---
title: "Nephrology Clinical Research Feed | MedicHelpline"
specialty: "Nephrology"
specialty_slug: "nephrology"
canonical_url: "https://medichelpline.com/clinical-feed/nephrology"
content_type: "clinical_feed_specialty"
page: 1
articles_in_batch: 30
generated_at: "2026-09-05T23:52:15.056Z"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Nephrology — Clinical Research Feed
## Specialty Overview: Nephrology
Latest peer-reviewed clinical trials, guidelines, and observational research in **Nephrology**, indexed and structured for clinical intelligence and AI reasoning.
## Latest Nephrology Publications
### 1. [Kidney‑conditioned urinary peptidomic ageing clock predicts mortality and age‑related outcomes](https://medichelpline.com/clinical-feed/medrxiv-7-a-kidney-conditioned-urinary-peptidomic-biological-ageing-clock-predicts-all.md)
- **Source:** medRxiv (Clinical Preprints) | **Published:** 2026-09-04
- **Detail Markdown URL:** [Kidney‑conditioned urinary peptidomic ageing clock predicts mortality and age‑related outcomes](https://medichelpline.com/clinical-feed/medrxiv-7-a-kidney-conditioned-urinary-peptidomic-biological-ageing-clock-predicts-all.md)

> **Executive GIST:** - Researchers developed a urinary peptidomic biological ageing clock measured by capillary electrophoresis–mass spectrometry (CE‑MS) and adjusted for kidney function using a Filtrate‑Aware Calibration (FAC) to create a **kidney‑conditioned** clock (k‑UPBioAge). - An initial unconditioned model (UPBioAge) was derived in a cohort with preserved kidney function (n = 1,811); FAC conditioning used a kidney‑diverse cohort (n = 7,798). - The conditioned clock estimated chronological age with a calibrated holdout mean absolute error of 4.91 years (r = 0.945) in development and 5.43–5.47 years in two independent validation cohorts. - Kidney‑conditioned age acceleration (k‑UPBioAgeAcc) — the discrepancy between predicted and chronological age after correction — was evaluated in a clinically enriched follow‑up cohort (n = 7,469; 625 deaths; median follow‑up 3.95 years). - Each standard deviation increase in k‑UPBioAgeAcc was associated with higher risk of all‑cause mortality (HR 1.48, 95% CI 1.35–1.63) and incident age‑related conditions: coronary artery disease (HR 1.44), heart failure (HR 1.27) and chronic kidney disease progression (HR 1.35). - Associations were consistent across sexes and generally independent of baseline comorbidities after multiple‑testing correction; however, no association was observed in participants with severely reduced eGFR (15–29 mL/min/1.73 m2) or macroalbuminuria. - The model retained 2,631 peptides; summary statistics, coefficients and parent‑protein annotations are provided as supplementary material; individual‑level data are proprietary and available by agreement. - Authors conclude that multiple urinary peptides track biological ageing, that kidney function materially influences urinary ageing signals and therefore requires correction, and that the corrected urinary peptidomic clock may merit evaluation for monitoring or guiding personalised interventions.

### 2. [Transportable AKI Prediction with an Explainable XGBoost Model Using MIMIC‑IV](https://medichelpline.com/clinical-feed/medrxiv-2-toward-transportable-acute-kidney-injury-prediction-an-explainable-xgboost.md)
- **Source:** medRxiv (Clinical Preprints) | **Published:** 2026-09-03
- **Detail Markdown URL:** [Transportable AKI Prediction with an Explainable XGBoost Model Using MIMIC‑IV](https://medichelpline.com/clinical-feed/medrxiv-2-toward-transportable-acute-kidney-injury-prediction-an-explainable-xgboost.md)

> **Executive GIST:** - This study developed a 37-feature **XGBoost** model to predict **acute kidney injury (AKI)** using the MIMIC‑IV dataset, where AKI prevalence was 5.4% in the cohort. The model's hyperparameters were optimized with Optuna and output probabilities calibrated with isotonic regression. - Temporal, patient-level internal validation simulated prospective deployment by training on 2008–2016 admissions and testing on 2017–2022 admissions; the internal test AUROC for predicting AKI onset within a 12–24 hour window was 0.794 (95% CI 0.789–0.799). - External validation used the eICU Collaborative Research Database (multi-center, 208 US hospitals). The trained model was applied without retraining and achieved an AUROC of 0.750. - Explainability was provided with SHAP TreeExplainer to generate feature-level explanations for individual predictions. - The authors report equitable discrimination across subgroups defined by gender, age, chronic kidney disease status, race, and AKI stages on both datasets. - The study emphasizes transportability and clinical utility achieved with substantially fewer features than many prior models that require hundreds to thousands of inputs. - Data sources were MIMIC‑IV v3.1 and eICU CRD v2.0 accessed via PhysioNet under Data Use Agreements; code is available on request from the corresponding author. - Ethical approval was obtained from the Ethics Committee of the School of Computing, Miva Open University. The authors declared no competing interests.

### 3. [Cross-System ML Meta-Analysis Identifies Value-Specific Risk Drivers for Acute Kidney Injury](https://medichelpline.com/clinical-feed/medrxiv-7-cross-system-meta-analysis-of-machine-learning-predictors-identifies-value.md)
- **Source:** medRxiv (Clinical Preprints) | **Published:** 2026-09-02
- **Detail Markdown URL:** [Cross-System ML Meta-Analysis Identifies Value-Specific Risk Drivers for Acute Kidney Injury](https://medichelpline.com/clinical-feed/medrxiv-7-cross-system-meta-analysis-of-machine-learning-predictors-identifies-value.md)

> **Executive GIST:** - This study pooled interpretable machine learning results from nine U.S. academic medical centers using electronic health records from 785,497 adult inpatients (2010–2019) to identify generalizable risk patterns for **acute kidney injury (AKI)**. - Site-level models used interpretable gradient boosting machines to quantify predictor–outcome associations; results were integrated using meta-regression to characterize nonlinear value–risk relationships and bivariate interactions. - Key continuous biomarker findings included a 1.46-fold higher AKI risk when glucose increased from 100 mg/dL to 140 mg/dL, a 1.14-fold risk increase for anion gap across 4–12 mmol/L, and a 1.28-fold risk increase for chloride across 96–100 mEq/L. - Electrolytes such as potassium, calcium, and sodium exhibited quadratic (U-shaped) associations with AKI risk, indicating elevated risk at both low and high values. - Bivariate meta-regression identified interactions between important predictors, showing that combinations of biomarkers jointly modulate AKI susceptibility rather than acting independently. - The analysis translates machine learning-derived associations into clinically interpretable, value-specific thresholds that could inform risk stratification and personalized prevention in hospital care. - Data were de-identified EHRs governed by the Greater Plains Collaborative and PaTH networks and are not publicly available; access requires data use agreements and coordinating center approval. - The paper discloses several unrelated industry financial relationships for some authors and notes IRB waivers or approvals as reported by participating institutions.

