Autosomal dominant Alport syndrome is a genetic kidney condition that can also affect hearing and vision. Many people first hear about Autosomal dominant Alport syndrome when a routine urine test shows blood or protein. It often causes persistent blood in the urine, gradual kidney problems, and hearing loss that usually starts in late childhood or adulthood. It is lifelong, and severity varies, but many people with Autosomal dominant Alport syndrome maintain kidney function for years with monitoring and treatment. Care focuses on blood pressure control, ACE inhibitors or ARBs, hearing support, and eye care, and some may eventually need dialysis or a kidney transplant.
Overview
Autosomal dominant alport syndromeSymptoms
Autosomal dominant Alport syndrome often starts with urine changes—tea- or cola-colored urine or foamy urine from protein. Over time, many develop gradual hearing loss and sometimes vision problems. Some progress to kidney trouble with swelling, fatigue, and high blood pressure.
Outlook and prognosis
Many people with autosomal dominant Alport syndrome keep stable kidney function for years, with gradual changes that doctors monitor. Hearing loss, if it appears, often develops in adulthood and can be managed with aids. Regular kidney checks, blood‑pressure control, and early treatment help preserve health.
Causes and risk factors
Autosomal dominant Alport syndrome stems from one altered type IV collagen gene, inherited or new. Early symptoms of Autosomal dominant Alport syndrome aside, main risk is family history; severity worsens with hypertension, kidney-harming medicines, smoking, or noise.
Genetic influences
Genetics are central in autosomal dominant Alport syndrome. A single altered COL4A3 or COL4A4 gene copy can cause disease, and severity varies with the specific variant. Family history strongly guides risk, and genetic testing supports diagnosis, monitoring, and counseling.
Diagnosis
Autosomal dominant Alport syndrome is diagnosed by clinical features, family history, and confirmed genetic tests. Kidney biopsy, plus eye and hearing exams, may support the diagnosis of Autosomal dominant Alport syndrome.
Treatment and drugs
Treatment for autosomal dominant Alport syndrome focuses on protecting kidney function, hearing, and eye health. Doctors often use ACE inhibitors or ARBs to reduce urine protein and slow kidney changes, alongside regular hearing and vision checks. When kidneys weaken, care may include diet changes, blood pressure control, and, if needed, dialysis or a transplant.
Symptoms
Changes often start in the kidneys, showing up as urine that looks darker or foamy, or as rising blood pressure. Early features of Autosomal dominant alport syndrome often include persistent microscopic blood in the urine and, later, protein in the urine. Features vary from person to person and can change over time. Some people also develop gradual hearing loss and, less often, subtle eye findings.
Many people have persistent blood in the urine that’s too small to see without a test. You may notice cola- or tea-colored urine during a cold or after hard exercise. This is common in Autosomal dominant alport syndrome.
Protein leaking into the urine can make it look bubbly or frothy. This often starts after the blood-in-urine pattern and is a sign the kidney filter is under strain.
As the kidneys work harder, blood pressure can creep up. Some feel headaches, fatigue, or nosebleeds, while others have no warning signs.
Over years, some develop chronic kidney disease with tiredness, ankle swelling, or needing to urinate at night. In Autosomal dominant alport syndrome, this often progresses more slowly than in other forms, but monitoring is important.
How people usually first notice Autosomal dominant alport syndrome?
Many families first notice autosomal dominant Alport syndrome through blood or protein found on a routine urine test, often during a school physical or pregnancy visit, even when the person feels well. Over time, some develop early signs like hearing difficulty for high-pitched sounds or ringing in the ears, and a few may have gradual vision changes related to the eye’s lens or retina. Doctors often connect these clues with a family pattern of kidney issues or hearing loss, which helps identify the first signs of autosomal dominant Alport syndrome.
Types of Autosomal dominant alport syndrome
Autosomal dominant Alport syndrome has a few recognized clinical variants that differ mainly in how early hearing or eye issues appear and how quickly kidney problems progress. These variants tie back to differences in the COL4A3 or COL4A4 gene and, in some families, specific mutation types. People with the same variant can still experience a wide range of severity. Not everyone will experience every type.
Classic dominant type
Kidney changes often start with blood in the urine in childhood or teens, while kidney function can stay stable for many years. Hearing loss, if it happens, usually appears in adulthood and tends to be milder than in other forms.
