The role of genomics in contemporary nephrology and the imminent horizons of genomic reanalysis

Abstract Genomic medicine has profoundly transformed Nephrology—a specialty uniquely positioned to take advantage of the mechanistic insights provided by genomics that can guide precision care. Genetic kidney diseases account for a substantial proportion of chronic kidney disease in both children and adults, and the integration of genomic testing has redefined diagnosis, management, and even the conceptual architecture of kidney disorders. Contemporary Nephrology is increasingly guided by genomic understandings that clarify pathogenesis, refine clinical classification, and enable precision interventions. As genomic sequencing becomes embedded in clinical workflows, the focus is shifting from single-timepoint analysis to iterative genomic reanalysis. The reinterpretation of genomic data in light of new knowledge, improved annotation, and evolving classification criteria substantially increases diagnostic yield and optimises patient care. Reanalysis represents not only a technical evolution but also a philosophical shift- viewing genomic data as a living, longitudinal resource that requires continual stewardship. This review explores the foundational role of genomics and genetic kidney disease in Nephrology, the state of genomic integration in clinical practice, and the transformative potential of genomic reanalysis. It also considers imminent frontiers, including multi-omics, artificial intelligence, and the foundational importance of equity in genomic care. Together, these advances signal a reimagining of Nephrology—from a phenotype-based discipline to one rooted in molecular precision and iterative discovery.