From reactive to predictive nephrology: A framework for precision kidney care

Despite advances in disease-modifying therapies, kidney care remains challenged by the timely identification of disease activity and individualized risk.Serum creatinine, estimated glomerular filtration rate, and albuminuria remain essential diagnostic and prognostic measures, but they do not fully characterize the biological processes underlying kidney injury or explain the heterogeneity of disease trajectories.Molecular biomarkers, multi-omics, artificial intelligence, and digital health may provide complementary information for earlier detection of biological injury, individualized risk assessment, and longitudinal monitoring.However, their clinical readiness varies, and improved predictive performance does not necessarily translate into better patient outcomes.In this opinion review, I propose the predictive nephrology continuum, a conceptual framework comprising six interconnected stages: Detect, predict, personalize, prevent, monitor, and adapt.Its proposed contribution is to integrate these activities into a kidney-specific, iterative approach that connects biological and clinical information with preventive action, treatment response, and subsequent reassessment.Implementation will require incremental clinical value beyond established assessment, prospective evaluation of prediction-guided care, appropriate integration with evidence-based therapies, and attention to safety, cost, and equity.The continuum is intended to guide research and clinical implementation rather than to represent a validated model of care.Its potential value will ultimately depend on whether it enables more timely, effective, and equitable kidney care.