Late-onset kidney-predominant
Kidney function may be normal into midlife, then gradually declines later. Hearing and eye findings are uncommon or very mild in this pattern.
Hearing-predominant variant
Hearing loss can show up first, typically in the high pitches, with only subtle or slow-moving kidney changes for many years. Daily life often makes the differences between symptom types clearer.
Eye-involved variant
Certain eye features, like a change in the front curve of the lens or a dot-and-fleck pattern in the retina, may be noticed on eye exam. Kidney issues are still the core feature, but eye signs can help confirm the diagnosis.
Family-specific variants
Some families share a specific COL4A3 or COL4A4 change linked to a predictable course, such as later kidney decline or milder hearing changes. Researchers describe these categories to better understand patterns of the condition.
What genetics can tell you about symptoms
Some people with autosomal dominant Alport syndrome who inherit certain COL4A3 or COL4A4 changes notice blood in the urine early and gradual hearing loss later. Specific variants can weaken kidney filters and the inner ear’s support mesh, linking to proteinuria, high blood pressure, and progressive kidney disease.
Causes and risk factors
The main cause is a change in a collagen gene called COL4A3 or COL4A4.
This change may be inherited in an autosomal dominant way, or it can occur as a new change.
Each child of a parent with autosomal dominant Alport syndrome has a 50% chance to inherit the gene change.
Some risks are written in our DNA, passed down through families.
Risk factors for autosomal dominant Alport syndrome getting worse include high blood pressure, smoking, a high-salt diet, regular use of painkillers like ibuprofen or naproxen, and long, loud noise exposure.
Environmental and biological risk factors
People planning a pregnancy or thinking ahead for their family often ask what might raise the chance of Autosomal dominant Alport syndrome occurring. Before thinking about early symptoms of Autosomal dominant Alport syndrome, it helps to understand the internal and external factors that can influence baseline risk. Doctors often group risks into internal (biological) and external (environmental). Below are factors that can shift the odds slightly, along with what they mean in everyday terms.
As men get older, the number of new DNA changes in sperm rises. This slightly increases the chance of a first-time change that could result in Autosomal dominant Alport syndrome. For any single pregnancy, the absolute risk remains low.
Significant ionizing radiation to the ovaries or testes before conception can increase new DNA changes in reproductive cells. This includes high-dose therapeutic radiation or substantial occupational/accidental exposure, not routine X-rays or airport scanners. Any added risk for Autosomal dominant Alport syndrome is considered small.
Some cancer treatments that damage DNA can raise the rate of new changes in eggs or sperm for a period after treatment. Timing, medicine type, and recovery all influence this effect. Many people conceive safely after medical guidance on when it’s appropriate.
Genetic risk factors
Genetic changes in collagen genes that support the kidney filter are the main driver of Autosomal dominant alport syndrome. Most people have a single harmful change in COL4A3 or COL4A4 inherited from a parent, giving a 50% chance of passing it to each child. Carrying a genetic change doesn’t guarantee the condition will appear, and severity can vary widely even within one family. In some families the change starts for the first time, so a clear family history may be missing.
COL4A3 variants: A single harmful change in the COL4A3 gene can cause the autosomal dominant form. This gene helps build a key type of collagen in the kidney filter.
COL4A4 variants: A single COL4A4 change can lead to the same condition. It disrupts the same collagen network in kidneys, and sometimes affects ears and eyes.
Dominant inheritance: When a parent carries a COL4A3 or COL4A4 variant, each child has a 50% chance to inherit it. The chance is the same for boys and girls.
First-in-family changes: Some people are the first in their family with the variant due to a new (de novo) change. Parents may test negative, but the person can still pass it to their children.
Variable expression: Features and timing can differ widely even with the same variant. One relative may only have microscopic blood in the urine, while another develops kidney or hearing problems.
Reduced penetrance: Not everyone who inherits the variant shows clear signs. This can make a family history look quiet despite a real genetic risk.
Parental mosaicism: A parent can carry the variant in a fraction of their egg or sperm cells only. This raises the chance of another affected child even when the parent’s blood test is negative.
Variant type matters: The exact genetic change and where it sits in the gene can influence severity. Certain changes are linked to earlier kidney scarring or hearing involvement.