### 4. [Correction: Perioperative Positive Fluid Balance and Postoperative AKI After Open Hepatectomy — Au](https://medichelpline.com/clinical-feed/plos-one-10-correction-the-impact-of-perioperative-positive-fluid-balance-on-postoperative.md)
- **Source:** PLOS ONE (Medicine) | **Published:** 2026-09-01
- **Detail Markdown URL:** [Correction: Perioperative Positive Fluid Balance and Postoperative AKI After Open Hepatectomy — Au](https://medichelpline.com/clinical-feed/plos-one-10-correction-the-impact-of-perioperative-positive-fluid-balance-on-postoperative.md)

> **Executive GIST:** - This document is a formal **correction** to a previously published PLOS ONE research article examining the impact of **perioperative positive fluid balance** on **postoperative acute kidney injury (AKI)** in patients who underwent **open hepatectomy**. - The correction clarifies that the authors should not have been listed as having contributed equally; equal-contribution attribution was incorrect. - The correction also amends an author affiliation: the seventh author, Warangkana Lapisatepun, was incorrectly assigned affiliation #4 and should be listed with affiliation #1, Department of Anesthesiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. - The notice cites the original article (Phothikun et al., PLoS One. 2025;20(4):e0319856) and provides DOI links for the original work and the correction. - Publication metadata for the correction are reported (published September 1, 2026; DOI: 10.1371/journal.pone.0357444). - The correction is open access under the Creative Commons Attribution License and references a CrossMark update; no other changes to study data, analyses, or conclusions are reported in this correction. - Specific details about the original article’s data, statistical findings, or whether any other author-attribution changes were made beyond those stated are not provided in this correction notice.

### 5. [Urinary collagen type I (COL1) peptides as a shared biomarker signature for fibrosis in chronic di](https://medichelpline.com/clinical-feed/medrxiv-7-urinary-collagen-type-i-degradation-products-as-common-fibrosis-biomarkers-in.md)
- **Source:** medRxiv (Clinical Preprints) | **Published:** 2026-08-31
- **Detail Markdown URL:** [Urinary collagen type I (COL1) peptides as a shared biomarker signature for fibrosis in chronic di](https://medichelpline.com/clinical-feed/medrxiv-7-urinary-collagen-type-i-degradation-products-as-common-fibrosis-biomarkers-in.md)

> **Executive GIST:** - Fibrosis involves excessive accumulation of **collagen type I (COL1)** and is common to chronic liver disease (LD), chronic kidney disease (CKD) and heart failure (HF). - The study used capillary electrophoresis–mass spectrometry (CE-MS) to detect naturally occurring **COL1 degradation products** (urinary peptides) in patients and matched controls. - Discovery cohorts included LDs (n=127), CKD (n=263) and HF (n=187) compared with equal numbers of matched controls; independent validation cohorts comprised LDs (n=110), CKD (n=93), HF (n=32) and pooled controls (n=643). - Disease-associated COL1 peptides were identified separately per condition; peptides consistently associated across all three diseases were combined to define a common fibrosis signature. - The resulting common signature comprised 50 urinary COL1 degradation peptides, predominantly downregulated in fibrotic disease versus controls. - A support vector machine model trained on these 50 peptides achieved high discriminatory performance in an external pooled validation cohort: AUC 0.935 (95% CI 0.917–0.953, p<0.0001). - Disease-specific AUCs in validation were strong: LDs 0.917 (95% CI 0.890–0.944), CKD 0.951 (95% CI 0.931–0.971), and HF 0.950 (95% CI 0.903–0.997); all p<0.0001. - Model scores correlated with fibrosis severity metrics: fibrosis stage in LDs (p=0.0097) and interstitial fibrosis and tubular atrophy in CKD (p=0.045). - Because the peptides exclusively represent collagen degradation, the authors interpret findings as evidence of impaired collagen degradation contributing to fibrosis across organs. - The authors state that future clinical studies are needed to test utility for early fibrosis detection and to inform earlier anti-fibrotic interventions. Data are available from corresponding author on request. - Competing interests and ethics: Several authors are employees, co‑founder or former employee of Mosaiques Diagnostics; ethical approvals and informed consent procedures are reported for component cohorts; some data were anonymized per ethics opinion.

### 6. [Spaceflight renal stone risk shifts from bone-centric to kidney-centric across environments](https://medichelpline.com/clinical-feed/medrxiv-10-from-bone-centric-to-kidney-centric-environment-dependent-shift-of-spaceflight.md)
- **Source:** medRxiv (Clinical Preprints) | **Published:** 2026-08-31
- **Detail Markdown URL:** [Spaceflight renal stone risk shifts from bone-centric to kidney-centric across environments](https://medichelpline.com/clinical-feed/medrxiv-10-from-bone-centric-to-kidney-centric-environment-dependent-shift-of-spaceflight.md)

> **Executive GIST:** - The authors developed a 12-state mechanistic ODE model of calcium flow between bone, urine and stone formation and calibrated 11 physiological parameters using eight ISS-derived targets by Bayesian identification (M0 model). M1, which adds a direct **GCR**-bone coupling term, was tested for parsimony but found unidentifiable at current ISS doses. - Posterior distributions from the calibrated M0 model were propagated to four mission environments: ISS, Lunar subsurface, Lunar surface, and Mars. Model outputs included lumbar lower bone mineral density (BMD) loss and renal stone incidence rates per 1000 person-years. - Results show lumbar lower **BMD** loss increases with mission duration and decreasing gravity (example: ISS 180 d −4.83% vs Mars 730 d −12.15%). Variance decomposition (2^3 factorial) attributes most effect to duration (≈82.9%), gravity (≈12.5%), with negligible direct GCR main effect. - Stone incidence follows the opposite gradient: ISS had higher modeled stone rates than Mars (ISS 16.1 vs Mars 13.1 per 1000 person-years), indicating a shift in dominant pathway from **bone-centric** (bone resorption driving urinary changes) on ISS to **kidney-centric** (residual urinary chemistry changes independent of bone resorption) on Mars. - The direct GCR-bone coupling term is not supported by current ISS data (Delta WAIC ~ +0.0076 ± 0.126 SE); therefore the simpler M0 model was retained for primary inference. - Pharmacologic countermeasures: bisphosphonates are predicted to provide ≥84% protection of BMD but leave residual urinary-chemistry changes; thus bisphosphonate monotherapy may underestimate stone risk in deep-space environments. Combination therapy with **potassium–magnesium–citrate** shows modeled benefit (reported RRR_RSS 51%) and is recommended as part of countermeasure packages. - A 365-day **Lunar surface** mission is predicted to cross a composite RED threshold on the NASA roadmap; a shielded 180-day regolith-shielded profile differs in cumulative GCR (~69-fold) and duration (2×), preventing isolation of a pure shielding effect in this analysis. - Independent validation using a 60-day head-down tilt bedrest RCT (Culliton 2025, control arm n=8) supports the M0 posterior predictive distribution for lumbar BMD loss. Data sources were previously published literature and NASA Human Research Program public reports; model data produced are available on reasonable request. - Limitations noted in the source: lack of identifiability for the GCR-bone coupling at current doses, potential inability to isolate shielding-specific effects between profiles, and reliance on extrapolation beyond six-month ISS data for deep-space mission durations.

