Christine Limonte is an assistant professor at UW Medicine and a study investigator for the Kidney Precision Medicine Project.

Kidney Biopsies Challenge Diabetic Nephropathy Diagnoses in CKD, With Christine Limonte, MD

According to data from 39 kidney biopsies, only 54% of patients clinically diagnosed with diabetic kidney disease actually had diabetic nephropathy confirmed on biopsy.

The data may challenge long-held beliefs about chronic kidney disease (CKD) prognosis, highlighting that before biopsies were performed, only 15% of clinicians expected to find something different, yet 26% reported the results were different than expected.

These findings come from the Kidney Precision Medicine Project (KPMP), a multicenter prospective cohort study obtaining research protocol biopsies in adults with suspected diabetic kidney disease (DKD) or hypertension-associated chronic kidney disease (HCKD) for comprehensive clinicopathologic characterization.

"Only about half of participants enrolled into the diabetic kidney disease or hypertensive chronic kidney disease cohorts actually had classic diabetic nephropathy or hypertension-associated nephropathy on biopsy, respectively," said study investigator Christine Limonte, MD, assistant professor of medicine at UW Medicine. "A number of participants had unexpected findings, IgA nephropathy, fibrillary glomerulonephritis, as well as nonspecific findings that precluded a definitive diagnosis."

Beyond missed or unexpected diagnoses, biopsies frequently revealed lesions not captured by existing diagnostic frameworks: acute tubular injury, interstitial inflammation extending into nonfibrotic parenchyma, glomerular microaneurysms, and tubular mitochondrial abnormalities. These findings were prevalent even among participants with confirmed diabetic nephropathy, suggesting the histopathologic heterogeneity of common CKD presentations is broader than traditional classifications reflect.

"In our group of 39 participants, we obtained clinician post-biopsy reports and found that over 70% of clinicians reported that biopsy results did affect their prognostic discussions with patients, and in about 38% of cases, impacted clinical management," Limonte noted.

For nephrologists managing patients with presumed DKD or HCKD, these findings underscore the diagnostic limitations of a clinical-only approach.

Limonte CP, Aw S, Alpers CE, et al. Case Series of Histopathological Findings in Chronic Kidney Disease: Insights From the Kidney Precision Medicine Project. 

. Published online December 2025:101206. doi:https://doi.org/10.1016/j.xkme.2025.101206

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Data from 39 kidney biopsies may challenge longterm beliefs about diabetic nephropathy in CKD.

Clinical

clinical page is a resource for content on every specialty, disease, and topic available on our medical news site.

News

news page, resources on the topics of disease- and specialty-specific medical news and expert insight can be found. Content includes articles, interviews, videos, podcasts, and breaking news on health care research, treatment, and drug development.

Nephrology

The HCPLive nephrology page is a resource for medical news and expert insights on kidney disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in nephrology, and more.

Chronic Kidney Disease

Corey Cavanaugh, DO, is an academic nephrologist at the Cleveland Clinic. 

Who Gets What, When? Navigating Therapy Selection in IgA Nephropathy, With Corey Cavanaugh, DO

 has considerably expanded recently, clinicians continue to navigate how best to select and sequence these emerging therapies for their patients.

New breakthrough developments have brought treatment options well beyond traditional approaches, such as corticosteroids and supportive care, now encompassing complement inhibitors and APRIL/BAFF-targeting agents.

“On the immunosuppressive side, we still have corticosteroids, we still have targeted release… sort of the newer kids on the block, if you will, are the complement inhibitor… and then our anti April therapies that are numerous and rolling out. Those are the major ones we're fixating on,” ​​said Corey Cavanaugh, DO, an academic nephrologist at the Cleveland Clinic, in an interview with HCPLive. “The major question is, who gets what and when, and that still is… this is a matter of, just to be clear right off the bat, this is not necessarily evidence-based. This is all just opinion-based.”

2025 Kidney Disease: Improving Global Outcomes (KDIGO) 

updated IgAN guidelines marked a conceptual shift, recommending clinicians to initiate therapies targeting pathogenic IgA production simultaneously with those addressing the consequences of existing nephron loss, a dual-track approach departing from the traditional stepwise model. The guidelines also introduced a more stringent proteinuria target, with the goal of achieving <0.3 g/d.

 proteinuria and eGFR remain the only validated biomarkers 

to guide therapy selection in the continuously expanding therapeutic landscape. Combination regimens may offer additive benefits, but supporting evidence is still emerging, and there is no existing evidence-based framework for sequencing decisions yet.