Family history clues: Relatives with long-standing blood in the urine, kidney disease, or high-tone hearing loss can point to the gene running in the family. Noticing early symptoms of Autosomal dominant alport syndrome across generations can help map who may be at higher genetic risk.
Lifestyle risk factors
Autosomal dominant Alport syndrome is a genetic condition; lifestyle habits do not cause it, but they can influence kidney and hearing outcomes over time. Focusing on blood pressure, kidney stressors, and hearing protection can meaningfully affect symptoms and complications. The following addresses lifestyle risk factors for Autosomal dominant Alport syndrome to help guide everyday choices. This is not a cure, but it can help slow progression and protect quality of life.
Excess salt raises blood pressure and can increase proteinuria, both of which strain the glomerular basement membrane affected in Alport syndrome. Lower-salt eating patterns may help slow kidney function decline.
Very high protein intake can increase intraglomerular pressure and worsen protein leakage in urine. Moderating protein to clinician-recommended levels may reduce kidney workload in Alport syndrome.
Frequent use of NSAIDs like ibuprofen can reduce kidney blood flow and trigger acute kidney injury. Choosing alternative pain strategies and using NSAIDs only under medical advice can help protect kidney function.
Smoking accelerates chronic kidney disease progression and raises cardiovascular risks that accompany kidney impairment. Quitting can help preserve kidney function and reduce complications in Alport syndrome.
Risk prevention
Autosomal dominant Alport syndrome can’t be prevented at its root, but you can lower the chance of complications and slow kidney, hearing, and eye problems. Prevention works best when combined with regular check-ups. Knowing early symptoms of autosomal dominant Alport syndrome, such as blood in the urine or subtle hearing changes, can prompt earlier care. Partner with your care team to tailor steps to your age, health, and family plans.
Routine urine and blood tests can spot blood, protein, or rising creatinine early. Seeing a kidney specialist and getting hearing and eye checks on a schedule helps catch changes before they advance.
Keeping blood pressure in a healthy range protects the kidneys and the heart. Home checks and clinic visits help you and your team adjust treatment in time.
Medicines that relax blood vessels in the kidneys, such as ACE inhibitors or ARBs, can lower protein loss in urine and slow damage. Your clinician may start them even with normal blood pressure if urine protein is present.
Limit or avoid NSAID pain relievers like ibuprofen unless your doctor says otherwise. Tell providers about Alport syndrome before imaging so contrast dyes can be used carefully or alternatives considered.
Transmission
Autosomal dominant Alport syndrome is not contagious; it doesn’t spread through contact, air, food, or blood. It’s passed through families when a person inherits one altered copy of a gene from a parent with the condition, so each child has a 50% chance of inheriting it. This pattern—how Autosomal dominant Alport syndrome is inherited—affects people of all sexes equally, and only one parent needs to carry the change. In some families, the condition appears for the first time due to a new genetic change, and rarely a parent may have very mild signs despite carrying the change.
When to test your genes
Consider genetic testing if you have persistent blood in urine, early hearing loss, or a family history of Alport syndrome, kidney disease, or hearing/eye problems. Test before pregnancy or if planning children to clarify inheritance and options. People with unexplained kidney findings or thin basement membrane signs also benefit.
Diagnosis
People with autosomal dominant Alport syndrome are often first flagged by persistent blood in the urine found on a routine check or after a family member is diagnosed. Diagnosis focuses on patterns seen in kidney, hearing, and eye health, then confirms the cause with targeted tests. Genetic testing may be offered to clarify risk or guide treatment. In many families, the genetic diagnosis of Autosomal dominant alport syndrome is confirmed by finding a change in the COL4A3 or COL4A4 gene.
A detailed family and health history can help connect scattered clues like long‑standing microscopic blood in urine across relatives. This pattern supports a hereditary cause and guides which tests come next.
A simple urinalysis looks for microscopic blood and measures protein. Repeating the test helps confirm it’s persistent and not due to infection or exercise.
Blood tests check creatinine and estimate kidney filtration (eGFR). Results show how well the kidneys are working and provide a baseline for future comparison.
Audiometry checks for early high‑frequency hearing changes, which can occur in Alport syndromes. Finding a characteristic pattern can support the suspected diagnosis.
