Progress in the development of RNA-based therapeutics has been accelerated by the identification of organ-enriching carriers and cell-specific targeting conjugates, leading to their approval for a range of indications. However, attempts to develop RNA-based therapeutics for kidney diseases have proved challenging. This Review describes the physiological, technological and pharmacological hurdles that need to be overcome to realize the potential of RNA therapeutic approaches to kidney diseases.

Here, the authors discuss how spatial metabolomics could contribute to better understanding of cellular mechanisms in kidney health and disease, as well as the discovery of blood and urine biomarkers and drug targets for new therapies to halt kidney disease progression.

Urinary components can reflect kidney biology in health and disease. Here, the authors examine current data on urinary biomarkers that can provide insight into kidney function and metabolism, and discuss their potential application value as diagnostic, prognostic and/or therapeutic monitoring biomarkers.

The authors discuss the dysregulated host response in sepsis and the use of biomarkers to gauge the immunological status of patients and potentially guide precision medicine. They also highlight potential immunomodulatory therapies for sepsis and discuss the future of sepsis clinical trials.