Glycosylation emerges as a key player in kidney disease progression

Kidney diseases affect nearly 700 million people worldwide and are a growing cause of mortality and health care costs. Chronic kidney disease (CKD) alone contributes to over 1.2 million deaths annually, with AKI as a critical precursor. Despite this burden, effective treatments remain limited. A major challenge lies in understanding the molecular modifications that reshape proteins and disrupt cellular balance. Among more than 300 known post-translational modifications, glycosylation is particularly significant, influencing over half of human proteins. Aberrant glycosylation alters immunity, metabolism, and signaling, making it central to the pathology of renal disease. Due to these challenges, deeper investigation of glycosylation in kidney health and disease is urgently needed.

A research team from Sichuan University and collaborators published a comprehensive review (DOI: 10.1093/pcmedi/pbaf017) on July 11, 2025, in Precision Clinical Medicine, highlighting how protein glycosylation shapes kidney disease. The study integrates molecular biology, glycoproteomics, and clinical evidence to show how changes in glycosylation drive immunological, metabolic, and oncogenic pathways in the kidney. By compiling evidence across multiple disorders, the authors emphasize glycosylation as both a mechanistic driver and a potential diagnostic and therapeutic target in renal medicine.

The review outlines how distinct glycosylation patterns underpin a spectrum of kidney diseases. In IgAN, defective O-glycosylation of immunoglobulin A1 (IgA1) creates galactose-deficient molecules that trigger immune complex deposition and renal inflammation. In DKD, hyperglycemia fuels excessive O-GlcNAcylation, disrupting mesangial cells, podocytes, and tubular structures, driving fibrosis and proteinuria. In ADPKD, abnormal glycosylation of polycystin-1 and polycystin-2 impairs calcium signaling and accelerates cyst formation. Renal cell carcinoma progression is tied to N-glycan biosynthesis pathways that enhance tumor invasion. Beyond disease mechanisms, the review emphasizes analytical innovations—such as mass spectrometry, lectin microarrays, and liquid chromatography—that enable precise mapping of glycans and identification of disease-specific biomarkers. Despite advances, major barriers persist: high analytical costs, lack of standardized protocols, incomplete databases, and limited integration with multi-omics. These challenges highlight why glycosylation remains both a frontier and a bottleneck in kidney research.

Glycosylation acts as a hidden language of the kidney. By decoding this glycan code, we can better understand how diseases initiate and progress at the molecular level. However, the complexity of glycan structures and the lack of standardized analytical tools mean that this field requires collaborative innovation. Bridging glycobiology with clinical nephrology will be essential for translating these discoveries into diagnostic biomarkers and therapeutic strategies that can directly benefit patients."

Prof. Yong Zhang, corresponding author of the review

The findings underscore glycosylation as both a diagnostic and therapeutic frontier. Serum glycan signatures, such as galactose-deficient IgA1 in IgAN or altered IgG glycosylation in lupus nephritis, already show potential as biomarkers for disease activity. Therapeutically, modulating glycosylation enzymes or pathways could slow progression of DKD or prevent cyst growth in ADPKD. Looking ahead, integrating glycoproteomics with genomics, transcriptomics, and metabolomics may provide a systems-level view of renal disease. Ultimately, precision diagnostics and glycosylation-targeted therapies could transform kidney medicine, shifting from symptom management to molecularly guided interventions that improve patient outcomes.