Stages of Autosomal dominant alport syndrome
Autosomal dominant alport syndrome does not have defined progression stages. The course varies from person to person and is usually tracked by changes in urine findings, protein levels, blood pressure, and overall kidney function rather than by set disease “phases.” Different tests may be suggested to help confirm the diagnosis and follow kidney, hearing, and eye health over time. Doctors typically use urine and blood tests, hearing checks, eye exams, and sometimes genetic testing to confirm a COL4A3 or COL4A4 gene change; early symptoms of autosomal dominant alport syndrome often include persistent microscopic blood in the urine before any drop in kidney function.
Outlook and prognosis
Many people ask, “What does this mean for my future?”, and the answer with Autosomal dominant Alport syndrome depends on your age, kidney health, and any hearing or eye changes so far. The outlook is not the same for everyone, but many people with the autosomal dominant form have mild to moderate kidney issues that progress slowly over decades. Some notice blood in the urine from childhood, while others only learn about the condition after a routine test as an adult. Early care can make a real difference, especially if blood pressure is controlled and kidney-protective medicines are started promptly.
Doctors call this the prognosis—a medical word for likely outcomes. In this form of Alport syndrome, the risk of reaching kidney failure is lower and later than in the X-linked type; many never need dialysis or a transplant. Hearing changes, like trouble catching higher-pitched sounds, may appear in mid-adulthood and can be managed with hearing aids. Eye findings are usually subtle and rarely threaten vision. When thinking about the future, it helps to know the early symptoms of Autosomal dominant Alport syndrome often center on persistent microscopic blood in the urine, with protein showing up later if kidney scarring progresses.
Mortality is generally similar to the general population when kidney disease is mild and blood pressure is well controlled; higher risks mainly come from advanced kidney failure and its complications. With ongoing care, many people maintain stable kidney function for years and continue full work, family, and exercise routines. Genetic testing can sometimes provide more insight into prognosis, especially if other relatives had early kidney problems. Talk with your doctor about what your personal outlook might look like, including hearing and eye screening schedules and the best timing to start kidney-protective treatments.
Long-term effects
For many living with Autosomal dominant Alport syndrome, the day-to-day impact starts small and unfolds slowly over years. You may feel well for a long time, even as quiet changes appear in urine tests or blood pressure checks. Long-term effects vary widely, with some people staying stable for decades and others developing kidney or hearing issues later in adulthood. Doctors may track these changes over years to see patterns and plan care.
Microscopic blood in the urine is common and often starts in childhood. Early symptoms of Autosomal dominant alport syndrome may be limited to persistent blood on urine tests without pain.
Protein can gradually leak into urine as the kidney filters become less selective. This change often appears in adolescence or adulthood and can signal higher kidney risk ahead.
Some people with Autosomal dominant alport syndrome develop chronic kidney disease over time. Kidney failure, if it occurs, is more likely in mid- to later adulthood and is less common than in other Alport types.
Blood pressure may climb as kidney changes progress. This can add strain on the heart and blood vessels over the long term.
How is it to live with Autosomal dominant alport syndrome?
Living with autosomal dominant Alport syndrome often means normal day-to-day life with a few steady watchpoints: regular hearing checks, blood and urine tests to track kidney health, and protecting the ears from loud noise that can speed hearing loss. Some notice gradual hearing changes in adolescence or adulthood and occasional blood in the urine without symptoms, while others go for years with only lab abnormalities; planning ahead—hydration, blood pressure control, and following kidney-safe medication advice—helps preserve function. Family members may feel the ripple effects, from accompanying clinic visits to considering their own testing, but many find that sharing information early and building simple routines—like annual screenings—reduces anxiety and keeps everyone on the same page.
Treatment and drugs
Treatment for autosomal dominant Alport syndrome focuses on protecting kidney function, managing hearing or eye issues if they arise, and monitoring for changes over time. Many people start blood pressure–lowering medicines called ACE inhibitors or ARBs early, even if their blood pressure is normal, because these drugs can reduce protein loss in urine and slow kidney damage. Doctors also often recommend salt restriction, staying well hydrated, avoiding tobacco, and using kidney-safe pain relievers; your doctor can help weigh the pros and cons of each option. Regular check-ins typically include urine and blood tests, blood pressure checks, and hearing and eye evaluations, with referrals to audiology or ophthalmology if needed. If kidney function declines significantly, options may include more intensive medicines, clinical trials where available, and—if advanced kidney failure develops—dialysis or kidney transplant.
