About

Alexander Smith is a mathematician specializing in number theory, with a particular focus on the distribution of Selmer groups in twist families and their applications to major conjectures such as the Cohen-Lenstra-Gerth heuristics and Goldfeld's conjecture. He is recognized for his significant contributions to understanding the behavior of \( \ell^\infty \) Selmer groups in degree \( \ell \) twist families, work that has been accepted for publication in the Journal of the American Mathematical Society. His research also explores the connections between Selmer groups, class groups, and conjectures in arithmetic geometry, including the Birch and Swinnerton-Dyer conjecture and its implications for Goldfeld's conjecture. Smith has collaborated with other mathematicians on topics such as the Cassels-Tate pairing for finite Galois modules and the distribution of congruent numbers, demonstrating a broad engagement with deep problems in algebraic number theory and arithmetic statistics. Beyond Selmer groups, Smith's research extends to problems involving algebraic integers and abelian varieties, including the distribution of algebraic integers with prescribed conjugate distributions and the construction of abelian varieties of prescribed order over finite fields. His work has appeared in prestigious journals such as the Annals of Mathematics and Mathematics of Computation. Additionally, he has contributed to the study of the Schur-Siegel-Smyth trace problem and has ongoing projects related to lattice points near hypersurfaces and applications of the Chebotarev density theorem. Smith's early work includes collaborations on geometric and representation-theoretic problems, reflecting a diverse mathematical background.

Research topics

• Artificial Intelligence
• Internal medicine
• Computer Science
• Medicine
• Urology
• Pathology
• Radiology
• World Wide Web
• Biology

Selected publications

• IP15-05 FROM IPSS TO LURN SI-10: EMPIRIC CUTOFFS ALIGNING MILD/MODERATE/SEVERE BPH SYMPTOMS USING 6,382 SAME-DAY ASSESSMENTS

  The Journal of Urology · 2026-04-27

  articleSenior author
  PublisherDOI

• New Index Demonstrates Association between Social Vulnerability, Environmental Burden, and Kidney Failure Risk among Individuals with Glomerular Disease.

  UNC Libraries · 2026-01-18

  articleOpen access1st authorCorresponding

  BACKGROUND: The Centers for Disease Control and Prevention (CDC) Environmental Justice Index Social-Environmental Ranking (EJI-SER) combines a Social Vulnerability Module (SV) with an Environmental Burden Module (EB) to characterize cumulative environmental and social burden at the census tract level. This analysis evaluates the association between EJI-SER and kidney outcomes in glomerular disease (GD) patients. METHODS: Cure Glomerulopathy (CureGN) is an observational cohort study of adults and children with biopsy-proven GD. EJI-SER is a percentile ranking by census tract, with a higher score indicating a more severe burden. Associations between EJI-SER and its components with kidney failure (initiation of kidney replacement therapy, transplant, or two estimated glomerular filtration rates [eGFRs] <15ml/min/1.73m2) and longitudinal eGFR were tested using multivariable Cox regression and linear mixed models, respectively, adjusted for demographics, histologic diagnosis, eGFR and urine protein to creatinine ratio at enrollment, and time from biopsy to enrollment. RESULTS: Among 1,149 participants with census tract data, the median (IQR) follow-up was 5.4 (3.0-7.0) years, the median (IQR) age at biopsy was 24 (10-48), and self-identified racial distribution was 5% Asian, 18% Black, and 70% White. Median (IQR) EJI-SER was 0.49 (0.26-0.75). EJI-SER scores in the lowest two quartiles were associated with a lower hazard of kidney failure compared to the highest quartile (adjusted HR [95% CI] 0.62 [0.36-1.08] and 0.43 [0.25-0.76] for EJI-SER 0-25% and >25-50% vs. >75%, respectively) and higher eGFR at enrolllment (adjusted mean 90.1 vs. 87.1 ml/min/1.73m2 for 0-25% vs. >75%, p=0.08). CONCLUSION: As captured by EJI-SER, higher environmental and social burdens are associated with lower eGFR and a higher risk of kidney failure in the CureGN cohort. This first use of the EJI-SER in GD demonstrates the need for additional investigation into social drivers of disparities in GD and policies and resources that address these structural inequities.

