KIDNEY DISORDERS-A STUDY

Kidneys are remarkable organs. Both blood filters and endocrine organs, kidneys remove waste, regulate electrolytes and acid-base homoeostasis, control fluid balance and blood pressure, and regulate bone metabolism and red blood cell production. They are intimately connected with the functioning of other organs, such as the heart and liver, and can be devastated by diseases as varied as diabetes, autoimmune disorders, and many infections. Yet, more than almost any other organ, they are often ignored and misunderstood. A UK survey for the Think Kidneys campaign in 2014 found that only 51% of people knew that kidneys made urine, and 8% thought the kidneys pumped blood and fluids around the body.

The kidney's public image might, paradoxically, be a victim of its own success. People can live normal, symptom-free lives until they have lost almost 70% of their renal function. When kidneys do fail, they can be replaced?because of a century of pioneering research. Human haemodialysis was first tried in 1924 in Giessen, Germany, and, as a World Report in today's Lancet shows, peritoneal dialysis is now available in some of the most deprived countries on earth. The first successful human organ transplantation was of a kidney in Boston, USA, in 1954, and kidneys are the most commonly transplanted organs today.

This renal-themed issue of The Lancet contains research articles on topics as diverse as a new antibiotic for complicated urinary tract infections, renal denervation for hypertension, and a hospital-based electronic alert system for acute kidney injury. Two Series papers discuss advances in the understanding of membranous nephropathy and management of autosomal dominant polycystic kidney disease, and the Profile is of Andrzej Wi?cek, a nephrologist whose present focus is on adipose tissue as an endocrine organ. But the very nature of kidneys means that assessments of renal function and disease are made on the basis of proxy markers, and these estimates are often far from perfect. Much research focusing on biomarkers and targets for treatment is, by necessity, preliminary and preclinical. Research in kidney disease has come a very long way, and has a very long way to go.