### 7. [Runx1 Drives Cyst Growth in ADPKD: Inhibition with Ro5-3335 Slows Disease Progression](https://medichelpline.com/clinical-feed/pubmed-42640700.md)
- **Source:** PubMed / NCBI | **Published:** 2026-08-31 | DOI: [10.1096/fj.202600741R](https://doi.org/10.1096%2Ffj.202600741R)
- **Detail Markdown URL:** [Runx1 Drives Cyst Growth in ADPKD: Inhibition with Ro5-3335 Slows Disease Progression](https://medichelpline.com/clinical-feed/pubmed-42640700.md)

> **Executive GIST:** - Autosomal dominant polycystic kidney disease (**ADPKD**) features progressive kidney cyst formation that destroys renal parenchyma. The transcription factor **Runx1** is identified as a key driver of cyst growth in ADPKD. - Runx1 expression is markedly increased in **Pkd1** mutant renal epithelial cells and in kidneys from Pkd1 mutant mice. Upregulation occurs at both mRNA and protein levels and is evident in multiple renal epithelial cell populations. - Runx1 induction is mediated by **cAMP/PKA signaling**: Runx1 protein and mRNA increase with forskolin or constitutively active PKA and decrease with PKA inhibition or constitutive PKA suppression in Pkd1 models. - Pharmacologic inhibition of Runx1 using the selective inhibitor **Ro5-3335** significantly reduces cyst progression in both rapidly progressive (Pkd1 nl/nl) and slowly progressive (Pkd1 RC/RC) mouse models. - Ro5-3335 treatment reduced cystic index and kidney-weight-to-body-weight ratios and improved blood urea nitrogen (BUN) levels; Ki67 staining showed decreased epithelial proliferation. Reported group sizes included n = 9 per treatment in the cited experiments and several endpoints reached p < 0.01 or p < 0.05. - Mechanistically, Runx1 promotes cyst-lining epithelial cell proliferation by activating **AKT-mTOR**, **MAPK/ERK**, and **STAT3** signaling cascades and by suppressing **p53**-mediated apoptosis. - Runx1 also augments inflammatory and fibrotic responses: it promotes macrophage infiltration and NF-κB activation and aggravates interstitial fibrosis through **TGF-β/Smad2** signaling. - Collectively, the data identify Runx1 as a pivotal regulator of cyst growth and a potential therapeutic target in ADPKD; Ro5-3335 is presented as a candidate Runx1 inhibitor that slows cyst progression in preclinical Pkd1 mouse models. - Conflict of interest: authors declare no conflicts. Full experimental details, dosing regimens, and longer-term outcome data are available in the source article; any details not explicitly reported there are not inferred here.

### 8. [Long-term Renal Outcomes After Neonatal and Pediatric Renal Vein Thrombosis](https://medichelpline.com/clinical-feed/medrxiv-15-renal-outcomes-in-survivors-of-neonatal-and-pediatric-renal-vein-thrombosis.md)
- **Source:** medRxiv (Clinical Preprints) | **Published:** 2026-08-27
- **Detail Markdown URL:** [Long-term Renal Outcomes After Neonatal and Pediatric Renal Vein Thrombosis](https://medichelpline.com/clinical-feed/medrxiv-15-renal-outcomes-in-survivors-of-neonatal-and-pediatric-renal-vein-thrombosis.md)

> **Executive GIST:** - This administrative database study used the Pediatric Health Information System to identify 383 cases of **renal vein thrombosis** in patients under 18 years and followed them across 796 patient-years. - Nearly half (48.8%) of cases occurred in neonates (≤28 days); non-neonatal pediatric cases were analyzed separately in sub-analyses to compare characteristics. - Comorbidities included pre-existing complex chronic conditions in 25.3% of cases and nephrotic syndrome at onset in 9.1% of cases. - Overall mortality after renal vein thrombosis was 15.1%, but the database design precludes assigning causality for deaths. - Most patients (80.2%) received **anticoagulation**; the remaining cohort was small, raising concern for treatment selection bias. - Long-term renal sequelae were common: **acute kidney injury** in 24.0% of cases, **chronic kidney disease** in 22.2%, **hypertension** in 26.9%, and proteinuria in 3.1%. - The authors found no discernable effect of anticoagulation on the risk of these long-term renal outcomes in this dataset. - The study concludes that survivors of pediatric renal vein thrombosis warrant ongoing **kidney health surveillance**, and notes limitations inherent to administrative data and possible anticoagulation treatment bias. - Ethical oversight: the IRB of Nationwide Children's Hospital waived approval; competing interests and funding sources were disclosed by authors.

### 9. [Semaglutide Lowers Risk of COVID-19 and Serious Infections in FLOW Trial Participants with T2D and](https://medichelpline.com/clinical-feed/pubmed-41728915.md)
- **Source:** PubMed / NCBI | **Published:** 2026-08-27 | DOI: [10.1093/ndt/gfag036](https://doi.org/10.1093%2Fndt%2Fgfag036)
- **Detail Markdown URL:** [Semaglutide Lowers Risk of COVID-19 and Serious Infections in FLOW Trial Participants with T2D and](https://medichelpline.com/clinical-feed/pubmed-41728915.md)

> **Executive GIST:** - This prespecified analysis from the FLOW randomized trial evaluated the effect of once-weekly subcutaneous **semaglutide** 1.0 mg versus placebo on serious infections and **COVID-19** outcomes in participants with **type 2 diabetes** (T2D) and **chronic kidney disease** (CKD). - The primary composite outcome combined time to first infection serious adverse event (SAE), first hospitalization for infection, or all-cause death. - Semaglutide reduced the risk of the primary composite outcome versus placebo: hazard ratio (HR) 0.79 (95% CI 0.69–0.89), P = .0002. - Absolute and relative rates: the semaglutide group had lower rates of infection SAEs (17.9% vs 21.3%; P = .0070), hospitalization due to infection (17.5% vs 20.4%; P = .015), COVID-19 SAEs (6.7% vs 8.8%; P = .0155), and COVID-19 adverse events (20.3% vs 22.9%; P = .0190). - Subgroup analyses showed larger relative benefit among participants with baseline hemoglobin A1c >8% (HR 0.63; 95% CI 0.52–0.76) compared with ≤8% (HR 0.93; 95% CI 0.79–1.11); interaction P = .0027. - Greater benefit also observed for participants with higher baseline albuminuria: UACR ≥2000 mg/g (HR 0.53; 95% CI 0.39–0.72) versus UACR <100 mg/g (HR 0.90; 95% CI 0.58–1.39); interaction P = .0367. - The analysis included other endpoints such as all infection SAEs, death due to infection, and death concurrent with a COVID-19 SAE; specific numeric details for some secondary outcomes were not reported in the abstract. - Authors conclude that **semaglutide** reduced infection-related serious adverse events, infection hospitalizations, and all-cause death, with greater benefit in those with poorer glycemic control and higher albuminuria, suggesting potential benefits beyond kidney, cardiovascular, and metabolic outcomes in high-risk T2D with CKD patients.

### 10. [ETV Transcription Factors and Hedgehog Signaling in Renal Cyst Initiation and Progression](https://medichelpline.com/clinical-feed/biorxiv-4-mechanism-of-renal-cyst-initiation-and-progression-through-etv-transcription.md)
- **Source:** bioRxiv (Biomedical Preprints) | **Published:** 2026-08-26
- **Detail Markdown URL:** [ETV Transcription Factors and Hedgehog Signaling in Renal Cyst Initiation and Progression](https://medichelpline.com/clinical-feed/biorxiv-4-mechanism-of-renal-cyst-initiation-and-progression-through-etv-transcription.md)

> **Executive GIST:** - The study used genetic mutation models targeting the **ETV** family of transcription factors—**ETV1**, **ETV4**, and **ETV5**—and a pharmacological hedgehog pathway inhibitor, cyclopamine, to study mechanisms of renal cyst formation and growth. - Renal cyst biology was parsed into two phases: **cyst initiation** and **cyst progression/promotion**, recognizing that pathogenic cysts arise from repeated initiation followed by growth. - Nephron-specific deletion of **ETV4** and **ETV5** triggered initial cyst formation, indicating these factors constrain early cyst initiation in the kidney. - Despite initial cyst formation after ETV4/ETV5 deletion, most early cysts did not continue to grow during animal maturation; only a limited subset progressed further without additional perturbation. - Additional deletion of **ETV1** was required to produce ongoing, continuous cyst initiation and to promote further cyst growth, implicating combined loss of ETV factors in sustained pathogenic cyst development. - Pharmacologic blockade of **hedgehog signaling** with cyclopamine reduced the promotion of cyst progression but had minimal effect on the initial formation of cysts, suggesting hedgehog activity drives growth rather than initiation. - The data support that **cyst initiation and cyst progression are genetically and molecularly distinct** processes that can be separately modulated by transcription factor status and hedgehog pathway activity. - These findings imply potential strategies to suppress pathogenic renal cyst growth by targeting progression-promoting pathways while recognizing initiation may require different interventions. - The report is a preprint posted on bioRxiv (August 26, 2026) by Borum Ryu, Ligyeom Ha, Del L Dsouza, Erika I Boesen, and Sung-Ho Huh; authors declared no competing interests.

