Kidney Week 2025 Annual Meeting-Cardiovascular-Kidney-Metabolic Interactions and More: Multimorbidity and the Era of Integrated Care, Including the Barry M. Brenner, MD, Endowed Lectureship

Video Transcription

Video Summary

The transcript honors nephrologist Dr. Barry Brenner, highlighting his transformative research on glomerular filtration, hyperfiltration, and progressive kidney disease, which led to major advances in patient care and the landmark textbook <em>Brenner and Rector’s The Kidney</em>. His work showed hyperfiltration drives fibrosis and helped establish therapies that slow progression. The session then features a memorial lecture focused on SGLT2 inhibitors as “cardiorenal metabolic drugs.” The speaker traces their origins to phlorizin from apple tree bark and early animal and human studies showing rapid glucose lowering via induced glucosuria, reversal of glucotoxicity, improved insulin sensitivity, and improved beta-cell function. A key mechanistic finding is a renal–hepatic axis: SGLT2-induced glucosuria stimulates hepatic glucose production, limiting hypoglycemia risk and explaining safety.

Cardiovascular outcomes (e.g., EMPA-REG) demonstrate reduced mortality and heart failure events, with benefits appearing within 1–2 months. Proposed mechanisms include diuresis/natriuresis (reduced preload/afterload), decreased arterial stiffness, reduced sympathetic activity, increased hematocrit, and potential energetic advantages from ketones. Kidney-focused data show SGLT2 inhibitors lower glomerular filtration and filtration fraction consistent with altered intrarenal hemodynamics, with correlations to rising ketones.

A second talk argues eye disease should be integrated into CKD care: diabetic retinopathy, glaucoma, cataracts (notably steroid-related), and age-related macular degeneration share risk factors and pathways with CKD. Screening is underutilized, and some eye treatments (anti-VEGF) may affect kidney outcomes.

A liver-focused talk explains MASLD/MASH progression and its strong association with CKD, emphasizing shared metabolic and inflammatory biology and therapeutic overlap (GLP-1s, SGLT2s, thyroid-β agonists, FGF21). The final lecture reviews arthritis and CKD, noting high comorbidity, risks from NSAIDs, potential renal benefits of biologic DMARDs in rheumatoid arthritis, and unresolved questions about urate-lowering therapy—suggesting better gout control may reduce kidney failure risk.

Asset Subtitle

Moderator(s): Charles Ginsberg, Susanne Nicholas

Presentation(s):

SGLT2 Inhibitors: Cardiometabolic Renal Drugs for the Ages: The Barry M. Brenner, MD, Endowed Lectureship - Ralph DeFronzo
Nephrology and Eye Care in Diabetes - Merlin Thomas
Kidney-Liver Pharmacotherapies: What Is the State of the Art? - Arun Sanyal
Rheuma-Nephrology: Protecting Bones, Joints, and Nephrons - Austin Stack

ASN gratefully acknowledges Monarch Pharmaceuticals for support of the Brenner Endowed Lectureship.

Note: Continuing education credits are not being offered for this session.

Meta Tag

Date 11/6/2025

Pathway 1 Diabetic Kidney Disease

Pathway 2 Pharmacology

Session ID 507082

Keywords

Barry Brenner

glomerular hyperfiltration

progressive kidney disease

Brenner and Rector’s The Kidney

renal fibrosis

SGLT2 inhibitors

cardiorenal metabolic drugs

phlorizin

renal–hepatic axis

EMPA-REG OUTCOME

heart failure outcomes

intrarenal hemodynamics

diabetic retinopathy screening

MASLD/MASH and CKD

gout and urate-lowering therapy