Cystic kidney diseases are a wide range of genetic, developmental, and acquired disorders that are characterized by the presence of fluid-filled cysts that develop in one or both kidneys and can lead to massive kidney enlargement and hemorrhage, and damage to the liver, pancreas, heart, and brain. Autosomal dominant polycystic kidney disease (PKD) is the most common form of cystic kidney disease. Division faculty provide multidisciplinary care for patients with PKD and access to PKD research cores through the Baltimore Polycystic Kidney Disease Research and Clinical Core Center. The center has recruited experts in biochemistry, genetics, and structural biology to determine the molecular causes for cyst development in the kidney, and stop its evolution to renal failure.To learn more about the Baltimore PKD Center, visit www.baltimorepkdcenter.org.
Early Renal Insufficiency Program
The Early Renal Insufficiency (ERI) Program is a resource for the care of patients at the earliest stages of kidney disease. The ERI Program consists of four clinics at University of Maryland Medical System-connected facilities and offers patients access to enriched disease management and opportunities to participate in clinical trials. For more information and a list of available services, visit the ERI Program Web site.
One important goal is to identify why people with kidney disease develop more rapid cardiovascular disease. With more than 10 years of support from the National Institutes of Health (NIH), this group has enrolled patients in the large ongoing Chronic Renal Insufficiency Cohort (CRIC) Study which continues to provide seminal observations explaining why people with kidney disease experience earlier and more rapid heart and kidney disease progression. There is also active research as to why people with kidney disease develop cerebrovascular disease, and whether exercise may remedy this problem.
Safe Kidney Care Study
Because patients with chronic kidney disease (CKD) have special needs for their medical treatment, but these needs often are overlooked, unintended harm can result in hospitalization, more kidney problems, and even death. This study aims to help prevent acute medical injuries in patients with CKD by understanding the frequency with which these patients are exposed to injury-inducing medicines, tests or procedures. Additionally, the study will assess the efficacy of medical alert accessory in preventing patient safety events. Supported by the National Institute of Diabetes and Digestive and Kidney Diseases at the National Institutes of Health, the study began enrolling patients in spring 2011. To learn more about the study requirements, visit ClinicalTrials.gov and search for trial number NCT01407367.
Transplant Clinical Research Program
Despite many advances in kidney transplant science, research is needed to help improve the health and survival of both the transplant recipient and the transplanted organ. The Division of Nephrology and Transplantation actively collaborate on the majority of projects antibody-mediated transplant injury, non-traditional risk factors for poor transplant outcomes, and how to optimize immune-suppressing medications to improve long-term success.
Kidney donation is an essential part of transplantation today, yet determining the safety of donation for all potential living donors remains an area of ongoing research. Our group is in its sixth year of NIH funding to examine whether kidney donation is safe from a cardiovascular standpoint. Many different factors may influence risk such as pre-donation level of blood pressure, cholesterol, and glucose. We are using sensitive techniques to measure these and other biomeasures of cardiovascular risk longitudinally over time to correlate with blood vessel injury and overall safety of donation.
In collaboration with the University of Maryland Institute for Genome Sciences we are examining the microbiota of transplant patients to evaluate how microbiota of these patients modify in different immune responses. We are also studying gene expression in the kidney transplant biopsies.
Renal Physiology Program
The focus of the laboratory is to investigate the role of the renal medullary microcirculation in physiological mechanisms of hypertension, intra-renal oxygenation and protection from ischemia. In response to an ischemic event the smooth muscle and endothelial layers of medullary microvessels adapt in several ways. They increase vasodilator generation, modify their electrical characteristics and become resistant to influences that favor further vasoconstriction. We are investigating accompanying changes in ion channel architecture, cell to cell electrical conduction through gap junctions, and control of cellular membrane potential that modifies voltage gated cation entry into the smooth muscle cells of the vessel wall.
Normal tissue radiation injury and the kidney
This work tests mediators and mechanisms of radiation nephropathy and other normal tissue radiation injuries. Radiation injury to kidneys is a special example of the larger field of Onco-Nephrology, which is the overlap area between cancer and kidney disease. We have shown the benefit of angiotensin converting enzyme inhibitors to prevent, mitigate, and also to treat radiation nephropathy. The current renal studies are funded by the Department of Veterans Affairs and are focused on endothelial dysfunction and its mitigation. We have collaborative studies underway with the University of Maryland Division of Translational Radiation Sciences that build on earlier work by that Division that was supported by the Medical Countermeasures Against Radiation Threats (MCART) program.