### 11. [Gut microbiome signatures precede chronic kidney disease diagnosis in a large canine cohort](https://medichelpline.com/clinical-feed/biorxiv-4-gut-microbiome-signatures-precede-chronic-kidney-disease-diagnosis-in-a-large.md)
- **Source:** bioRxiv (Biomedical Preprints) | **Published:** 2026-08-26
- **Detail Markdown URL:** [Gut microbiome signatures precede chronic kidney disease diagnosis in a large canine cohort](https://medichelpline.com/clinical-feed/biorxiv-4-gut-microbiome-signatures-precede-chronic-kidney-disease-diagnosis-in-a-large.md)

> **Executive GIST:** - The study integrated insurance claims, fecal and oral 16S rRNA profiles, and clinical laboratory data from a cohort of companion dogs to examine microbial changes before chronic kidney disease (CKD) diagnosis. - Among 140,025 dogs, **lower gut microbial diversity** was associated with incident CKD after adjusting for age, sex and body size. - Prediagnostic fecal samples showed reduced evenness-related diversity, modest community shifts and seven genera with differential abundance relative to dogs without later CKD. - The authors derived a **five-genus score** that was elevated more than two years before claims-defined CKD diagnosis; the score was created and tested within the same cohort and was not presented as a validated predictive model. - In a laboratory subset, shifts in gut microbiome composition preceded the largest increases in **blood urea nitrogen** and **creatinine**, suggesting microbial changes may occur before routine lab markers rise. - Paired oral–gut samples showed limited exploratory associations between periodontal-associated taxa and the gut score, indicating possible but not definitive mouth–gut links. - The findings identify microbial features associated with future, claims-defined canine CKD and underscore the need for independent validation and mechanistic work. - Funding and competing interests were disclosed: some authors and a research chair received support from Anicom Holdings, Inc.; one coauthor is an employee of Anicom Holdings, Inc.; other authors declared no competing financial interests. - The study was posted as a bioRxiv preprint on August 26, 2026; full methods and certain details beyond the abstract were not reported in the provided source text.

### 12. [Urinary Clusterin and uEGF as Protein Biomarkers for Risk Stratification in CKD](https://medichelpline.com/clinical-feed/pubmed-41874429.md)
- **Source:** PubMed / NCBI | **Published:** 2026-08-25 | DOI: [10.1093/ndt/gfag068](https://doi.org/10.1093%2Fndt%2Fgfag068)
- **Detail Markdown URL:** [Urinary Clusterin and uEGF as Protein Biomarkers for Risk Stratification in CKD](https://medichelpline.com/clinical-feed/pubmed-41874429.md)

> **Executive GIST:** - The article evaluates **urinary clusterin** (uCLU/Cr) and **urinary epidermal growth factor** (uEGF/Cr) as mechanism-informed pharmacodynamic biomarkers in chronic kidney disease (CKD). - Albuminuria is the current standard for monitoring CKD and treatment response but has limitations: variability and predominant reflection of glomerular injury. - uCLU/Cr is associated with **tubular injury**, while **uEGF/Cr** reflects tubular repair processes; both may complement albuminuria by capturing intrarenal pathways. - Two randomized trial populations were analyzed: the atrasentan enrichment phase of SONAR for effects of endothelin receptor antagonists (ERA) on uCLU/Cr, and DAPA-CKD for effects of SGLT2 inhibitors (SGLT2i; dapagliflozin) on uEGF/Cr across CKD etiologies and diabetes status. - In SONAR, 6 weeks of atrasentan reduced uCLU/Cr by 46.3% (95% CI -57.8 to -37.1) and increased serum ET-1 by 23.4% (95% CI 19.2-27.4); baseline uCLU/Cr correlated with urinary ET-1 (Pearson r = 0.65, P < .0001). - There were no effects of atrasentan on serum clusterin and only a numerical decrease in urinary ET-1 reported. - In DAPA-CKD, dapagliflozin attenuated the decline in uEGF/Cr over 1 year, with heterogeneity by CKD etiology: largest relative increases in diabetic kidney disease, absent effects in glomerulonephritis and hypertensive nephropathy. - SGLT2i effects on uEGF/Cr were greater in participants with type 2 diabetes and higher baseline HbA1c. - Intrarenal EGF mRNA expression from kidney biopsy single-cell RNA sequencing correlated positively with uEGF/Cr, supporting a mechanistic link between urinary biomarker and tissue expression. - Authors conclude that **urinary clusterin** and **uEGF** reflect distinct intrarenal pathways engaged by ERA and SGLT2i therapies and can provide a more comprehensive biological assessment than albuminuria alone. - The article does not report additional methodological details beyond the trial populations, nor does it provide long-term outcome data or full assay characteristics in this abstract.

### 13. [CHICKADEE study protocol: kidney outcomes and hypertension after pediatric congenital heart diseas](https://medichelpline.com/clinical-feed/plos-one-9-the-congenital-heart-disease-in-children-kidney-associated-conditions-with.md)
- **Source:** PLOS ONE (Medicine) | **Published:** 2026-08-20
- **Detail Markdown URL:** [CHICKADEE study protocol: kidney outcomes and hypertension after pediatric congenital heart diseas](https://medichelpline.com/clinical-feed/plos-one-9-the-congenital-heart-disease-in-children-kidney-associated-conditions-with.md)

> **Executive GIST:** - The CHICKADEE study is a multi-center prospective cohort protocol designed to characterize **kidney disease** and **hypertension** in children several years after cardiac surgery for **congenital heart disease (CHD)**. - The study plans to enroll 300 children aged 4–16 years, recruited 4–12 years after their index CHD surgery, across three clinical sites with stratification by CHD severity and enrichment for **hypoplastic left heart syndrome (HLHS)** and other single-ventricle defects. - Primary endpoints include prevalent and incident **hypertension**, **chronic kidney disease (CKD)**, and kidney failure assessed years after cardiac surgery. - Phenotyping includes standardized clinical assessments, echocardiography, **ambulatory blood pressure monitoring (ABPM)**, and both targeted and untargeted proteomic biomarker discovery; a biorepository will be created to support ancillary studies. - The protocol emphasizes the need to address under-recognition and under-treatment of kidney complications in pediatric CHD, noting prior pediatric cohorts with elevated rates of albuminuria, hypertension, and CKD and low referral rates to pediatric nephrology. - The study highlights high-risk subgroups, notably single-ventricle physiology and **Fontan** patients, whose unique hemodynamics may predispose to kidney injury. - The protocol recognizes limitations of routine clinic blood pressure measurement and supports ABPM for detecting masked hypertension and nocturnal non-dipping patterns previously observed in CHD cohorts. - The study will leverage proteomic advances (measurement of >10,000 proteins) to discover mechanistic pathways and therapeutic targets and considers genetic contributors to CHD-related kidney risk, noting 47 candidate genes identified in prior review, including ciliary genes. - Funding source is the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK135518). Details on some operational elements and analytic plans beyond those reported in the source were not provided in the protocol summary.

