33b)⚠️ MR activation outside hypotension is mediated via aldosterone (ligand) and non-ligand stimulation, driving 🚨 Inflammation 🚨 Fibrosis 🚨 Vascular dysfunction

33c) This isn’t just salt and water—it’s a fibrotic, pro-inflammatory cascade damaging heart and kidney. 🔓 ajkd.org/article/S0272-…

34) In #heartfailure, #aldosterone and non-ligand MR activation worsens: 🫀 Cardiac remodeling 💦 Volume overload 🧠 #Neurohormonal activation 🔓 pubmed.ncbi.nlm.nih.gov/35529088/

35) In the kidney, #aldosterone and non-ligand MR activation drives: ⚠️ #Albuminuria ⚠️ #Glomerulosclerosis ⚠️ #Tubulointerstitial fibrosis Aldosterone’s toxicity extends beyond hemodynamics—structural renal injury is real. 🔓 pubmed.ncbi.nlm.nih.gov/35529084/

40) More recent studies have shown that the #GPER-1 mediates some of the rapid effects of #aldosterone in vascular endothelial cells and in the heart See pubmed.ncbi.nlm.nih.gov/27942913/

42) Why might aldosterone synthase inhibitors #ASIs offer an advantage over #MRAs? A. They ↑ aldosterone B. Block it at the renal tubule C. Inhibit aldosterone synthesis upstream of MR activation D. Only reduce BP, not proteinuria

43) Medications modifying aldosterone and MR activation are needed to address these issues ✔️MRAs ▶️ Steroidal: Spironolactone, Eplerenone ▶️ Nonsteroidal: Finerenone, Esaxerenone ✔️Aldosterone synthase inhibitors → block synthesis upstream 🔓 pubmed.ncbi.nlm.nih.gov/36653520/

46) 🔁 Recap: ✔️ Aldosterone = key in BP & fluid balance ✔️ MR activation can occur even w/ normal aldosterone ✔️ Dysregulation worsens #HF, #CKD, #T2D ✔️ #MRAs & new inhibitors #ASIs = essential tools

47) 🧠 Take-home: Effective #BP control isn’t just about volume—it’s about managing the hormonal and inflammatory milieu.

First #ERA25 day, my highlights 👉Officially started a new role for the Social Media team (🔥team)

Fantastic to see CONFIDENCE trial results presented at #ERA25 and in NEJM Prevention of CV events, esp. heart failure, is probably most compelling rationale for rapid initiation of combo therapy in CKD/T2D, with benefits on kidney failure accruing gradually over time

Tobias B. Huber International Society of Glomerular Disease #ERA25 Insights on Anti-Nephrin 🧬 🔹 Diagnostic aid — may even help avoid biopsy in select cases! 🔹 Guides treatment — aligns with immunosuppressive responsiveness 🔹 Potential role in prognostication — under investigation Exciting future for precision nephrology! Tweets by

Officially starting LBCT II, en force with Vlado Perkovic presenting an interim from the ViSIONARY trial. in the ph 2 trial, called ENVISION, Sibeprenlimab reduced proteinuria in IgA Nephropathy #era25 nejm.org/doi/full/10.10…

Vlado Perkovic announcing the 🔥 sibeprenlimab results ❤️‍🔥Plus the crowd reacting #era25

5/ the conclusions, strengths and limitations #era25 ✨💖and the promise it will be published soon, in a big journal, that should not be named

⭐️Find out more about #NephJC internship and new interns Shellie Fravel Sejal Lakhani, DO Sejal Patel M.D.,CCRP, FASN Jeyakumar Meyyappan Marc Soco, MD Akshaya Jayachandran Dr.Sridatta A.K.A Nephron_Endowment Dr.Sai Vani The kidney whisperer Natalia Nombera Aznaran Clemens Weber Swapnil Hiremath @hswapnil.medsky.social nephjc.com/news/2025/6/21…

👏 Congratulations to the 23 KidneyCure grant recipients for 2025! This group of emerging investigators join a cohort of 22 continuing grantees from the most prestigious research institutions in the United States. Meet the recipients: asn.click/45z5nPd

💊ACEi/ARB: HyperK, Cr Rise & HypoTN 📊Starting ACEi/ARB? Know what to do if 🧂K⁺ spikes, Cr rises >30%, or 💥hypotension strikes! Save this #NephPearl from APSN DKD Guidelines👇 📉Manage wisely. Don’t fear the Cr bump! 🔗doi.org/10.1111/nep.13… #MedTwitter #Nephrology #HTN

KI Reports Impact Factor just released: 5.7 Unlike many journals, we held steady this year. Grateful for the incredible work by our editorial team, reviewers, and authors! #Nephrology #OpenAccess #ImpactFactor #KIReports

SGLT2i in CKD: impact beyond kidneys 🔻 15% all-cause hospitalizations ✅ Consistent across eGFR, UACR & diabetes 🏥 ~36 fewer hospitalizations per 1000 pt-years Large absolute gains for patients & health systems. Meta-analysis in ASN Publications: 🔗 journals.lww.com/cjasn/abstract…