The edition · Nephrology
Measured GFR finds no link between testosterone and kidney function decline in middle-aged men
Iohexol clearance over 11 years undercuts a hypothesis built on creatinine; a new research assay may one day let NELL1 membranous nephropathy be diagnosed and tracked in blood; and an ACC statement tackles DOAC underuse and misdosing, including in kidney disease.
The edition in brief
In the Norwegian Renal Iohexol Clearance Survey, 800 men aged 50 to 62 without diabetes, cardiovascular or kidney disease had GFR measured by iohexol clearance three times over a median 10.9 years. Total and free testosterone and SHBG were not associated with GFR decline, although higher testosterone and SHBG went with slightly higher baseline GFR; earlier links relied on creatinine-based eGFR, which muscle mass distorts. A luciferase immunoprecipitation assay for anti-NELL1 antibodies showed 90% sensitivity and 100% specificity against biopsy-proven NELL1 membranous nephropathy, and titres tracked proteinuria in three patients (published June 2026). A meta-analysis of 17 cohorts (2,986 children) put acute kidney injury after paediatric liver transplantation at 30.7%. The 2026 ACC scientific statement (published June 2026) reviews DOAC use across atrial fibrillation, venous thromboembolism and special populations including chronic kidney disease, and highlights continuing underuse and inappropriate dosing.
Testosterone did not predict measured GFR decline over 11 years in middle-aged men
Do not attribute kidney function decline in middle-aged men to their natural testosterone level; check whether eGFR is being distorted by muscle mass.
A membranous nephropathy subtype may one day be diagnosed and tracked by a blood test for anti-NELL1 antibodies
For PLA2R-negative membranous nephropathy, request NELL1 staining; a blood test for it is in development.
Almost a third of children developed acute kidney injury after liver transplantation
Treat AKI as an expected complication of paediatric liver transplantation and plan to prevent and detect it early.
Dose DOACs by Cockcroft-Gault creatinine clearance, not eGFR
Use Cockcroft-Gault creatinine clearance for DOAC dosing, and do not reduce doses without meeting the label criteria (apixaban's AF criteria use age, weight and serum creatinine).
ACC statement targets DOAC underuse and misdosing, including in kidney disease
Audit DOAC prescriptions in CKD patients for correct indication, drug choice and dose; the statement flags underuse and inappropriate dosing as persistent problems.
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