纤维化和动脉硬化区域发现了腺嘌呤,为糖尿病患者肾小球中n -聚糖的调节提供了新的见解,并实现了肾癌亚型的新的代谢组学分类。利用计算信息学平台将基因组学、转录组学、蛋白质组学和表观基因组学与代谢组学相结合,将进一步提升空间代谢组学的临床应用价值。
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引用次数: 0
Insights from Nepal into implementing transplantation programmes in low-resource settings 尼泊尔在低资源环境下实施移植方案的见解。
IF 39.8 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-10-08 DOI: 10.1038/s41581-025-01019-z
Dibya Singh Shah  (, )
The success of the kidney transplantation programme in Nepal offers lessons in persistence, collaboration and policy reform. In low-resource settings, access to transplantation remains limited, but locally led efforts — supported by training and political will — can shift the landscape and make equitable transplant care possible.
尼泊尔肾移植项目的成功提供了坚持、合作和政策改革的经验。在资源匮乏的环境中,获得移植的机会仍然有限,但在培训和政治意愿的支持下,由地方领导的努力可以改变现状,使公平的移植护理成为可能。
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引用次数: 0
Urine as a source of biomarkers and biological knowledge in chronic kidney disease 尿液作为慢性肾脏疾病生物标志物和生物学知识的来源。
IF 39.8 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-10-07 DOI: 10.1038/s41581-025-01008-2
Antonia Vlahou, Raymond Vanholder
Albuminuria and estimates of glomerular filtration rate remain the main diagnostic and monitoring metrics used in people with chronic kidney disease (CKD). Although these are both useful markers of kidney disease, they represent the consequence rather than the cause of CKD, can neither detect disease at its earliest stages nor determine its aetiology, and are often suboptimal in guiding therapeutic intervention. By contrast, nucleotide, protein, peptide and metabolite findings from urine can provide a wealth of information about kidney-tissue biology and pathological processes, thereby representing a source of potential biomarkers for early disease detection, prognostication and therapeutic guidance. Urinary biomarker research is currently dominated by studies of protein biomarkers that reflect tissue injury and repair, inflammation and fibrosis, and can be combined for use in multi-marker panels. Data on biomarkers for guiding therapy are scarce, underscoring the urgent need for more targeted studies, given the availability of several new therapies that are effective in attenuating CKD progression and improving patient outcomes. Consequently, although several (mainly protein) biomarkers with evidenced potential to improve disease management are currently available, their clinical implementation is limited by the paucity of clinical and health-economic impact data, especially data on the combined use of urinary biomarkers and the latest therapies available for people with CKD. Urinary components can reflect kidney biology in health and disease. Here, the authors examine current data on urinary biomarkers that can provide insight into kidney function and metabolism, and discuss their potential application value as diagnostic, prognostic and/or therapeutic monitoring biomarkers.
蛋白尿和肾小球滤过率的估计仍然是慢性肾病(CKD)患者的主要诊断和监测指标。虽然这些都是肾脏疾病的有用标记,但它们代表的是CKD的结果而不是原因,既不能在早期阶段检测疾病,也不能确定其病因,并且在指导治疗干预方面往往不是最佳的。相比之下,尿液中核苷酸、蛋白质、肽和代谢物的发现可以提供有关肾脏组织生物学和病理过程的丰富信息,从而代表了早期疾病检测、预后和治疗指导的潜在生物标志物的来源。尿液生物标志物的研究目前以反映组织损伤和修复、炎症和纤维化的蛋白质生物标志物的研究为主,并且可以在多标志物面板中组合使用。指导治疗的生物标志物数据很少,鉴于几种有效减缓CKD进展和改善患者预后的新疗法的可用性,强调迫切需要更有针对性的研究。因此,尽管目前有几种(主要是蛋白质)生物标志物被证明有改善疾病管理的潜力,但它们的临床应用受到缺乏临床和健康经济影响数据的限制,特别是关于泌尿生物标志物和CKD患者可用的最新治疗方法的联合使用数据。
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引用次数: 0
Inhibitory effects of oestradiol on ferroptosis may underlie sex differences in AKI 雌二醇对铁下垂的抑制作用可能是AKI性别差异的基础。
IF 39.8 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-09-29 DOI: 10.1038/s41581-025-01013-5
Ellen F. Carney
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引用次数: 0
Author Correction: Green nephrology: from evidence to action 作者更正:绿色肾病学:从证据到行动。
IF 39.8 1区 医学 Q1 UROLOGY & NEPHROLOGY Pub Date : 2025-09-29 DOI: 10.1038/s41581-025-01014-4
Katherine A. Barraclough, Karin G. F. Gerritsen
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引用次数: 0
期刊
Nature Reviews Nephrology
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