Meaningful progress toward personalized therapy in IgAN will depend on identifying biomarkers which can guide which patients are most likely to benefit from complement inhibition, APRIL blockade, or targeted intestinal therapy with Nefecon.

“My personal preference is to avoid steroids as much as I can, whether it be targeted release or oral systemic corticosteroids. That's just my personal preference. When we have a steroid-sparing option, I'm going to choose it. Young people don't like steroids… like anyone else.”

Current evidence supports guideline recommendations to avoid corticosteroid therapy in those with an eGFR <30 mL/min/1.73 m² and the suggestion to exercise cautiously in individuals at high risk of developing corticosteroid-related side effects, such as those with diabetes mellitus, obesity, latent infections, active peptic ulceration, uncontrolled psychiatric illness, and severe osteoporosis.

Editor’s Note: Cavanaugh reports relevant disclosures with Otsuka Pharmaceutical Co, Novartis Pharmaceutical Corporation, Travere Therapeutics, and Vera Therapeutics.

Floege J, Barratt J, Cook HT, et al. Executive summary of the KDIGO 2025 Clinical Practice Guideline for the Management of Immunoglobulin A Nephropathy (IgAN) and Immunoglobulin A Vasculitis (IgAV). 

https://doi.org/10.1016/j.kint.2025.04.003

In a rapidly evolving therapeutic landscape, how can clinicians make decisions to personalize IgAN care?

IgA Nephropathy

The HCPLive Berger disease page is a resource for medical news and expert insights on IgA nephropathy. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments in Berger disease, and more.

Abigail Brooks is an assistant managing editor for 

She joined MJH Life Sciences in August 2023 shortly after graduating from Monmouth University where she earned her BA in Communication with a concentration in Public Relations/Journalism and later an MA in Interactive Digital Media. She enjoys traveling, running, and reading books. She can be reached at abrooks@mjhlifesciences.com.

The US Food and Drug Administration has cleared MiniMed’s MiniMed Flex™, a next-generation discreet, smartphone-controlled insulin pump designed to fit seamlessly into everyday life.

As described in a March 18, 2026, release from the Company, the MiniMed Flex is about half the size of the MiniMed™ 780G pump and roughly the size of 2 stacked insulin vials. It is cleared for individuals ≥ 7 years of age with type 1 diabetes and for individuals ≥ 18 years of age with insulin-requiring type 2 diabetes. MiniMed Flex is the company's first screenless design created in partnership with people living with diabetes to deliver an intuitive, lifestyle‑friendly way to manage the condition.

"MiniMed Flex™ represents an important leap forward for MiniMed," Anders Carlson, MD, Medical Director of the International Diabetes Center at Park Nicollet, Director of the HealthPartners Diabetes Program, and an assistant professor in the University of Minnesota Medical School, said in a statement. "For many people living with diabetes, the burden of daily management can be overwhelming. By combining a discreet, screenless form factor with a powerful adaptive algorithm that responds quickly to changes in glucose, MiniMed Flex™ brings meaningful innovation exactly where it's needed—into the flow of everyday life. This level of automation, paired with the freedom of smartphone control, has the potential to improve consistency, confidence, and ultimately clinical outcomes for a broad range of patients with diabetes."

In January 2026, the FDA granted 510(k) clearance to Medtronic’s MiniMed Go Smart Multiple Daily Injection (MDI) app for use by patients with type 1 diabetes or type 2 diabetes aged ≥7 years, as well as for children between 2-6 years under adult supervision.

The new MiniMed Flex™ is powered by MiniMed’s most advanced SmartGuard™ algorithm with Meal Detection™ technology, which has proven clinical performance that exceeds worldwide Time in Range recommendations. At commercial launch, MiniMed Flex™ will support the company's newest sensor portfolio, including Simplera Sync™ sensor and the Instinct sensor, made by Abbott.

Key product features include the small, sleek design with high insulin capacity, delivering a 300-unit insulin reservoir to support a range of insulin needs; the ability to manage the product through a compatible mobile app; sensor compatibility with the Company's newest sensor portfolio, including Simplera Sync™ sensor and the Instinct sensor, made by Abbott; extended infusion set options; and proven AID performance, with real-world results demonstrating 80% Time in Range with recommended settings.

MiniMed additionally announced the MiniMed™ Forward Program, which allows customers who start on the MiniMed™ 780G system to upgrade to the MiniMed Flex™ system at no cost.