### 14. [Chronic kidney disease increases anxiety vulnerability via an angiotensin II–central amygdala path](https://medichelpline.com/clinical-feed/biorxiv-18-chronic-kidney-disease-promotes-anxiety-susceptibility-through-an-angiotensin.md)
- **Source:** bioRxiv (Biomedical Preprints) | **Published:** 2026-08-20
- **Detail Markdown URL:** [Chronic kidney disease increases anxiety vulnerability via an angiotensin II–central amygdala path](https://medichelpline.com/clinical-feed/biorxiv-18-chronic-kidney-disease-promotes-anxiety-susceptibility-through-an-angiotensin.md)

> **Executive GIST:** - Chronic kidney disease (CKD) is associated with increased risk of neuropsychiatric comorbidity; this study used mouse models to probe mechanisms linking CKD to anxiety susceptibility. - An adenine-induced CKD model was selected as the preferred platform to study neurobehavioral alterations after model comparison. - Anxiety susceptibility was defined as development of anxiety-like behavior after subthreshold unpredictable stress (SUS), assessed with behavioral paradigms; CKD mice lacked a consistent baseline anxiety phenotype but developed robust anxiety-like behavior after SUS. - Region-focused c-Fos mapping and fiber photometry identified the **central amygdala (CeA)** as a stress-sensitized limbic node in CKD. - Chemogenetic inhibition of CeA GABAergic neurons reduced anxiety-like behavior after SUS, supporting a causal role for CeA activity in the behavioral phenotype. - CKD elevated circulating **angiotensin II (Ang II)** and increased CeA accumulation of peripherally administered FAM-Ang II signal, implicating peripheral-to-central Ang II trafficking or enhanced CeA sensitivity. - CeA-specific knockdown of **Agtr1a** (AT1 receptor) attenuated anxiety-like behavior and altered stress-evoked CeA calcium responses, indicating a contribution of local **AT1R** signaling. - Exploratory activation of hypothalamic paraventricular nucleus (PVN) glutamatergic neurons worsened early renal injury markers in a mild renal injury model, suggesting possible brain-to-kidney feedback. - Overall, findings support a kidney-to-brain model where CKD primes CeA stress circuits and local Ang II–AT1R signaling promotes stress-induced anxiety susceptibility, with preliminary evidence for reciprocal brain-to-kidney influence. - The authors declared no competing interests.

### 15. [Diabetic kidney disease: proximal tubule signaling, lipid-associated macrophages, and PPARG/TCF12](https://medichelpline.com/clinical-feed/frontiers-in-immunology-12-injured-proximal-tubule-driven-paracrine-signaling-promotes-lipid-associated.md)
- **Source:** Frontiers in Immunology | **Published:** 2026-08-20
- **Detail Markdown URL:** [Diabetic kidney disease: proximal tubule signaling, lipid-associated macrophages, and PPARG/TCF12](https://medichelpline.com/clinical-feed/frontiers-in-immunology-12-injured-proximal-tubule-driven-paracrine-signaling-promotes-lipid-associated.md)

> **Executive GIST:** - The source provides an article title: "Injured proximal tubule-driven paracrine signaling promotes lipid-associated macrophage expansion and chondroitin sulfate biosynthesis via PPARG/TCF12 in diabetic kidney disease" published in Frontiers in Immunology. - The online page from Frontiers in Immunology included site navigation and journal metadata but did not contain the article text or abstract in the provided source content. - No methods, results, sample sizes, experimental models, or quantitative outcomes were present in the supplied material. - The title indicates key molecular terms: **diabetic kidney disease**, **proximal tubule**, **paracrine signaling**, **lipid-associated macrophage**, **chondroitin sulfate biosynthesis**, **PPARG**, and **TCF12**; however, the source did not report how these terms were investigated or linked. - Because the body content was missing, specific claims, evidence, and clinical or translational implications were not reported and cannot be summarized or interpreted from the provided material. - Users should consult the full published article at the journal site or request the full text to obtain study design, results, and conclusions before applying findings in research or clinical contexts. - The absence of article details in the provided source means no factual statements beyond the title and journal attribution can be asserted without risk of fabrication.

### 16. [How a Nephrology Inpatient Unit Cut Hospital-Onset Clostridioides difficile Infections by 90%](https://medichelpline.com/clinical-feed/pubmed-42615593.md)
- **Source:** PubMed / NCBI | **Published:** 2026-08-19 | DOI: [10.1056/CAT.25.0492](https://doi.org/10.1056%2FCAT.25.0492)
- **Detail Markdown URL:** [How a Nephrology Inpatient Unit Cut Hospital-Onset Clostridioides difficile Infections by 90%](https://medichelpline.com/clinical-feed/pubmed-42615593.md)

> **Executive GIST:** - **Clostridioides difficile** (C. diff) is a leading cause of hospital-acquired infection, occurring after disruption of normal gut flora, for example from **antibiotics** or immunosuppressive agents. - Active C. diff infections typically present with gastrointestinal symptoms such as loose, watery stools and are an increasing source of morbidity and death among hospitalized adults. - A nephrology inpatient unit at **Henry Ford Hospital** was responsible for a disproportionate share of hospital-acquired C. diff infections within the facility. - The unit implemented a targeted program focused on **early detection**, **interdisciplinary collaboration**, and sustained **culture change** to address the cluster of infections. - Following these measures, the unit achieved a reported **90% reduction** in hospital-onset C. diff infections. - The report is authored by clinicians and safety staff at Henry Ford Health and is indexed as PMID 42615593 with DOI 10.1056/CAT.25.0492. - The source provides outcome magnitude (90% reduction) and high-level intervention elements but does not report granular operational details, timelines, infection rates before/after, specific diagnostic or testing protocols, antimicrobial stewardship actions, or statistical analysis in the abstract. - Where procedural or numeric specifics are absent from the abstract, the source did not report those details; readers should consult the full article for implementation steps and measurable metrics.

