Since publication of the first issue of Nature Reviews Nephrology 20 years ago, advances across various subspecialities of nephrology have provided insights into disease processes and led to the development of new therapeutics for people with kidney disease. However, despite this progress, many kidney diseases remain untreatable, the costs of kidney disease care are immense, and vast inequities persist in disease burden and access to care. In this Viewpoint, we ask experts from several key subspecialties of nephrology to reflect on progress made over the past 20 years, remaining challenges and the steps needed to move the field forward.
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Authors and Affiliations
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Urmila Anandh is an Adjunct Professor and head of Nephrology at the Amrita institute of Medical Sciences and Research, Faridabad, India. Her areas of interest include advocacy in CKD and deceased donor transplantation. She is the Founding President of Women in Nephrology, India.
Hans-Joachim Anders is a Professor of Nephrology at the University of Munich and chair of the Inner City department of Nephrology, Munich, Germany. His clinical activity and research focus on the molecular mechanisms and conceptual frameworks of immunonephrology, CKD combination therapy and AKI-to-CKD transition. He serves as Editor-in-Chief for Nephrology Dialysis Transplantation.
Justine Bacchetta is a Professor of Pediatrics, specialized in paediatric nephrology and phosphate/calcium diseases. Her research programme focuses on bone impairment in CKD and rare inherited renal diseases. She has published more than 300 peer-reviewed publications, given more than 150 invited lectures, and received the 2016 IPNA Renee Habib award.
David Johnson is Director of Metro South Kidney and Transplant Service and Medical Director of Queensland Kidney Transplant Service at Princess Alexandra Hospital, Brisbane, Australia. He is Immediate Past President of Australia and New Zealand Society of Nephrology, Past-President of the International Society for Peritoneal Dialysis, Past International Society of Nephrology (ISN) Councillor, Co-chair of ISN Global Kidney Health Atlas project and Chair of the Australasian Kidney Trials Network.
Valerie Luyckx is a nephrologist at the Children’s Hospital in Zurich. She is the President of the European Kidney Health Alliance and contributes as a consultant to the WHO’s Health Ethics and Governance Unit, Research for Health Department and the Noncommunicable Diseases Management-Screening, Diagnosis and Treatment Unit, Non-communicable Diseases Management Department.
Giuseppe Remuzzi is Director of Mario Negri Institute for Pharmacological Research, Italy, and “Chiara Fama” Professor of Nephrology, University of Milan. He was Chief of Nephrology at Bergamo Hospital and Director of the Department of Medicine. He has been a member of the Consiglio Superiore di Sanità since February 2019. He was President of the ISN for the biennium 2013–2015. His main research interests include the causes of glomerulonephritis and the mechanisms of progression of kidney diseases. He has also conducted many studies in the field of transplant rejection.
Bernardo Rodriguez-Iturbe is currently Medical Science Researcher in the Nephrology and Mineral Metabolism Department of the Instituto Nacional de Ciencias Médicas y Nutrición “Salvador Zubirán” in Mexico City. His research interests are post-streptococcal glomerulonephritis, inflammatory immune reactivity in hypertension and kidney functional stress responses.
Katalin Susztak is a Professor of Medicine and Genetics at the University of Pennsylvania and Director of the Kidney Innovation Center. Her research focuses on the genetics and genomics of kidney disease, integrating single-cell and spatial omics with AI to drive precision diagnostics, therapeutics and translational discovery.
Katherine R. Tuttle is Executive Director for Research at Providence Inland Northwest Health and Professor of Medicine at the University of Washington. Her collective body of work has shaped the ‘pillars of therapy’ for diabetic kidney disease across the spectrum of scientific discovery, clinical trials and population-level implementation.
Motoko Yanagita is the first Chair and Professor of the Department of Nephrology at Kyoto University, Japan, and is the Deputy Dean of the Graduate School of Medicine at Kyoto University. She is the Vice President of the Japanese Society of Nephrology. Internationally, she is a member of the Executive Committee of KDIGO, and is also an elected member of the American Society for Clinical Investigation. She is an Honorary Fellow at RWTH Aachen University, Germany, and an Honorary member of the Australia and New Zealand Society of Nephrology.
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Competing interests
H.-J.A. has received lecture and consultancy fees from GSL, Novartis, AstraZeneca, Roche, Bayer, Boehringer-Ingelheim, SOBI, Otsuka and CSL Vifor. He receives payments for his role as Editor-in-Chief of Nephrology Dialysis Transplantation. Within the past 3 years, J.B. has received consultant and speaker fees from Kyowa Kirin, Alnylam, Novonordisk, Biocodex, Amgen, Alexion, Viatris and Amolyt, and research grants from Kyowa Kirin. D.W.J. has received consultancy fees, research grants, speaker’s honoraria and travel sponsorships from Baxter Healthcare and Fresenius Medical Care, consultancy fees from AstraZeneca, Bayer, and AWAK, speaker’s honoraria from ONO and Boehringer Ingelheim & Lilly, and travel sponsorships from Ono and Amgen. He is a current recipient of an Australian National Health and Medical Research Council Leadership Investigator Grant (APP1194485). K.S. has consulted for Otsuka, Pfizer, Vertex and ProKidney therapeutics and is a founder of Tarna Therapeutics. The Susztak laboratory receives funding from Regeneron, Genentech, Novartis, Boehringer Ingelheim, Gilead, Novo Nordisk, GSK and Calico. K.T. has received grants from Bayer and Travere for investigator-initiated research paid to her institution, has consulted for Eli Lilly and Company, Boehringer Ingelheim, Bayer, AstraZeneca, Novo Nordisk and ProKidney. M.Y. received research grants from Mitsubishi Tanabe Pharma and Boehringer Ingelheim, lecture honoraria from Astellas, AstraZeneca, Kyowa Kirin, Mitsubishi Tanabe Pharma Corporation and Chugai Pharmaceuticals, and is on the advisory board of AstraZeneca and Novartis. The other authors declare no competing interests.
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Anandh, U., Anders, HJ., Bacchetta, J. et al. Two decades of nephrology research: progress and future challenges. Nat Rev Nephrol (2025). https://doi.org/10.1038/s41581-025-00996-5
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DOI: https://doi.org/10.1038/s41581-025-00996-5