"At MiniMed, our Mission is to make every day a better day for people with diabetes," said Que Dallara, chief executive officer of MiniMed. "MiniMed Flex™ embodies that promise. It's designed to work quietly and reliably in the background — advanced automation wrapped in a compact, smartphone‑controlled pump. The result is technology that lets people spend less time managing diabetes and more time living their lives. Securing FDA clearance for our first product as a standalone, public company — just one week after our IPO — marks a major milestone and underscores our commitment to delivering the breakthrough innovation our customers deserve."

MiniMed. MiniMed Announces FDA Clearance of MiniMed Flex™, the Company's Smallest Insulin Pump Featuring Its First Smartphone-Controlled Design. March 18, 2026. Accessed March 16, 2026. 

https://www.prnewswire.com/news-releases/minimed-announces-fda-clearance-of-minimed-flex-the-companys-smallest-insulin-pump-featuring-its-first-smartphone-controlled-design-302716864.html

Livingston R. FDA Clears MiniMed Go Smart MDI App for Adults and Children with T1D, T2D. HCPLive. January 12, 2026. 

https://www.hcplive.com/view/fda-clears-minimed-go-smart-mdi-app-for-adults-and-children-with-t1d-t2d

Articles

FDA clearance enables commercialization of MiniMed Flex, a compact, screenless, smartphone-controlled insulin pump positioned to reduce daily management burden in diabetes. The device is approximately half the size of the MiniMed 780G and supports a 300‑unit reservoir. Indications include type 1 diabetes in patients aged ≥7 years and insulin-requiring type 2 diabetes in adults. Flex runs the latest SmartGuard algorithm with Meal Detection and is slated to pair with Simplera Sync and Abbott-made Instinct sensors, with reported real-world performance near 80% time-in-range.

The MiniMed Flex is a discreet, smartphone-controlled insulin pump that is roughly the size of 2 stacked insulin vials.

Endocrinology

The HCPLive endocrinology page is a comprehensive resource for clinical news and insights on endocrine system conditions. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for diabetes, hormonal disease, and more.

Type 2 Diabetes

FDA News

FDA Clears MiniMed Flex, A Smaller and Smartphone-Controlled Insulin Pump

Viet Le, DMSc, PA-C, is a preventive cardiology PA at Intermountain Health and the former president of the Academy of Physician Associates in Cardiology.

ACC/AHA Dyslipidemia Guidelines Refocus Hypertriglyceridemia Treatment, With Viet Le, DMSc, PA-C

On March 13, 2026, the American College of Cardiology (ACC) and American Heart Association (AHA) released an updated clinical guideline for the management of 

, replacing the 2018 Guideline on the Management of Blood Cholesterol.

Another core focus of the new guidelines is hypertriglyceridemia. In the updated document, patients with a triglyceride measurement of 150-999 mg/dL with 

atherosclerotic cardiovascular disease (ASCVD)

 and LDL-C or non-HDL-C above goal on max statins should receive intensified LDL-C lowering therapy first. Additionally, olezarsen, a new apoC3 inhibitor, has received the guidelines’ recommendation for patients with familial chylomicronemia syndrome with triglycerides ≥1000 mg/dL as an adjunct to diet.

“Hypertriglyceridemia gets a strong voice with the guidelines here, and it’s important to recognize that statins are still foundational,” Viet Le, DMSc, PA-C, associate professor of research and preventive cardiology PA at Intermountain Health and ACC editor in chief, told 

 in an exclusive interview. “When we talk about ASCVD risk, there’s still a dichotomy when we think about hypertriglyceridemia as either a risk for cardiovascular disease or as a pancreatitis risk.”

Le also breaks down the 5 most important takeaways from the guidelines, emphasizing the cornerstones of dyslipidemia management and care moving forward. These takeaways include the following:

Switch from the Pooled Cohort Equations to the AHA’s PREVENT calculator to predict ASCVD risk in patients with dyslipidemia

Monitor LDL-C and non-HDL-C targets, with >100 and >55, respectively, as key goals to shoot for in managing dyslipidemia

Monitor lipoprotein(a) in all patients, as it is a universal cascade predictor of ASCVD in patients with dyslipidemia and their relatives

Continue to monitor coronary artery calcium (CAC), a major predictor of ASCVD risk

Use the CPR model – Calculate 10-year ASCVD risk, Personalize the estimated risk by considering factors not included in the PREVENT equations, and Reclassify with selective use of CAC

Additionally, Le also addresses dietary supplements, a substantial player in modern lipid management despite not possessing clinical evidence of their efficacy. Supplements are widely used for their ostensible lipid-lowering effects, and Le recommends accepting this while encouraging patients to rely on medically proven therapies first and foremost.

