The sodium-glucose cotransporter 2 (SGLT2) is exclusively expressed in the brush border of the proximal tubule of the kidney, where it effects glucose reabsorption. However, a recent study of young persons with type 2 diabetes (T2D) and early kidney injury showed that treatment with SGLT2 inhibitors (SGLT2i) was associated with significant transcriptional changes across virtually all tubular segments in the kidney.1 SGLT2i are not only effective in treating diabetic kidney disease but also in protecting against both heart and kidney failure in various types of chronic kidney disease (CKD ..read more

Genetic diagnosis promises to guide treatment and manage expectations for patients and physicians. Yet even when a variant in a disease gene is identified, the assignment of pathogenic impact is not always possible.1 Of the 215 million possible substitutions in approximately 19,900 genes, 71 million are missense mutations that result in an amino acid substitution rather than a stop codon or a frameshift.2 Only 4 million missense variants have been observed, of which approximately 2% have been clinically classified as pathogenic or benign by testing companies and collected in the public ClinVar ..read more

Responding to the letter from Tantisattamo et al, we are very grateful for the interest in our paper on improving kidney care through effective implementation of available scientific knowledge into real-world clinical practices. The author highlighted a framework to help clinicians to systematically think of the achievable goal into implementation, service, and clinical outcomes [1]. We agree that implementation science is advancing and certainly may help to promote the usage of effective drugs in real-world settings such as the use of sodium glucose cotransporter 2 inhibitors [2 ..read more

As a medical student at King Chulalongkorn Memorial Hospital, Bangkok, I found the article 'Mind the gap in kidney care: translating what we know into what we do' published in Kidney International1, deeply resonant with my observations in our Dialysis unit ..read more

We thank the author for his interest and comments on this important topic on translating what we know into what we do in kidney care [1], and for highlighting Thailand's success in integrating dialysis and kidney care within its universal health coverage [2]. We agreed that this may be a commendable model for extending critical healthcare services, especially for middle-income countries. Indeed, this was shown in the ESCORT studies in Thailand, where an integrated comprehensive multidisciplinary kidney care program was shown to delay kidney disease progression, even in resource-limited setting ..read more

Chronic kidney disease (CKD) is now the 7th most common cause of death from non-communicable disease (NCD) worldwide. Approximately 10% of the world’s population is affected by CKD, and many remain undiagnosed.1 Its prevalence has risen from 11% in the early 90s to over 15% in the last decade. The burden of CKD on the healthcare system and individuals and their families is substantial.2 Progressive decline in kidney function is associated with significant symptom burden, reduced quality of life (QoL) and survival ..read more

Organ transplant demands, especially among patients with kidney failure, far surpass the current availability of organs. This challenging situation is further compounded by the presence of pretransplant high levels of anti–human leukocyte antigen (HLA) antibodies, clinically known as sensitization,1 making the matching process a highly complex one. Consequently, the waiting time on a transplant waitlist can be substantially lengthy, resulting in dire consequences where patients may tragically succumb to organ failure before receiving a life-saving organ transplant ..read more

The kidney is a complex organ consisting of various cell types. Previous studies have aimed to elucidate the cellular relationships among these cell types in developing and mature kidneys using Cre-loxP-based lineage tracing. However, this methodology falls short of fully capturing the heterogeneous nature of the kidney, making it less than ideal for comprehensively tracing cellular progression during kidney development and maintenance. Recent technological advancements in single-cell genomics have revolutionized lineage tracing methodologies ..read more

Evidence from the Oxford IgA nephropathy (IgAN) cohort supports the clinical value of subclassifying focal segmental glomerulosclerosis lesions (S1). Using the larger Validation in IgA (VALIGA) study cohort, we investigated the association between podocytopathic changes and higher proteinuria, kidney outcome and response to immunosuppressive therapy. All biopsies were evaluated for glomeruli with segmental capillary occlusion by matrix (“not otherwise specified”, NOS lesion), simple capsular adhesion without capillary occlusion (Adh), tip lesions, and podocyte hypertrophy (PH ..read more

Atacicept is a first-in-class, dual anti-B-cell Activation Factor–A Proliferation-Inducing Ligand fusion protein in clinical evaluation for treatment of IgA nephropathy. To compare efficacy and safety of atacicept versus placebo in patients with IgAN, this randomized, double-blind, placebo-controlled phase 2b clinical trial ORIGIN enrolled 116 individuals with biopsy-proven IgA nephropathy. Participants were randomized to atacicept 150, 75, or 25 mg versus placebo once weekly for up to 36 weeks ..read more