Nature study: Estrogen protects the kidneys – research from Dresden and Heidelberg proves the relevance of gender-specific medicine for understanding disease and therapy

The number of people suffering from kidney disease is rising worldwide. According to estimates by the World Health Organization (WHO), kidney disease will be one of the five leading causes of death by 2050. Kidney disease often goes undetected for a long time, meaning that damage is already at a critical stage and usually irreversible by the time it is noticed. As its basic mechanisms are not yet fully understood, more research is essential to improve our understanding of the disease and enable its successful prevention and early detection. A research team with scientists from Dresden and Heidelberg, alongside their international partners, has now identified new mechanisms that explain why kidney damage differs significantly between women and men. These findings are attributable to the effect of the hormone estrogen. The study, entitled “Multiple oestradiol functions inhibit ferroptosis and acute kidney injury,” has now been published in the renowned journal Nature. 

One of the main causes of acute kidney damage is ferroptosis, also known as “biological rust.” This process causes the loss of nephrons, which are the functional units of the kidney. In the study, the research team led by Prof. Andreas Linkermann, who works at the Medical Clinic III (MK III) at Dresden University Hospital (UKD) and is director of the V. Medical Clinic at Mannheim University Medical Center, and Prof. Stefan Bornstein, director of MK III at UKD, demonstrated that the female reproductive hormone estrogen protects the kidneys in many ways against damage caused by ferroptosis.

“Recently, it has become increasingly clear that the mechanisms of kidney damage are different in female and male individuals,” explains Dr. Wulf Tonnus, one of the three lead authors of this study and an early-career researcher at MK III. “It turned out that estradiol, a hormone from the estrogen group, increases resistance to ferroptosis. The body's own metabolites of estradiol directly intercept harmful radicals, while the original hormone activates a complex genetic program to prevent ferroptosis.”

These findings once again show how important reproductive hormones are for all sorts of processes in the body. Getting a better fundamental understanding of how they work will also help develop better treatments for people with kidney disease in the long run. Overall, understanding diseases in a gender-specific way is a big step toward personalized approaches and more gender equality in medicine.

“This study is a major scientific success. The fact that young clinical scientists have achieved this alongside renowned scientists underscores the excellent research environment offered by the Faculty of Medicine at TUD Dresden University of Technology and the Medical Clinic and Polyclinic 3,” explains Prof. Esther Troost, Dean of the Faculty of Medicine. 

“The new findings give us the opportunity to treat kidney disease in a more targeted manner in the future. At Dresden University Hospital, we can develop new, individually tailored therapies so that kidney disease can be detected early on and treated effectively—for better health and quality of life,” adds Prof. Uwe Platzbecker, Medical Director of the University Hospital. 

Publication: “Multiple oestradiol functions inhibit ferroptosis and acute kidney injury” (DOI 10.1038/s41586-025-09389-x): https://www.nature.com/articles/s41586-025-09389-x.
Accompanying editorial “news and views”: https://doi.org/10.1038/d41586-025-02422-z

Background:
The research project was funded in particular by the German Research Foundation (DFG): https://gepris.dfg.de/gepris/projekt/522190184. Numerous other support programs were added to it.

Contact:
Anne-Stephanie Vetter
Staff Unit Public Relations of the Carl Gustav Carus Faculty of Medicine
at TUD Dresden University of Technology
Tel.: +49 351 458 17903
Email:
https://tu-dresden.de/med?set_language=en

Academic contacts:
Prof. Dr. Andreas Linkermann, FASN
Director of Medical Clinic V – Nephrology/Hypertension/Transplant Medicine
Endocrinology/Diabetology/Lipidology/Rheumatology/Pneumology
Specialist in internal medicine, nephrologist, transplant physician
Visiting Professor at Albert Einstein College of Medicine – Department of Nephrology Faculty of Medicine at Heidelberg University
University Medical Center Mannheim GmbH
+49 621 383 3660

Dr. med. Wulf Tonnus
Specialist in internal medicine and nephrology
Junior Group Leader // Senior Physician
Nephrology Section – Medical Clinic and Polyclinic III
Carl Gustav Carus University Hospital
at TUD Dresden University of Technology
+49 351 458 19520