The edition · Nephrology
Childhood kidney disease follows patients into adulthood, and a repurposing that flopped
Reviews track how childhood nephrotic syndrome and congenital kidney anomalies carry into adult care, an interleukin-1 blocker is explored for gout flares in CKD, and fluconazole fails to help nephrogenic diabetes insipidus.
The edition in brief
Today's nephrology edition leads with a review of childhood nephrotic syndrome: steroid response and genetics drive prognosis, about a quarter of steroid-sensitive patients still relapse in adulthood, and steroid-resistant and monogenic disease carries a three- to fourfold higher risk of kidney failure, so transition planning matters. A feasibility trial of anakinra versus intramuscular steroid for gout flares in CKD hinted at faster pain relief but under-recruited, keeping it a signal rather than an answer for a setting where NSAIDs and colchicine are constrained. A clean negative open-label study found fluconazole did not reduce urine output in congenital arginine vasopressin resistance, despite preclinical promise. A pearl reinforces pairing an SGLT2 inhibitor with a renin-angiotensin blocker in albuminuric CKD. The edition closes on congenital anomalies of the kidney and urinary tract, the commonest cause of paediatric CKD, where a life-course model and selective genetic testing shape adult outcomes.
Childhood nephrotic syndrome often does not resolve at puberty
Risk-stratify childhood nephrotic syndrome by steroid response and genetics, and arrange deliberate adult transition, since relapses often persist.
An IL-1 blocker for gout flares when the kidneys tie your hands
Keep IL-1 blockade in mind as a steroid- and NSAID-sparing option for gout flares in CKD, recognising the evidence is still only a feasibility signal.
Fluconazole did not help nephrogenic diabetes insipidus
Do not repurpose fluconazole for nephrogenic diabetes insipidus; a clinical study found no reduction in urine output despite preclinical promise.
Pair an SGLT2 inhibitor with a RAS blocker in albuminuric CKD
In albuminuric CKD, combine an SGLT2 inhibitor with a RAS blocker, counsel on the initial eGFR dip, and give sick-day rules.
Treat congenital kidney anomalies as a lifelong, planned trajectory
Manage CAKUT as a planned life-course condition, with targeted genetics and structured transition timed to the adolescent rise in kidney-failure risk.
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