Non-drug treatment
Living with Autosomal dominant alport syndrome often means protecting kidney function while caring for hearing and vision over time. Beyond prescriptions, supportive therapies can help you build daily habits that steady blood pressure, reduce kidney strain, and spot changes early. Noticing early symptoms of Autosomal dominant alport syndrome—like persistent blood in the urine or new difficulty following conversations in noise—can help you seek timely checks. Close follow-up with kidney, hearing, and eye specialists helps you adjust routines as your needs change.
Emphasize whole foods with plenty of fruits and vegetables and moderate protein portions. A registered dietitian can tailor meals to protect kidney function and fit your preferences.
Limiting salty snacks and processed foods can lower blood pressure and ease kidney stress. Aim to cook more at home and taste food before adding salt.
Drink steady amounts of water unless your clinician advises a restriction. Avoid dehydration and very high-protein shakes that can strain the kidneys.
Pain relievers like ibuprofen or naproxen can stress the kidneys. Ask about safer options for pain and fever when needed.
Your genes may have an impact on how drugs work for you
Two people can take the same Alport syndrome medicine and respond differently because gene variants affect how quickly the body activates, transports, or clears a drug. Pharmacogenetic testing can sometimes guide dose choices or alternative options to improve safety and benefit.
Pharmacological treatments
Treatment focuses on protecting kidney function, lowering urine protein, and managing complications that can develop over time. Some people start kidney-protective drugs when there’s only mild urine protein, sometimes before noticeable early symptoms of autosomal dominant Alport syndrome. Not everyone responds to the same medication in the same way. Your care team will tailor choices and doses to blood pressure, kidney labs, and side effects.
Ramipril, lisinopril, or enalapril lower pressure inside the kidney filters and reduce protein in the urine. They’re often started early to slow kidney damage and are usually the backbone of treatment. Cough can occur with this group.
Losartan, valsartan, or irbesartan offer similar kidney protection and are used if ACE inhibitors aren’t tolerated or as an alternative. They also reduce urine protein and help control blood pressure. Blood tests check potassium and kidney function.
Dapagliflozin or empagliflozin can further reduce protein loss in urine and may slow kidney decline, even in people without diabetes. These are add-on medicines to standard therapy. Your clinician will review risks like genital yeast infections.
Amlodipine can help reach blood pressure targets when ACE inhibitors or ARBs alone aren’t enough. It lowers blood pressure but doesn’t directly reduce urine protein. Swelling in the ankles can occur.
Genetic influences
In autosomal dominant Alport syndrome, a single change in one copy of a collagen gene that helps build the kidneys’ filters (usually COL4A3 or COL4A4) is enough to cause the condition. Family history is one of the strongest clues to a genetic influence. Because this inheritance is “autosomal dominant,” an affected parent has a 50% (1 in 2) chance of passing the gene change to each child, regardless of sex. The same gene change can affect relatives differently, so some may have mild kidney findings while others develop more serious issues over time. Less commonly, the change arises for the first time in a child, even when both parents test negative. Genetic testing for autosomal dominant Alport syndrome can confirm the gene involved and help clarify risks for siblings and future pregnancies.
Is Autosomal dominant alport syndrome genetic?
Genetics are central in autosomal dominant Alport syndrome. A single altered COL4A3 or COL4A4 gene copy can cause disease, and severity varies with the specific variant. Family history strongly guides risk, and genetic testing supports diagnosis, monitoring, and counseling.
Pharmacogenetics—how genetics influence drug effects
In Autosomal dominant Alport syndrome, treatment choices often center on protecting kidney function and hearing, and your genetic result helps guide timing and caution with certain medicines. When genetic testing for autosomal dominant Alport syndrome confirms a change in a collagen IV gene, doctors often start kidney-protective medicines—such as ACE inhibitors or ARBs—earlier to lower urine protein and slow kidney damage. It also alerts your team to avoid or use extra caution with drugs that can stress the kidneys or ears, including frequent high-dose NSAIDs and certain antibiotics called aminoglycosides. Genetic testing can sometimes identify how your body handles specific medicines, which may help tailor doses for drugs like some statins, codeine-like pain medicines, or warfarin if you ever need them. That said, your Alport gene change itself generally does not determine which ACE inhibitor or ARB is chosen, and pharmacogenetic dosing for these medicines isn’t standard today. As new therapies that act on the collagen pathway emerge, your genetic diagnosis may help determine eligibility for trials and specialized care, but right now it mainly supports earlier treatment and safer prescribing.
