Primary aldosteronism (PA) is common, underdiagnosed, and associated with excess cardiorenal risk. We review recent changes in screening, diagnosis, treatment, and implementation.

Tirzepatide is a dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist that is being increasingly used for the management of type 2 diabetes mellitus and obesity. Gastrointestinal adverse effects associated with incretin-based therapies can influence water balance through nonosmotic vasopressin release and reduced oral solute intake. In this case report, we report a patient who developed severe symptomatic hyponatremia with biochemical features compatible with the syndrome of inappropriate antidiuretic hormone secretion temporally associated with tirzepatide therapy. A woman with type 2 diabetes mellitus and morbid obesity on regular insulin and chronic torsemide therapy presented with anorexia, weakness, and drowsiness 10 days after tirzepatide administration. Serum sodium was 104 mmol/L, and she was clinically euvolemic. Renal, hepatic, hematologic, acid-base, and other endocrine parameters were normal. The calculated serum osmolality was 224 mOsm/kg. Urinary sodium remained elevated after withdrawal of the diuretic. The patient was managed with fluid restriction and hypertonic saline, and this resulted in progressive correction of sodium and clinical improvement. This case suggests a potential association between tirzepatide therapy and severe euvolemic hyponatremia. Clinicians should consider electrolyte monitoring in patients receiving incretin-based therapy who develop significant gastrointestinal symptoms or reduced oral intake.

Lower respiratory tract infections require high local antibiotic concentrations in the lung, yet current dry powder inhaler (DPI) technologies are poorly suited to delivering high drug payloads while maintaining particle stability, dispersibility, and antimicrobial function. Here, we report a novel solvent-minimized mechanochemical strategy for the design of high-dose inhalable antibiotic powders based on ciprofloxacin-maleic acid (CIP-MA) salt formation. CIP-MA was prepared by oscillatory ball milling and co-processed with l-leucine (L-Leu), polyvinylpyrrolidone 10,000 (PVP), or D-mannitol (D-Man) using a design of experiment approach to tune the milling frequency, processing time, and excipient loading. The process generated crystalline, thermally stable powders with respirable particle sizes, controllable morphology, and reduced hygroscopicity compared with raw ciprofloxacin. Excipient selection provided distinct formulation functions. L-Leu improved dispersibility and achieved the highest proportion of particles with geometric diameter below 5 μm (89%) and fine particle fraction < 5 μm (∼37%) measured using a next-generation impactor at a 200 mg dose in the OrbitalTM high-dose DPI. However, PVP and D-Man favored improved device emptying and altered dissolution behavior. All CIP-MA formulations retained antimicrobial potency, with minimum inhibitory concentrations comparable to raw ciprofloxacin and approximately 95% reduction in viable Pseudomonas aeruginosa biofilm. Importantly, the formulations showed accelerated dissolution under pulmonary-relevant flow-through conditions, releasing 70-80% of ciprofloxacin within 30 min, compared with the slower dissolution of raw ciprofloxacin. These findings establish oscillatory ball milling as a lower solvent use, tunable solid-state approach that integrates salt formation, preservation of crystallininty, particle engineering, high-dose aerosol delivery, and biological performance for next-generation inhalable antibiotic formulations.

Chronic kidney disease (CKD) and cardiovascular disease (CVD) frequently coexist, with an increasing risk of CVD as kidney function declines. Therefore, effective cardiovascular risk management is an essential part of the clinical care of patients with CKD. This article summarizes recent evidence of cardiovascular risk reduction in clinical trials of patients with CKD, focusing on sodium-glucose cotransporter-2 inhibitors (SGLT2i), in addition to mineralocorticoid receptor antagonists (MRAs) and glucagon-like peptide-1 receptor agonists (GLP-1 RAs). On the basis of current evidence, practice guidelines from 'Kidney Disease: Improving Global Outcomes (KDIGO 2024)' recommend the use of SGLT2i for patients with estimated glomerular filtration rate (eGFR) >20 mL/min/1.73 m[2]. The 2025 guidelines from the American Diabetes Association (ADA) also recommend SGLT2i for people with T2D and CKD (eGFR ≥20 mL/min/1.73 m[2]) to reduce the risk of CKD progression and cardiovascular events. At present, finerenone is the only nonsteroidal MRA with evidence of cardiovascular and renal benefits in patients with CKD and T2D, and the use of this agent is recommended for patients with T2D at high risk of CKD progression and cardiovascular events. Cardiorenal protective effects have been observed with GLP-1 RAs. The ADA recommends a GLP-1 RA with demonstrated benefit in reducing cardiovascular risk and kidney disease progression for patients with CKD and T2D. A combination of SGLT2i, GLP-1 RAs, and nonsteroidal MRA may be considered for management of patients with CKD and T2D. Overall, a holistic, multidisciplinary approach to the care of people with CKD is recommended. This may involve multiple disease specialists, including cardiologists, nephrologists, endocrinologists, primary care physicians, and other healthcare professionals in the medical team. Clinicians have a key role in ensuring the implementation of evidence-based therapies for patients with CKD, with the ultimate aim of slowing progression of CKD, reducing metabolic complications, and improving cardiovascular outcomes.

Alismatis Rhizoma is a traditional Chinese medicinal herb widely used for diuretic and dampness-eliminating purposes, and its active triterpenoid component Alisol A (AA) has been reported to exert cytotoxic effects on human renal tubular epithelial cells. The present study aimed to evaluate the nephrotoxic effects of AA on renal tubular cells in vivo and further explore the underlying molecular mechanisms. In this study, eight-week-old C57BL/6J mice were intraperitoneally injected with 20 or 40 mg/kg AA for four consecutive days, with DMSO as the vehicle control, and renal function, biochemical indexes, histological morphology and molecular alterations were comprehensively examined. Western blotting and immunohistochemistry were used to detect the expression of key proteins involved in renal injury, while in vitro cell experiments were performed to further verify AA-induced nephrotoxicity and the potential involvement of the ERK signaling pathway. The results demonstrated that AA treatment markedly impaired renal function, increased tubular cell apoptosis, induced oxidative stress, and triggered renal inflammatory responses in mice. Both in vivo and in vitro evidence indicated that AA-induced renal tubular injury was closely associated with elevated ERK phosphorylation. Consistently, activated ERK signaling was accompanied by upregulated pro-apoptotic Bax and cleaved caspase-3, as well as decreased anti-apoptotic Bcl-2, and pharmacological inhibition of ERK effectively alleviated AA-mediated tubular cell damage. Collectively, these findings suggest that ERK pathway activation and subsequent renal apoptosis contribute to AA-related nephrotoxicity, revealing a potential safety risk of AA and providing experimental evidence for the rational clinical application and quality control of Alismatis Rhizoma.

Previous studies have documented higher medication consumption among females than males; however contemporary sex-based differences across age and therapeutic classes remain poorly characterized.