“Folks should know that dietary supplements are not recommended for lipid lowering,” Le said. “Please recognize that we need to go to those things that have clinical evidence. Don’t frown on patients who want to use dietary supplements, but it has to be made clear that in the guidelines, we don’t have evidence that dietary supplements help in lowering LDL-C.”

Editors’ Note: Le reports disclosures with Janssen, Pfizer, Novartis, Idorsia, Amarin, and Lexicon.

Blumenthal RS, Morris PB, Gaudino M, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APHA/ASPC/NLA/PCNA guideline on the management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. Published online March 13, 2026. 

Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APHA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;139(25). 

Le discusses the AHA/ACC clinical guidelines for the management of dyslipidemia, highlighting the shifting attitude towards hypertriglyceridemia treatment.

Cardiology

Cardiology condition center page is a comprehensive resource for clinical news and insights on cardiovascular and cardiometabolic diseases. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for heart disease and cardiovascular events, as well as associated diabetes, renal failure, and more...

Dyslipidemia

Atherosclerotic Cardiovascular Disease

Strategic Alliance Partnership

Natasha Mesinkovska, MD, PhD, is a dermatologist and researcher at the University of California, Irvine School of Medicine Department of Dermatology.

Networking, Niches, and Why Authenticity Is Your Biggest Career Asset in Dermatology

, the conversation opened with both physicians sharing the speakers they most admire and actively try to emulate. Host Mona Shahriari, MD, named Linda Stein Gold as a formative influence, praising her ability to translate complex material through analogy and metaphor in a way that made audiences not just understand a topic, but feel it emotionally.

Guest Natasha Mesinkovska, MD, PhD, pointed to Ted Rosen as her model, drawn to his stripped-down presentation style, big letters, two words on a slide, a photograph, humor and a relaxed presence that made him feel like someone you just happened to know. She also credited Dirk Elston with teaching her the value of the pause, an acknowledgment that she naturally tends to run through material quickly. The throughline for Mesinkovska was clear: the speakers she gravitates toward are those who lead with images and simplicity, and that is the presenter she is working to become.

From there, Shahriari raised a more pointed question: whether women are judged differently on stage. Mesinkovska answered directly and without hesitation. She acknowledged that audiences scrutinize what women wear, down to their jewelry and shoes, in ways that simply do not apply to their male counterparts.

Rather than treating that reality as a liability, she reframed it as an opportunity. Women on stage, she argued, hold a particular kind of power and should lean into whatever makes them feel confident and authentic, whether that means a red dress, heels, or a sweatshirt. The message was simple: own it. Shahriari echoed the sentiment, noting that her own heels are a source of personal confidence she has never felt the need to apologize for.

The discussion then turned to authenticity and the pressures of personal branding in an era of social media and influencer culture. Mesinkovska was candid about the professional trade-offs that come with her commitment to honesty, acknowledging that her directness is not always considered industry-friendly. She has made peace with that, viewing the credibility she has built through institutional rigor and independent research as its own form of currency. She also admitted she is not well-suited to social media, finding the environment too harsh for someone who describes herself as sensitive.

Closing out the episode, Mesinkovska offered practical advice for women hoping to build a national presence. Her playbook started with human connection: find the people you admire and simply introduce yourself. From there, she stressed the importance of identifying genuine areas of interest rather than chasing prestige, finding a niche that excites you personally, and growing within it through research, collaboration, and willingness to change direction when your passions evolve. Her parting thought was characteristically direct: carve your own path, then carve a whole lot more of them.

Editor’s note: This episode was produced with the help of AI tools.

This discussion reflects on great speakers, the unique pressures women face on the podium, and what it takes to build a national platform in academic medicine.

Dermatology

The HCPLive dermatology page is a resource for medical news and expert insights on skin disease. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for dermatologic conditions, and more.

Andrea Kossler, MD, describes her multidisciplinary co-management model with ophthalmologists and outlines a forward-looking vision for earlier diagnosis, precision medicine, and optimized surgical integration in thyroid eye disease.