### 17. [Early detection of declining kidney function in a Sri Lankan working-age cohort](https://medichelpline.com/clinical-feed/medrxiv-4-detecting-early-loss-of-kidney-function-in-a-sri-lankan-cohort-study-of-working.md)
- **Source:** medRxiv (Clinical Preprints) | **Published:** 2026-08-19
- **Detail Markdown URL:** [Early detection of declining kidney function in a Sri Lankan working-age cohort](https://medichelpline.com/clinical-feed/medrxiv-4-detecting-early-loss-of-kidney-function-in-a-sri-lankan-cohort-study-of-working.md)

> **Executive GIST:** - This longitudinal cohort followed 425 adults aged 20–60 in Puhudivula, Anuradhapura district, Sri Lanka, over six years to detect early loss of kidney function after a 2017 cross-sectional survey suggested community-level risk. - The study excluded individuals with diabetes, hypertension or pre-existing chronic kidney disease to focus on **chronic kidney disease of undetermined cause (CKDu)**-like presentations. - Baseline population data motivating the study: a 2017 survey found low **eGFR** in 11.2% of men and 3.7% of women in North Central Province in the absence of traditional risk factors. - Researchers applied **hidden Markov models** (HMMs) to serial eGFR measurements to estimate latent kidney-health states and to identify transitions between healthy and unhealthy states over time. - Four distinct kidney-health trajectories were identified among participants: always healthy (74%), persistently unhealthy (5%), transition from healthy to unhealthy (10%), and reversion from unhealthy to healthy (11%). - Use of **smokeless tobacco** (including betel quid) was associated with being in an unhealthy category at measured timepoints (odds ratio 2.29; 95% CI 1.17–4.49). - Lagged exposures (prior-period exposures) to smoking (OR 2.26; 95% CI 1.25–4.10), smokeless tobacco (OR 1.98; 95% CI 1.13–3.48) and **weedkiller** (OR 1.72; 95% CI 1.15–2.59) were associated with transition from a healthy to an unhealthy kidney state. - Overall, nearly one quarter of working-age adults in this cohort showed eGFR changes consistent with poor kidney health over the study period. - The authors note ethical approval (EC-25-170) from the University of Colombo Ethics Review Committee and list data availability via contact with Dr Thilanga Ruwanpathirana. Funding sources included the National Science Foundation of Sri Lanka, Ministry of Health Sri Lanka, WHO Country Office Sri Lanka, Medical Research Council, and the Colt Foundation. - As a preprint, findings have not been peer reviewed and should not yet guide clinical practice; supplementary materials and data/code links are provided with the preprint.

### 18. [Trajectories of Psychological Resilience During Early Maintenance Hemodialysis and Baseline Predic](https://medichelpline.com/clinical-feed/plos-one-9-psychological-resilience-trajectories-and-baseline-factors-associated-with.md)
- **Source:** PLOS ONE (Medicine) | **Published:** 2026-08-17
- **Detail Markdown URL:** [Trajectories of Psychological Resilience During Early Maintenance Hemodialysis and Baseline Predic](https://medichelpline.com/clinical-feed/plos-one-9-psychological-resilience-trajectories-and-baseline-factors-associated-with.md)

> **Executive GIST:** - This multicenter longitudinal study followed 693 patients who had initiated **maintenance hemodialysis (MHD)** within the previous month, with resilience assessed seven times over 6 months using the Chinese Connor–Davidson Resilience Scale. - Latent growth mixture modeling (LGMM) identified three distinct longitudinal **resilience trajectories**: **high-level stable** (51.7%), **low-stable** (35.5%), and **high-level rapidly decreasing** (12.8%). - The study used full information maximum likelihood to handle wave-level missing data and excluded participants with fewer than three resilience assessments; sensitivity analyses included R3STEP and a complete-case LGMM. - Compared with the high-level stable class, the high-level rapidly decreasing trajectory was associated at baseline with **depressive symptoms**, **anxiety symptoms**, **sleep disturbance**, and a higher comorbidity burden. - The low-stable trajectory was associated with the above psychological and clinical factors and additionally with older age, unmarried status, lower income, more frequent hospitalizations, and lower physical activity at baseline. - Findings emphasize that psychological resilience is dynamic in the early dialysis period and that declining or persistently low resilience patterns are linked to specific sociodemographic, psychological, and clinical baseline characteristics. - The authors recommend early psychosocial assessment, routine monitoring of resilience during the early treatment period, and targeted supportive care to address patients at risk for declining or low resilience. - Study strengths include multicenter recruitment, repeated measures across seven time points, and use of LGMM to capture heterogeneity; limitations noted in methods concern attrition and reliance on self-report measures, with missing-data assumptions handled using FIML and sensitivity checks.

### 19. [Perceived Quality of Nursing Care for Adults on Haemodialysis in Northern Ghana](https://medichelpline.com/clinical-feed/plos-one-21-understanding-perceived-quality-of-nursing-care-among-adults-receiving.md)
- **Source:** PLOS ONE (Medicine) | **Published:** 2026-08-14
- **Detail Markdown URL:** [Perceived Quality of Nursing Care for Adults on Haemodialysis in Northern Ghana](https://medichelpline.com/clinical-feed/plos-one-21-understanding-perceived-quality-of-nursing-care-among-adults-receiving.md)

> **Executive GIST:** - This qualitative study explored how adults receiving **haemodialysis** at Tamale Teaching Hospital in Northern Ghana perceive the **quality of nursing care**. - Fifteen patients who had been on haemodialysis for at least six months were purposively sampled and interviewed using a semi-structured guide. - Interviews were audio-recorded, transcribed verbatim, and analysed using Braun and Clarke’s reflective thematic analysis. - Two overarching themes emerged from participants’ accounts: **respect for patient preferences** and **physical comfort**. - Respect for patient preferences included patient involvement in decision-making, preservation of dignity, respect for autonomy, and culturally sensitive care. - Physical comfort encompassed effective pain management, timely assistance with activities of daily living, and a clean hospital environment. - Participants described systemic constraints that shape care experiences, including limited dialysis resources, equipment breakdowns, unreliable water supply, staff shortages, and workflow inefficiencies. - Recommendations reported in the study emphasise nurse-led education in local languages, routine pain assessment and timely management during dialysis, preservation of privacy, compassionate communication, and culturally responsive care. - Strengthening dialysis centre resources and improving workflow to reduce waiting time were highlighted as necessary system-level interventions to improve patient satisfaction and treatment experiences. - The study was reported according to COREQ and positions quality nursing care as shaped by both interpersonal nursing behaviours and structural health-system factors in a resource-constrained setting.

### 20. [Albuminuria-Predominant Discordance and Cardiovascular Mortality Despite Lower TyG](https://medichelpline.com/clinical-feed/medrxiv-5-albuminuria-predominant-kidney-metabolic-discordance-and-cardiovascular.md)
- **Source:** medRxiv (Clinical Preprints) | **Published:** 2026-08-13
- **Detail Markdown URL:** [Albuminuria-Predominant Discordance and Cardiovascular Mortality Despite Lower TyG](https://medichelpline.com/clinical-feed/medrxiv-5-albuminuria-predominant-kidney-metabolic-discordance-and-cardiovascular.md)

> **Executive GIST:** - The study used nationally representative NHANES data from 1999–2018 (n=21,694) with mortality follow-up through 2019 to examine kidney-metabolic phenotypes defined by urinary albumin-to-creatinine ratio (**UACR**) and the triglyceride-glucose (**TyG**) index. - UACR was dichotomized at 30 mg/g and TyG at the survey-weighted median (8.575) to create four phenotype groups: concordant-low, metabolic-predominant, albuminuria-predominant, and concordant-high. - Primary analysis employed survey-weighted cause-specific Cox regression; supplementary analyses included competing-risk, interaction testing, time-varying, and multiple-imputation approaches. - Over a median 9.25 years of follow-up there were 997 cardiovascular deaths. In fully adjusted (Model 3) analyses, hazard ratios for cardiovascular death were 0.97 (95% CI 0.64–1.46) for metabolic-predominant, 2.16 (1.48–3.16) for albuminuria-predominant, and 2.22 (1.44–3.42) for concordant-high, compared with concordant-low. - No statistically significant interaction between UACR and TyG was detected (P=0.468); a relatively lower TyG did not materially attenuate albuminuria-associated cardiovascular risk. - In a lower-risk subgroup (no prior cardiovascular disease or diabetes, eGFR ≥60 mL/min/1.73 m2), the albuminuria-predominant hazard ratio was 2.27 (1.24–4.15) with a standardized 10-year absolute risk difference of 1.71 percentage points. - Noncardiovascular mortality was also elevated in albuminuria-positive phenotypes (hazard ratio 2.36; 95% CI 1.77–3.16). - The authors conclude excess mortality clusters with **albuminuria-positive phenotypes**, while isolated TyG elevation was not independently associated after multivariable adjustment. They note this phenotype is population-relative and not a clinical treatment threshold. - The analysis is a secondary study of deidentified public NHANES data; ethics approval for NHANES was by NCHS, and data and code supporting the analysis are archived in Zenodo (doi:10.5281/zenodo.21858614).