  PublisherDOI

• Text Messaging for Longitudinal Data Collection From Adults With Glomerular Disease: Lessons From the Cure Glomerulonephropathy Network

  Kidney Medicine · 2026-03-13

  articleOpen access

  Rationale & Objective: Mobile health technologies such as text messaging have been used to support self-management in chronic disease. This study sought to understand the use of and responsiveness to text messaging for data collection in an international longitudinal observational study. Study Design: A longitudinal text messaging program was administered in the Cure Glomerulonephropathy Network, an observational cohort study of primary glomerulonephropathies. Consented participants were sent monthly texts querying symptoms, medication adherence, relapses, or remissions. Participants responded via text. Setting & Participants: Adults enrolled in the Cure Glomerulonephropathy Network from October 23, 2020, to April 30, 2024, participated remotely via text messaging. Predictors: Age, histologic diagnosis, months since diagnosis using kidney biopsy, education level, and English as the primary language. Outcome: Program reach (proportion who did not opt out), response rate, and ongoing engagement were assessed. Analytical Approach: Multivariable logistic regression models were fitted to assess associations between responsiveness to text and participant characteristics. Results: < 0.001). Limitations: Unable to determine reasons for nonresponse to text messaging. Conclusions: Although text messaging does not require a smartphone and may reduce some barriers to research participation, we found that more vulnerable and older patients were less likely to respond. Additional efforts are needed to support targeted engagement with these participants to ensure that data collection overall remains equitable.

  PublisherOA PDFDOI

• New Index Demonstrates Association between Social Vulnerability, Environmental Burden, and Kidney Failure Risk among Individuals with Glomerular Disease

  Clinical Journal of the American Society of Nephrology · 2025-01-17 · 1 citations

  articleOpen access

  Key Points More tools are needed to explore upstream drivers of racial and ethnic disparities in kidney disease outcomes. The Centers for Disease Control and Prevention Environmental Justice Index is a new tool which characterizes cumulative social and environmental burden at the census tract level. This study is the first application of the Environmental Justice Index to understanding glomerular disease outcomes. Background The Centers for Disease Control and Prevention Environmental Justice Index Social-Environmental Ranking (EJI-SER) combines a Social Vulnerability Module with an Environmental Burden Module to characterize cumulative environmental and social burden at the census tract level. This analysis evaluates the association between EJI-SER and kidney outcomes in patients with glomerular disease (GD). Methods Cure Glomerulopathy is an observational cohort study of adults and children with biopsy-proven GD. EJI-SER is a percentile ranking by census tract, with a higher score indicating a more severe burden. Associations between EJI-SER and its components with kidney failure (initiation of KRT, transplant, or two eGFRs &lt;15 ml/min per 1.73 m 2 ) and longitudinal eGFR were tested using multivariable Cox regression and linear mixed models, respectively, adjusted for demographics, histologic diagnosis, eGFR and urine protein to creatinine ratio at enrollment, and time from biopsy to enrollment. Results Among 1149 participants with census tract data, the median (interquartile range [IQR]) follow-up was 5.4 (3.0–7.0) years, the median (IQR) age at biopsy was 24 (10–48), and self-identified racial distribution was 5% Asian, 18% Black, and 70% White. Median (IQR) EJI-SER was 0.49 (0.26–0.75). EJI-SER scores in the lowest two quartiles were associated with a lower hazard of kidney failure compared with the highest quartile (adjusted hazard ratio [95% confidence interval], 0.62 [0.36 to 1.08] and 0.43 [0.25 to 0.76] for EJI-SER 0%–25% and &gt;25%–50% versus &gt;75%, respectively) and higher eGFR at enrolllment (adjusted mean 90.1 versus 87.1 ml/min per 1.73 m 2 for 0%–25% versus &gt;75%, P = 0.08). Conclusions As captured by EJI-SER, higher environmental and social burdens are associated with lower eGFR and a higher risk of kidney failure in the Cure Glomerulopathy cohort. This first use of the EJI-SER in GD demonstrates the need for additional investigation into social drivers of disparities in GD and policies and resources that address these structural inequities.