Interactions with other conditions
Living with Autosomal dominant Alport syndrome alongside high blood pressure or diabetes can put extra strain on the kidneys, often raising protein in the urine and speeding kidney decline if not well controlled. Doctors call it a “comorbidity” when two conditions occur together. Early symptoms of Autosomal dominant Alport syndrome, like ongoing microscopic blood in the urine, can be mistaken for or overlap with IgA nephropathy or what many families know as thin basement membrane disease; in some families these conditions cluster because of changes in the same collagen genes. People previously labeled with focal segmental glomerulosclerosis (FSGS) may also turn out to have a COL4-related condition, which affects treatment choices and family screening. During pregnancy, complications such as preeclampsia (pregnancy-related high blood pressure and protein in the urine) can further stress the kidneys in those with Autosomal dominant Alport syndrome, so close monitoring is important. Hearing loss from the condition can make ear infections or other ear problems feel more disruptive day-to-day, but these do not typically change the course of kidney disease when managed promptly.
How genes can cause diseases
Humans have more than 20,000 genes, each carrying out one or a few specific functions in the body. One gene instructs the body to digest lactose from milk, another tells the body how to build strong bones and another prevents the body's cells from beginning to multiply uncontrollably and developing into cancer. As all of these genes combined are the building instructions for our body, a defect in one of these genes can have severe health consequences.
Through decades of genetic research, we know the genetic code of any healthy/functional human gene. We have also identified that in certain positions on a gene, some individuals may have a different genetic letter from the one you have. We call these hotspots "Genetic Variations" or "Variants" in short. In many cases, studies have been able to show that having the genetic letter "G" in the position makes you healthy, but having the letter "A" in the same position disrupts the gene function and causes a disease. Genopedia allows you to view these variants in genes and summarizes all that we know from scientific research, which genetic letters (Genotype) have good or bad consequences on your health or on your traits.
History
Throughout history, people have described families in which several relatives developed hearing troubles in youth, eye changes, and, years later, kidney failure. Generations remembered relatives with blood in the urine that doctors couldn’t explain, long before modern testing tied these clues together. Early hospital notes focused on the kidney findings alone; only after careful family tracing did patterns of hearing loss and eye findings emerge as part of the same condition.
From early theories to modern research, the story of autosomal dominant Alport syndrome shows how careful observation leads to clearer answers. In the early 20th century, reports of “hereditary nephritis” grouped many kidney problems together. Some families seemed to pass the condition from fathers to sons, others from either parent to a child. This mix caused confusion. As more detailed family trees were drawn, clinicians recognized that similar symptoms could follow different inheritance paths, including an autosomal dominant form where one changed copy of a gene from either parent was enough to raise risk.
With each decade, doctors added pieces. Hearing tests documented the typical high‑frequency loss that might start in the teens or adulthood. Eye exams noted anterior lenticonus and dot‑and‑fleck changes, features that can help confirm the diagnosis. Kidney biopsy techniques improved, revealing a distinctive thinning and splitting of the filtering membrane in some people with autosomal dominant Alport syndrome, even when urine changes were mild.
Advances in genetics in the late 20th and early 21st centuries clarified the picture. Researchers linked Alport syndromes to changes in collagen genes that help build the kidney’s filtering membrane, and DNA research now explains why some families follow an autosomal dominant pattern. This genetic work also showed why symptoms vary: the specific change in the gene can act like a dimmer switch, altering how much the collagen network is weakened, which influences when hearing or kidney issues begin.
Over time, descriptions became more precise, and the autosomal dominant form, once overshadowed by the X‑linked form, gained recognition as a distinct type. This shift mattered for families. It explained why men and women could be affected similarly in some family lines, why onset could be later, and why close relatives might have milder or more severe features.
Today, the history of autosomal dominant Alport syndrome continues to shape care. Knowing the condition’s history helps clinicians ask the right questions about family patterns, order focused hearing and eye exams, and use genetic testing thoughtfully. For many living with this condition, that long arc—from scattered observations to gene‑level insight—has opened doors to earlier diagnosis, clearer counseling, and plans to protect kidney and hearing health over time.