Avi Patel

, assistant professor of medicine (nephrology), first began her training at Yale, she was struck by the high rates of heart failure among her patients with kidney disease.

For many patients—especially those with advanced kidney disease approaching dialysis or already on dialysis—nephrologists often serve as both the kidney specialist and de facto primary care provider. However, nephrologists are not primarily trained or focused on managing nonrenal issues.

This gap in care sparked Mansour’s research. She set out to better understand the biological link between kidney injury and heart failure, aiming to identify patients at the highest risk and ensure they receive timely preventive measures, primary care follow-up, and specialist referrals.

“In the nephrology clinic, our focus is understandably on the kidney, but there is a need to integrate cardiovascular disease prevention,” Mansour says.

Most patients with kidney disease die not from kidney failure itself, but from heart failure, heart attacks, or sudden cardiac death.

, analyzed blood samples from nearly 1,500 hospitalized patients, half of whom had experienced acute kidney injury (AKI). Mansour and her team tested nine proteins known as vascular biomarkers, which reflect how well blood vessels are repairing or failing to repair after illness.

Using advanced clustering analysis, the researchers identified three patient profiles: a vascular injury group with poor repair, a repair group with strong recovery, and a dormant group with low signals of both injury and repair.

The researchers found that patients who had acute kidney injury while in the hospital, clustered in the vascular injury group, faced the highest risks of heart failure, kidney disease progression, and even death in the years after hospitalization.

“Those in the injury group were much more likely to have poor outcomes compared to the repair group,” Mansour says. “What fascinated me was that the computer had no knowledge of these patients or their outcomes yet was able to capture everything through biology alone.”

For Mansour, the clinical implications are clear: If clinicians can flag patients at highest risk for heart failure after AKI, they can devote more time to counseling on preventive strategies like diet, smoking cessation, and cardiovascular monitoring.

Mansour stresses that while the biomarker findings are promising, they are not yet ready for routine clinical use and must be validated in other patient groups. In the meantime, she is applying this work to kidney transplant patients, who remain at sharply elevated risk of heart disease even after receiving a new kidney.

For her, the ultimate goal is prevention of heart disease in patients with kidney disease.

“Most patients with kidney disease die not from kidney failure itself, but from heart failure, heart attacks, or sudden cardiac death,” she explains. That reality calls for a shift in focus. “We can’t wait for the disease to happen and then react—we need to be proactive, and intervene early, protecting both the kidney and the heart before problems arise.”

The research reported in this news article was supported by the National Institutes of Health (award 1K23DK127154-01A1), the American Heart Association (award 18CDA34110151), and Yale University. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or American Heart Association.

Nephrology is one of 10 sections in the Yale Department of Internal Medicine. Committed to excellence in patient care, research, and education, the section’s faculty and trainees aim to be national and international leaders in academic nephrology. To learn more, visit

Articles

Dr. Sherry Mansour's research highlights the critical link between kidney injury and heart failure, emphasizing the need for integrated cardiovascular disease prevention in nephrology. Her study, involving nearly 1,500 patients, identified three patient profiles based on vascular biomarkers, revealing that those with acute kidney injury face the highest risks of heart failure and mortality. While promising, these biomarker findings require further validation. Mansour advocates for proactive prevention strategies to mitigate heart disease risks in kidney disease patients, underscoring the importance of early intervention and comprehensive care.

Assessing the Risk of Heart Failure in Patients With Acute Kidney Injury

Yale Center for Asthma and Airways Disease

Yale Section of Pulmonary, Critical Care, and Sleep Medicine

 (Yale PCCSM), sheds light on how asthma behaves differently in males and females both in symptoms and at the level of gene expression. The results were recently 

Journal of Respiratory Cell and Molecular Biology

"Asthma is incredibly heterogeneous," says 

, Yale PCCSM assistant professor and the study's first author. "It starts at different times, presents with different symptoms, and responds differently to treatment. What really stood out to me in clinical training was how differently it affected males and females."

To explore that disparity, Kay and her team analyzed gene expression data from more than 6,000 samples across public databases and conducted a meta-analysis focused on blood-based immune cells. Their study identified 61 genes that were differentially expressed by sex in adults with asthma. Many of these genes were associated with key immune pathways—including those involving eosinophils, lymphocytes, and type 2 inflammation.

To detect subtle biological differences, the team pooled asthma gene expression data from more than 3,500 individuals and validated key findings in a local Yale cohort, where sex-biased genes aligned with asthma traits such as lung function and symptom severity.

The researchers found that gene expression differences aren’t just present between males and females—they also change with age and tissue type. They also found that different patterns emerged in children than in adults, suggesting that biological sex and hormonal fluctuations may shape asthma risk and severity across the lifespan.

“We see asthma symptoms and severity change during puberty, pregnancy, and menopause, even within the menstrual cycle, suggesting that hormones are a strong contributor to sex differences,” Kay says. “These differences in pathology can affect inflammation and possibly gene expression too.”

The findings could have important implications for treatment, the researchers say. Many newer asthma therapies—like biologics—target specific parts of the immune system. Understanding sex-specific immune profiles could eventually help match the right drug to the right patient.

“Right now, we don’t typically consider sex when choosing asthma treatment plans,” Kay says. “But these insights can start the conversation and ideally bring us closer to personalized asthma care.”

 Yale PCCSM associate professor of medicine and senior author of the study, notes that the aim of P2MED is to integrate high‑definition biomarkers from transcriptomics and genetics with dedicated clinical phenotypes.

“This project exemplifies our broader strategy of dissecting the molecular mechanisms of pulmonary diseases,” he says. “By defining the biological determinants of asthma, we can move beyond conventional classifications to provide a more precise view of this complex syndrome.”

He adds that the goals are twofold: first, to translate these mechanistic insights into clinical tools that improve patient care and second, to uncover novel associations that will drive future research.

Looking ahead, Kay hopes to build on this work by studying hormonal effects more directly and exploring the intersection between asthma and comorbid conditions like obesity.

For patients, the message is one of awareness and partnership. “Asthma doesn’t look the same for everyone—and sex and hormones play a part in that story,” she says. “These are important conversations worth having in the exam room.”

The research reported in this news article was supported by the National Institutes of Health (award R01HL153604) and Yale University. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The Section of Pulmonary, Critical Care and Sleep Medicine is one of 10 sections within Yale School of Medicine’s Department of Internal Medicine. To learn more about Yale-PCCSM,

A recent study by Yale researchers highlights sex-based differences in asthma, focusing on gene expression and immune pathways. Analyzing over 6,000 samples, they identified 61 genes with sex-specific expression in adults with asthma, linked to immune pathways like eosinophils and type 2 inflammation. The study found that gene expression varies with age and tissue type, and hormonal changes influence asthma risk and severity. These insights could lead to personalized asthma treatments by considering sex-specific immune profiles, moving beyond conventional classifications to improve patient care.