  PublisherOA PDFDOI

• #1721 Proteinuria as a clinical trial endpoint in focal segmental glomerulosclerosis: validation of PARASOL findings in RaDaR

  Nephrology Dialysis Transplantation · 2025-10-01 · 2 citations

  article1st authorCorresponding

  Abstract Background and Aims Focal segmental glomerulosclerosis (FSGS) is a rare condition that affects children and adults, lacks any approved therapy, and has a high risk of progression to kidney failure (KF). The PARASOL consortium was set up to establish evidence to inform adoption of feasible and clinically meaningful surrogate endpoints for FSGS clinical trials. Method PARASOL combined 9 registries of biopsy-proven or genetic FSGS patients from North America and Europe. Eligible participants required: (1) UPCR ≥1.5 g/g at any time post-biopsy or diagnosis or up to 3 months prior (index UPCR); (2) eGFR ≥30 ml/min up to 3 months prior to index UPCR; (3) ≥1 additional UPCR and eGFR measurement 3 to 24 months post-index; and (4) no evidence of KF (kidney replacement therapy, eGFR sustained &amp;lt;15 ml/min) prior to the first post-index measurements. Relationships between change in eGFR and proteinuria response (across various thresholds) in the first 24 months post-index and subsequent probability of kidney failure beyond 24 months were assessed using Cox proportional hazards models, using a landmark approach with a landmark time of 24 months post-index. Validation was performed among participants fulfilling the same criteria in the UK National Registry of Rare Kidney Diseases (RaDaR). Results PARASOL contained 1626 eligible participants, with median (IQR) follow-up time from kidney biopsy of 64.2 months (35.2, 103.1). At biopsy, median age was 19 years (IQR 7, 43), median UPCR was 3.8 g/g (IQR 2, 7.2) and median eGFR was 81 ml/min (IQR 54, 109). eGFR and the rate of eGFR decline were associated with KF hazard but were highly variable: sample size requirements for clinical trials using eGFR endpoints ranged from 500–1000 individuals per arm. Proteinuria reduction was strongly associated with reduced KF hazard. Using a UPCR responder threshold of 0.7 g/g, achieved in 406 participants, responders had an 85% lower hazard of kidney failure (HR = 0.15, 95% CI = 0.09–0.26) and a survival difference of +0.27 (95% CI 0.22–0.32) compared to non-responders, consistent in incident and prevalent subpopulations and in subgroups based on age and index proteinuria or eGFR level. Estimated sample size requirements for trials using this proteinuria endpoint was 100–200 per group. The findings were validated in RaDaR, which included 465 eligible participants. At index, RaDaR participants were older, median age 36 (14–55), with lower kidney function, median eGFR 71 ml/min (46–106), and higher proteinuria, median UPCR 5.3 g/g (2.7–8.9). Responder status based on UPCR at 24 months was similar to PARASOL. Stratifying by index UPCR into 1.5 to &amp;lt;3.5 g/g, 3.5 to &amp;lt;7.0 g/g and ≥7.0 g/g, in PARASOL 32%, 31%, and 34% achieved &amp;lt;0.7 g/g by 24 months compared with 25%, 42% and 29% in RaDaR (Fig. 1). At the 0.7 g/g threshold, adjusted hazard ratios and survival differences were similar to PARASOL at 0.07 (0.02–0.27) and 0.29 (0.22–0.36) respectively (Fig. 2), consistent in all subgroups analysed. Conclusion For most therapeutic effect sizes, variability in eGFR within and between patients with FSGS means that sample size requirements for trials using eGFR or eGFR slope endpoints are unfeasibly large. In contrast, there was consistent and strong association of proteinuria reduction (a biologically plausible parameter) with higher KF-free survival. Proteinuria reduction is therefore a potential surrogate endpoint for FSGS clinical trials that is both feasible and clinically meaningful.