### 21. [Correction notice: Tuberculosis in advanced chronic kidney disease — republication and author-name](https://medichelpline.com/clinical-feed/plos-one-0-correction-tuberculosis-in-advanced-chronic-kidney-disease-an-observational.md)
- **Source:** PLOS ONE (Medicine) | **Published:** 2026-08-12
- **Detail Markdown URL:** [Correction notice: Tuberculosis in advanced chronic kidney disease — republication and author-name](https://medichelpline.com/clinical-feed/plos-one-0-correction-tuberculosis-in-advanced-chronic-kidney-disease-an-observational.md)

> **Executive GIST:** - This is a formal correction notice published by The PLOS ONE Staff regarding the article titled **Tuberculosis in advanced chronic kidney disease: An Observational Study at a Tertiary Care Center in Mexico**. - The article was republished on June 17, 2026 to correct errors in the names of the sixth and seventh authors; the publisher issued an apology for the errors. - The corrected author names are Bernardo Alfonso Martínez-Guerra and Maria Fernanda González-Lara; the correction notice lists the corrected citation for the republished article. - The corrected citation given is: Hernández-Ibarra JA, Mercado-Torres TR, Ruiz-Ruiz JR, Román-Montes CM, Rajme-López S, Martínez-Guerra BA, et al. (2026) Tuberculosis in advanced chronic kidney disease: An Observational Study at a Tertiary Care Center in Mexico. PLoS One 21(3): e0338570. https://doi.org/10.1371/journal.pone.0338570. - The correction notice itself was published August 12, 2026 with its own DOI: 10.1371/journal.pone.0356043 and is designated as a Correction article (PLoS One 21(8): e0356043). - Supporting information files are provided: S1 File (originally published, uncorrected article) and S2 File (republished, corrected article), each available as PDF with distinct DOIs linked in the notice. - The notice includes a “Notice of Republication” section and links to the corrected article page and PDF. - The Correction notice includes bibliographic reference and links to PubMed/NCBI and Google Scholar entries for the corrected article, and shows the publisher’s standard open-access copyright and Creative Commons Attribution License statement. - The notice contains associated article metadata (metrics, citation count shown, CrossMark update prompt) and links for sharing and supplementary material download.

### 22. [DASH Diet Score Linked to Lower Risk of Kidney Decline and Mortality in Million Veteran Program](https://medichelpline.com/clinical-feed/medrxiv-1-the-dietary-approaches-to-stop-hypertension-dash-diet-score-and-its-association.md)
- **Source:** medRxiv (Clinical Preprints) | **Published:** 2026-08-12
- **Detail Markdown URL:** [DASH Diet Score Linked to Lower Risk of Kidney Decline and Mortality in Million Veteran Program](https://medichelpline.com/clinical-feed/medrxiv-1-the-dietary-approaches-to-stop-hypertension-dash-diet-score-and-its-association.md)

> **Executive GIST:** - This retrospective cohort study evaluated 251,921 Veterans in the Million Veteran Program (MVP) to test whether adherence to the **DASH diet** was associated with time to kidney function decline or death. - The **DASH diet score** was derived from a food frequency questionnaire and categorized into tertiles. - The primary composite outcome was either a sustained 40% decline in **eGFR** or end-stage kidney disease (ESKD), or death. - Median age of the cohort was 67 years; 90% were men. Maximum follow-up was 10 years (median 6.1 years). - Overall, 59,269 participants (23.5%) experienced the primary composite outcome during follow-up. - Crude incidence rates of the composite outcome across DASH tertiles were 43.3, 40.4, and 36.8 per 1,000 person-years (first to third tertile). - In adjusted Cox regression models, higher DASH adherence was associated with lower hazard for the composite outcome: third versus first tertile HR 0.81 (95% CI 0.80–0.83); second versus first tertile HR 0.90 (95% CI 0.88–0.92). - Subgroup analyses indicated that among individuals of African ancestry, Admixed American ancestry, and among females, only the highest DASH tertile showed a statistically significant reduction in the composite outcome. - The authors conclude the **DASH diet** has beneficial associations across subgroups but note that future work is needed to clarify gene–environment and other factors behind subgroup differences. - Data access requires VA request and IRB approval. The study is a preprint and authors declared no competing interests.

### 23. [Biallelic EXOSC3 Variants Cause Early-Onset Eculizumab-Resistant Renal Thrombotic Microangiopathy](https://medichelpline.com/clinical-feed/kidney-international-0-biallelic-pathogenic-variants-in-exosc3-mediate-renal-thrombotic.md)
- **Source:** Kidney International | **Published:** 2026-07-22
- **Detail Markdown URL:** [Biallelic EXOSC3 Variants Cause Early-Onset Eculizumab-Resistant Renal Thrombotic Microangiopathy](https://medichelpline.com/clinical-feed/kidney-international-0-biallelic-pathogenic-variants-in-exosc3-mediate-renal-thrombotic.md)

> **Executive GIST:** - This study identifies a strong association between biallelic pathogenic variants in **EXOSC3** and early-onset renal **thrombotic microangiopathy (TMA)** in children with pontocerebellar hypoplasia 1b (PCH1b). - Among 34 children with PCH1b due to EXOSC3 variants, 13 developed biochemical and clinical features of TMA (microangiopathic hemolytic anemia, thrombocytopenia, acute kidney injury), typically presenting at a median age of 6 months. - All TMA episodes in the cohort were preceded within 10 days by an infectious trigger in the reported episodes, most commonly respiratory infections. - Kidney histology from one post-mortem sample confirmed platelet- and fibrin-rich thrombi within glomerular capillaries and arterioles consistent with TMA. - No evidence of complement dysregulation was detected in tested patients; 5 children received **eculizumab**, with three treated long-term—one had no response and two relapsed while on treatment, indicating **eculizumab resistance** in EXOSC3-TMA. - Clinical outcomes were severe: 11 of the cohort with TMA died during follow-up (mean age at death 10 months); 8/13 showed renal recovery after episodes, while two progressed to end-stage kidney disease requiring long-term renal replacement. - A tamoxifen-inducible whole-body Exosc3 conditional knockout mouse (Exosc3KO) produced rapid weight loss, aplastic anemia, bone marrow hypocellularity, cell-cycle arrest at G0/G1, and increased apoptosis in rapidly dividing tissues; mice died a median of 8 days after recombination. - In Exosc3KO mice there was prominent pathology in bone marrow, thymus and large intestine but no renal TMA was observed in the acute timeframe examined, suggesting species or model differences or requirement for an infectious trigger. - Mechanistic interpretation: loss of EXOSC3 impairs RNA exosome function and ribosome biogenesis, triggers nucleolar stress with cell-cycle arrest and apoptosis in proliferative tissues; authors propose a “vascular ribosomopathy” as a shared mechanism with Shiga-toxin HUS. - Clinical implications: consider screening for TMA in children with PCH1b during or after infection; perform genetic testing for **EXOSC3** in eculizumab-resistant pediatric TMA, especially when a neurodevelopmental syndrome is present. Eculizumab has no role in EXOSC3-TMA based on these data.