Video Series

Combination Strategies, Multidisciplinary Care, and the Future of TED Management

Andrea Kossler, MD, explores the management of thyroid eye disease in special populations, emerging IGF‑1R agents and alternative targets such as interleukin 6 (IL‑6) and FcRn, and the potential role of serologic biomarkers in predicting response and relapse.

Special Populations, Emerging Targets, and Biomarkers

Andrea Kossler, MD, reviews the current therapeutic armamentarium for moderate to severe thyroid eye disease, including corticosteroids, teprotumumab, radiotherapy, and orbital decompression surgery, and discusses how these therapies fit into contemporary practice.

Therapeutic Landscape—Steroids, Biologics, Radiotherapy, and Surgery

Chelsie Derman is an associate editor for 

who covers psychiatry, sleep medicine, geriatrics, migraine, and allergy. She joined MJH Life Sciences in September 2023 after graduating from The College of New Jersey with a bachelor’s degree in journalism and professional writing. In her free time, she enjoys creative writing and reading.

BrainsWay’s SWIFT protocol reduced treatment visits from ~36 to 6 while maintaining response and remission rates in a randomized multisite trial.

Psychiatry

Psychiatry condition center page is a comprehensive resource for clinical news and insights on mental illnesses. This page consists of interviews, articles, podcasts, and videos on the research, treatment and development of therapies for depression, schizophrenia, bipolar disorder, anxiety, and more.

Major Depressive Disorder

Major Depressive Disorder condition center page, resources on the topics of medical news and expert insight into depression can be found. Content includes articles, interviews, videos, podcasts, and breaking news on MDD research, treatment, and drug development.

Accelerated Deep TMS Matches Standard Outcomes in TRD in 6 Days

Andrea Kossler, MD, discusses when to involve ophthalmology and how evolving use of activity and severity scores intersects with quality-of-life considerations in decisions about initiating therapy.

Referral Thresholds and Activity/Severity Scoring

 Andrea Kossler, MD, outlines her screening workflow for newly diagnosed Graves disease in light of updated American Thyroid Association guidelines and describes practical initial management strategies for early thyroid eye disease.


Screening, American Thyroid Association Guidelines, and Initial Management

Patrick Campbell is the editorial director of HCPLive. Patrick has spent years spearheading coverage surrounding cardiometabolic health and rheumatic disease for MJH Life Sciences. Before joining MJH Life Sciences in 2019, he spent time as a beat reporter and/or multimedia specialist with the Pocono Record, Star News Group, and NJ Advance Media. He is the executive producer for multiple HCPLive podcasts, including Diabetes Dialogue, Don't Miss a Beat, Kidney Compass, Medical Ethics Unpacked, The Medical Sisterhood, and Skin of Color Savvy. 


Follow him on Twitter @RealPatCampbell or reach him via email at PCampbell@mjhlifesciences.com.

FDA clears once-daily icotrokinra for moderate-to-severe plaque psoriasis in adults and teens.

Plaque Psoriasis

The HCPLive plaque psoriasis page is a resource for medical news and expert insights on psoriasis. This page features expert-led coverage, articles, videos and research on the therapies and development of treatments for psoriatic disease, and more.

Icotrokinra, an Oral Il-23 Inhibitor, Receives FDA Approval for Psoriasis

Overview of KIT D816V–driven disease biology in ISM and practical approaches to longitudinal symptom monitoring, including emerging use of the Mastocytosis Control Test.

KIT D816V Biology and Longitudinal Symptom Assessment in Indolent Systemic Mastocytosis

Discover how intestinal ultrasound and biomarkers help spot hidden IBD inflammation, guiding faster treat-to-target decisions beyond endoscopy.

Keeping Pace with Advances in Gastroenterology, With Benjamin McDonald, MD, at UChicago Medicine

Introduction to ISM with emphasis on evolving clinical perception, disease heterogeneity, and persistent unmet needs despite conventional symptomatic therapy.

Latest News

Kidney Biopsies Challenge Diabetic Nephropathy Diagnoses in CKD, With Christine Limonte, MD

Who Gets What, When? Navigating Therapy Selection in IgA Nephropathy, With Corey Cavanaugh, DO

FDA Clears MiniMed Flex, A Smaller and Smartphone-Controlled Insulin Pump

ACC/AHA Dyslipidemia Guidelines Refocus Hypertriglyceridemia Treatment, With Viet Le, DMSc, PA-C

Networking, Niches, and Why Authenticity Is Your Biggest Career Asset in Dermatology