Table 7.

Challenges and translational priorities.

Challenge	Why it matters	Recommended direction
Disease heterogeneity	AKI, DKD, CKD, aging, and PKD have different timing and dominant cells	Stratify models and patients by disease stage, cell type, and metabolic signature
Evidence grading	Associative omics data are often discussed with causal language	Use intervention-based evidence for causal claims and label hypotheses clearly
Immune complexity	Renal inflammation involves macrophages, T cells, DCs, neutrophils, and resident immune states	Use systems immunology and spatial methods to map immune-renal interactions
Drug specificity	Systemic epigenetic drugs can produce broad off-target effects	Develop renal-cell-targeted delivery and isoform-selective modulators
Clinical endpoints	Improved biomarkers may not predict durable renal benefit	Prioritize eGFR slope, albuminuria, fibrosis endpoints, safety, and patient selection