  PublisherDOI

• Glomerular Disease Outcomes Across the Lifespan: Report of the Cure Glomerulonephropathy (CureGN) Research Consortium

  Journal of the American Society of Nephrology · 2025-10-01

  article
  PublisherDOI

• Subnational Variations in the Quality of Population Health Data: A Geospatial Analysis of Household Surveys in Africa

  SSRN Electronic Journal · 2025-01-01

  preprintOpen access
  PublisherDOI

• Elevated exposure to air pollutants accelerates primary glomerular disease progression

  Clinical Kidney Journal · 2025-05-13 · 1 citations

  reviewOpen access

  Air pollution is a global problem and a major contributor to adverse health outcomes in patients of all ages. Most research has focused on the adverse effects of air pollution on cardiopulmonary events such as myocardial infarction, stroke and lung disease, with less attention given to kidney outcomes. In recent years, there is emerging evidence that air pollution contributes to the onset and progression of chronic kidney disease and, specifically, glomerular disease. This has been confirmed in epidemiological studies performed around the world. In this review, we summarize: (i) the major sources and components of air pollution; (ii) published reports detailing the relationship between air pollution exposure and the incidence and the clinical course of chronic kidney disease; and (iii) the existing literature assessing the impact of air pollution on the progression of primary glomerular diseases. We highlight important gaps in knowledge and the need for future collaborative work involving environmental scientists, epidemiologists and nephrologists to better understand the contribution of air pollution to the increasing number of people worldwide with chronic kidney disease. This work is important because air pollution exposure represents a potentially modifiable risk factor for chronic kidney disease progression that can be addressed by regulatory action, personal behaviors and implementation of interventions to prevent or limit exposure.

  PublisherOA PDFDOI

• Sex Differences in Kidney Failure in Adults Enrolled in CureGN

  Journal of the American Society of Nephrology · 2025-10-01

  article
  PublisherDOI

• Factors associated with erectile dysfunction in men with lower urinary tract symptoms (LUTS): a Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) study

  Translational Andrology and Urology · 2025-08-01

  articleOpen access

  Background: Erectile function (EF) and its associated covariates have not been extensively studied in a large covariate of patients seeking treatment for lower urinary tract symptoms (LUTS). Our objective is to determine the relationship between urinary symptoms and comorbidities with erectile dysfunction (ED) in 447 treatment-seeking men with LUTS. Methods: Data from the Symptoms of Lower Urinary Tract Dysfunction Research Network (LURN) observational cohort study were analyzed using multivariable logistic regression models to quantify the relationship between LUTS and ED. Models also included anxiety, depression, obesity, cardiovascular disease (CVD), diabetes, and medication use. Results: 69 years) and had lower prevalence of diabetes and CVD (13% and 15%, respectively) compared with men reporting no sexual activity (24% for diabetes and 27% for CVD). Among sexually-active participants, higher odds of ED were associated with diabetes [odds ratio (OR) =2.4; 95% confidence interval (CI): 1.1-5.0], age (per 5 years, OR =1.4; 95% CI: 1.2-1.6), urinary incontinence (UI) (OR =1.2; 95% CI: 1.0-1.4), and anxiety (per 10 T-score units, OR =1.4; 95% CI: 1.0-2.1). Low erectile confidence was related to older age in non-sexually-active men (per 5 years, OR =1.5; 95% CI: 1.2-1.8). In sexually-active men, anxiety (per 10 T-score units, OR =1.6; 95% CI: 1.1-2.4), age (OR =1.3; 95% CI: 1.2-1.5), PDE5-inhibitor use (OR =2.1, 95% CI: 1.0-4.3), and diabetes (OR =2.2; 95% CI: 1.1-4.7) were also associated with low erectile confidence. Conclusions: The association of UI with ED highlights the importance of screening men with UI for ED. Modifiable health variables, such as anxiety and diabetes, were related to ED and erectile confidence in treatment-seeking men with LUTS.

  PublisherDOI

Recent grants

• Enhanced Clinical Decisions for Management of Benign Prostatic Hyperplasia Using Patient-Reported Outcomes

  NIH · $715k · 2025–2027

Frequent coauthors

• Jarcy Zee

  Children's Hospital of Philadelphia

  142 shared

• Brenda W. Gillespie

  138 shared

• Lawrence B. Holzman

  University of Pennsylvania

  117 shared

• Laura Barisoni

  Duke University

  97 shared

• Avi Z. Rosenberg

  Johns Hopkins Medicine

  81 shared

• Laura H. Mariani

  University of Michigan–Ann Arbor

  80 shared

• Jeffrey B. Hodgin

  University of Michigan–Ann Arbor

  78 shared

• Robert M. Merion

  University of Michigan–Ann Arbor

  76 shared

Education

• PhD, Biostatistics

  University of Michigan

  2016