Editorial: Balancing act: exploring the impact of steroid hormones, diets/supplements, and new drugs on renal function

In this special edition, we have gathered articles that address various aspects of renal pathophysiology, with a strong emphasis on personalized approaches to both risk assessment and treatment.Sex steroids have been widely used as an essential tool in gender-affirming therapy (GAT). However, few studies have evaluated the impact of GAT on renal function. In the study by Lichtenecker et al. 2025, the role that sex hormones play in renal function when administered as GAT, mimicking the condition of transgender people, was studied. In this study, GAT impacts renal function differently in male and female rats. Females treated with testosterone showed increased expression of sodium transporters and reduced sodium excretion, which may predispose them to hypertension. On the other hand, in males, the combination of estradiol used decreased glomerular filtration rate, suggesting a maladaptive response. Considering that the incidence of chronic kidney disease is increasing, including in transgender patients (Collister et al. 2021), the Lichtenecker study provides valuable translational evidence, indicating that GAT can lead to adaptive functional changes that may affect the Higher physical activity appeared to reduce risk, especially among those with MUO. Overall, obesity itself emerged as a key factor linked to kidney stone history.Expanding the discussion on metabolic influences in kidney-related disorders, the study by Chen and Yin (2025) investigates the relationship between blood urea nitrogen (BUN) and the risk of hyperuricemia (HUA) in U.S. adults, with particular attention to sex differences. Using NHANES data from 1999 to 2020, the authors report that higher BUN levels are associated with an increased risk of HUA in the general adult population; however, the association may be stronger in females than in males. This disparity may stem from physiological differences, including the influence of sex hormones on uric acid metabolism and variations in renal clearance. The study underscores the importance of considering sex-specific factors in the diagnosis and management of conditions such as gout and KD, supporting a more individualized approach to care. Given the growing prevalence of these disorders, the findings highlight the need for targeted strategies that address risk factors differently in men and women.Turning to the molecular signaling pathways within the nephron, the Together, these six studies emphasize the multifaceted metabolic underpinnings of KD-from obesity and sex-specific metabolic variation to molecular signaling pathways within the nephron. They collectively highlight the importance of integrated, personalized approaches in understanding KD risk and improving therapeutic strategies.