Over the past year, the field of nephrology has seen remarkable progress in kidney transplantation and the treatment of kidney diseases. Kidney xenotransplantation has achieved a milestone with its first human recipients, marking a significant step forward in addressing the organ shortage crisis. Additionally, innovative procurement and preservation techniques have made previously under-used organs viable for transplantation, enhancing the pool of available organs for patients in need.
Innate immune memory has been identified as a significant barrier to successful kidney transplantation. Research has revealed that uraemic toxins in individuals with kidney failure can induce trained immunity, leading to systemic chronic inflammation as chronic kidney disease progresses. This inflammation, driven by long-lived memory macrophages, may contribute to the rejection of transplanted organs.
The year 2024 has seen a surge in novel therapeutic strategies for kidney disease entering clinical trials. Among these are an RNA interference therapeutic, a glucagon-like peptide 1 receptor agonist, a soluble guanylate cyclase activator, and an off-the-shelf, virus-specific T cell therapy. These advancements represent a beacon of hope for individuals suffering from kidney disease, offering potential new avenues for treatment.
Furthermore, the progression of chronic kidney disease to kidney fibrosis remains a critical challenge in nephrology. Recent studies have provided insights into the molecular signature of human kidney fibrosis and uncovered new mechanisms involved in its development, paving the way for targeted therapies.
A significant development in the treatment of IgA nephropathy has been the identification of key pathogenic processes, including the production of galactose-deficient IgA1 and IgA-containing immune complexes, as well as the activation of the complement and endothelin systems. Targeting these processes has shown promising outcomes, marking a turning point in the management of this condition.
Lastly, new data have demonstrated that kidney transplantation outcomes using HIV-positive donor kidneys are not inferior to those with HIV-negative donor kidneys for recipients with HIV infection. Importantly, donor-derived HIV strains do not persist in the recipients, supporting the use of HIV-positive donor kidneys as a standard of care for kidney transplantation in people living with HIV.