### 24. [Perivascular fat, hypertension, and cardiovascular disease](https://medichelpline.com/clinical-feed/kidney-international-1-perivascular-fat-hypertension-and-cardiovascular-disease.md)
- **Source:** Kidney International | **Published:** 2026-04-16
- **Detail Markdown URL:** [Perivascular fat, hypertension, and cardiovascular disease](https://medichelpline.com/clinical-feed/kidney-international-1-perivascular-fat-hypertension-and-cardiovascular-disease.md)

> **Executive GIST:** Overweight/obesity, diabetes, and hypertension are major risk factors for cardiovascular and kidney disease. They are all part of the recently coined cardiovascular-kidney-metabolic syndrome.1 Adipose tissue crosstalk with the vasculature plays an important role in maintaining vascular structure and function and thereby controlling blood pressure.2 It is noteworthy that the type of adipose tissue, more than the total amount, is a particularly critical factor in blood pressure regulation. Whereas excess white fat, especially visceral adiposity, is associated with increased blood pressure and risk of cardiovascular disease, brown fat produces heat and is associated with decreased cardiovascular risk, even in the presence of obesity.

### 25. [Kidney International introduces new article type: Clinical Journey in Translational Medicine](https://medichelpline.com/clinical-feed/kidney-international-0-kidney-international-introduces-new-article-type-clinical-journey-in-translational-medicine.md)
- **Source:** Kidney International | **Published:** 2026-04-16
- **Detail Markdown URL:** [Kidney International introduces new article type: Clinical Journey in Translational Medicine](https://medichelpline.com/clinical-feed/kidney-international-0-kidney-international-introduces-new-article-type-clinical-journey-in-translational-medicine.md)

> **Executive GIST:** Linked articles

### 26. [Kidney cancer screening – novel concepts beyond population level screening](https://medichelpline.com/clinical-feed/kidney-international-2-kidney-cancer-screening-novel-concepts-beyond-population-level-screening.md)
- **Source:** Kidney International | **Published:** 2026-04-15
- **Detail Markdown URL:** [Kidney cancer screening – novel concepts beyond population level screening](https://medichelpline.com/clinical-feed/kidney-international-2-kidney-cancer-screening-novel-concepts-beyond-population-level-screening.md)

> **Executive GIST:** Screening for kidney cancer has been identified as a research priority by several independent initiatives. Previous work revealed that the relatively low prevalence of kidney cancer in untargeted asymptomatic individuals hinders the cost-effectiveness and clinical utility of population screening. We therefore undertake a comprehensive literature review summarising novel screening concepts beyond whole population screening, including: targeting high-risk populations (to increase disease prevalence), screening for kidney cancer in combination with other abdominal conditions (to reduce costs), or combining both these approaches.

### 27. [Kidney xenotransplantation at a clinical inflection point](https://medichelpline.com/clinical-feed/kidney-international-3-kidney-xenotransplantation-at-a-clinical-inflection-point.md)
- **Source:** Kidney International | **Published:** 2026-04-06
- **Detail Markdown URL:** [Kidney xenotransplantation at a clinical inflection point](https://medichelpline.com/clinical-feed/kidney-international-3-kidney-xenotransplantation-at-a-clinical-inflection-point.md)

> **Executive GIST:** Kidney transplantation remains the optimal treatment for patients with end-stage kidney disease, offering superior survival, quality of life, and cost-effectiveness compared with dialysis. Yet the persistent and widening gap between organ supply and demand continues to limit timely access to transplantation. As a result, many patients remain dependent on long-term dialysis, often with substantial morbidity and mortality. Xenotransplantation has long been envisioned as a potential solution to this shortage by enabling a more predictable and scalable source of transplantable organs.

### 28. [Predicting Steroid Benefit in IgA Nephropathy for Personalized Care](https://medichelpline.com/clinical-feed/kidney-international-99-predicting-steroid-treatment-benefit-in-iga-nephropathy-are-we-ready-for-precision-care-.md)
- **Source:** Kidney International | **Published:** 2026-04-01
- **Detail Markdown URL:** [Predicting Steroid Benefit in IgA Nephropathy for Personalized Care](https://medichelpline.com/clinical-feed/kidney-international-99-predicting-steroid-treatment-benefit-in-iga-nephropathy-are-we-ready-for-precision-care-.md)

> **Executive GIST:** The treatment of patients with IgA nephropathy at risk of disease progression often requires therapies addressing the underlying immunologic pathogenesis. To date, steroids remain a viable treatment option; however, their use should be balanced against known associated toxicity. Canney et al. developed a prediction tool that utilizes readily available clinical data to calculate the expected response to steroid therapy for an individual patient. This shift to data-informed, patient-specific decision is the essence of personalized care.

### 29. [The Janus Face Of Parathyroid Hormone In Renal Osteodystrophy](https://medichelpline.com/clinical-feed/kidney-international-98-the-janus-face-of-parathyroid-hormone-in-renal-osteodystrophy.md)
- **Source:** Kidney International | **Published:** 2026-04-01
- **Detail Markdown URL:** [The Janus Face Of Parathyroid Hormone In Renal Osteodystrophy](https://medichelpline.com/clinical-feed/kidney-international-98-the-janus-face-of-parathyroid-hormone-in-renal-osteodystrophy.md)

> **Executive GIST:** This editorial comment discusses novel insights into renal osteodystrophy from a parallel publication, highlighting that uremia per se independently impairs bone cell viability and induces skeletal parathyroid hormone resistance. Using multimodal bone analyses, Wagner et al. show that parathyroid hormone exerts compartment-specific effects: protective for trabecular osteocytes yet detrimental to cortical integrity via increased porosity and by bone fibrosis and increased resorption. These findings redefine optimal parathyroid hormone targets and emphasize addressing uremic toxicity to reduce fracture risk in chronic kidney disease.

### 30. [ALDH1A1 as a Potential Target for Autosomal Dominant Polycystic Kidney Disease](https://medichelpline.com/clinical-feed/kidney-international-97-aldh1a1-is-a-potential-novel-target-for-treatment-of-adpkd.md)
- **Source:** Kidney International | **Published:** 2026-04-01
- **Detail Markdown URL:** [ALDH1A1 as a Potential Target for Autosomal Dominant Polycystic Kidney Disease](https://medichelpline.com/clinical-feed/kidney-international-97-aldh1a1-is-a-potential-novel-target-for-treatment-of-adpkd.md)

> **Executive GIST:** Cheng et al. identify aldehyde dehydrogenase 1A1 as a novel risk factor for autosomal dominant polycystic kidney disease, by both activating proliferative pathways and acting as a transcription factor. Targeting aldehyde dehydrogenase 1A1 with disulfiram delays cyst growth in autosomal dominant polycystic kidney disease mice. Combining low-dose disulfiram with anti–programmed death ligand 1 antibody synergistically attenuates cyst progression and improves the immune microenvironment. Although aldehyde dehydrogenase 1A1 upregulation occurs in other kidney diseases and its transcriptional mechanism warrants further study, repurposing aldehyde dehydrogenase 1A1 inhibitors and programmed death ligand 1 blockades may represent a novel strategy for autosomal dominant polycystic kidney disease therapy.

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