News & Comment

Autosomal dominant polycystic kidney disease is the most common inherited cause of kidney failure, yet therapeutic interventions remain limited. Scientific advances are undoubtedly catalysing the development of new interventions; however, consideration of randomized clinical trials that have been conducted to date provide important insights that should guide the development of future trials.

Large language models are increasingly used in clinical practice and are evolving from information retrieval tools towards agentic systems that support complex decision-making. Although key challenges remain, these models have the potential to reshape diagnostic workflows, improve clinical efficiency and reduce health inequities.

Early diagnosis of rare kidney diseases has profound implications for patients in terms of access to treatment, disease trajectory and the identification of affected relatives. The innovative and collaborative approach taken by the global Alport community has delivered a sustainable global network that has advanced treatments and knowledge and offers insights that are relevant to the entire nephrology community.

Early detection, strong primary care and community-based active conservative kidney management must form the foundation of Samoa’s response to chronic kidney disease (CKD). With diabetes driving the majority of CKD and kidney failure cases, prevention and primary care investment must be prioritized to enable the later expansion of nephrology services.

Thailand’s dialysis policy reform, introduced in 2022, aimed to enable universal access to life-sustaining dialysis, but instead exposed systemic vulnerabilities that undermined dialysis quality, compromised patient safety and threatened sustainability of care. These outcomes highlight three ethical dilemmas — access versus quality, continuity of care, and financial conflicts of interest — and offer powerful insights into the ethical tensions that are shaping kidney care globally.

Graph neural networks offer a unifying artificial intelligence framework to model related objects, ranging from tissue architecture and geometrical relationships to patient similarity and multi-organ networks. Applications of this technology in nephrology include computational representation of kidney histopathology and modelling of the complex interactions between organs in kidney diseases.

Kidney health data have long highlighted the disproportionate burden of kidney disease among Indigenous populations across the globe. It is time for meaningful interventions that can create real change.

Low- and middle-income countries face a rapidly increasing prevalence of chronic kidney disease in a setting of limited resources and heightened environmental vulnerabilities. Disease prevention strategies, optimization of kidney replacement therapies, technological innovations and adaptation of health policies to local realities is required to enable resilient and sustainable kidney care.

An increasing body of evidence has highlighted direct and indirect health implications of oil and gas expansion. Nations that produce oil, gas and petrochemicals must stop placing short-term interests above the health and future of humanity.

Chronic kidney disease of unknown origin (CKDu) has been reported in various tropical settings over the past 20 years, but clarity on key disease drivers is lacking. Several factors have slowed progress in understanding this disease or diseases, including low research funding, difficult case definition and multiple risk factors for kidney disease.

Artificial intelligence (AI) and deep learning could have a transformative effect on healthcare. However, this technology has a high carbon footprint, requires the use of natural resources and generates electronic waste. Consideration of the environmental impact raises ethical questions that must be addressed to enable sustainable use of AI in medicine.

Climate change is increasing the risk of acute kidney injury owing to heat stress, infectious and vector-borne diseases, food and water insecurity, pollution and nephrotoxins. Outdoor workers and underserved communities are most affected. Proactive prevention strategies, pathogen-specific care and climate-resilient kidney services can avert avoidable injury, narrow inequities and save lives.

Environmental sustainability movements have faced criticism for their often mechanical, anthropocentric approach that maintains standards of overconsumption within healthcare and has perpetuated planetary harm. Environmental stewardship, as practised within many Indigenous communities, instead focuses deeply on the interconnectedness of human and planetary health, and offers insights from which the health community can learn.

In this Tools of the Trade article, Nicholas Lucarelli (Computational Microscopy Imaging Lab, directed by Pinaki Sarder) describes the development of FUSION, a cloud-based platform for the integration of histology and spatial -omics data.