Eight members of the University of Iowa, most of whom are members our Division of Nephrology, participated in last month’s American Society of Nephrology (ASN) Educational Symposia, “Kidney Week 2016,” in Chicago. More than 15,000 attendees filled the halls of McCormick Place for five days to network, instruct, and present the latest advancements and discoveries in nephrology. These eight Hawkeyes represented well with 3 poster presentations and 2 oral presentations. Specifics on the participants and their presentations follow. A special thanks to Dr. Lama Nourreddine for delivering this excellent field report and, especially, for the photographs!
Melissa Swee, MD (3rd year renal transplant fellow) and Doreen Ventura, MD (2nd year renal fellow). Poster
Title: Successful Treatment of Severe Hyperkalemia and Hyponatremia Using Continuous Venovenous Hemodialysis
“A 59-year-old male with recently diagnosed CLL presented with respiratory failure due to H1N1 influenza. He had a whole blood potassium persistently >14 mEq/L and a sodium of 118 mEq/L. We found that CVVHDF using low sodium replacement fluids is a viable option for treating severe hyperkalemia without incurring osmotic demyelination. To our knowledge, this is the first instance of such a strategy being used to correct hyperkalemia while avoiding rapid shifts in sodium”
Maria Story, MD (3rd year medicine resident) and Sarat Kuppachi, MD (Clinical Assistant Professor of Internal Medicine). Poster
Title: Opinions of the Medical Community at the University of Iowa Regarding Disincentives and Incentives in Living Kidney Donation Based on Age.
“Our study examined the views on ‘incentivizing living kidney donation’ among the medical community at the University of Iowa and Medical students at the Carver College of Medicine. In this survey, those < 25 years of age were more likely to accept financial incentives for kidney donation compared to those ≥ 25 years. We found that most employees/students felt it reasonable to make kidney donation a financially neutral act (i.e. ensuring travel costs are refunded and recovery after surgery does not jeopardize current employment) but the jury was split on whether it was ethical or not to provide an incentive (i.e. health insurance, tax credit, cash) to donate a kidney. We have to better understand the long-term risks of living kidney donation so that younger donors can make well informed decisions regarding kidney donation”
Lama Noureddine, MD (Clinical Assistant Professor of Internal Medicine) et al. (in collaboration with Department of Internal medicine, University of Minnesota). Poster
Title: Collecting Duct-Specific Inactivation of HNF-1β Leads to Fibrocystic Disease and Impaired Urinary Concentration
“Hepatocyte nuclear factor-1β (HNF-1β) is an essential transcription factor that regulates tissue-specific gene expression in the kidney. In humans, mutations of HNF-1β cause renal cysts and diabetes (RCAD) and congenital anomalies of the kidney and urinary tract (CAKUT). We deleted HNF-1β specifically in renal collecting ducts in mice and found that HNF-1β mutant mice develop renal cysts, hydronephrosis, and a primary defect in urinary concentration. We found NR1H4 (FXR), a transcription factor known to regulate water homeostasis, to be a novel HNF-1 β target. HNF-1 β was bound to the FXR promotor. FXR mRNA was downregulated in HNF-1β mutant mice and FXR protein localized to collecting ducts in wild-type mice and was diminished in the cysts of HNF-1β mutant mice. Mouse inner medullary collecting duct cells exposed to hypertonic medium robustly upregulated FXR mRNA levels. This upregulation was lost in Hnf-1β mutant cells. We reveal a new role for HNF-1β in urinary concentration by regulating the transcription of FXR in the renal collecting duct”
Christie Thomas, MD (Professor of Internal Medicine) et al. Poster
Title: KidneySeqTM: A Comprehensive Inherited Kidney Disease Panel
“The Division of Nephrology at University of Iowa Carver College of Medicine and the Iowa Institute of Human Genetics have developed a comprehensive genetic kidney disease panel that can test for multiple genetic renal diseases. The test, called KidneySeqTM, uses advanced sequencing and analytic techniques to simultaneously evaluate for genetic variants in over 170 genes that cause more than 75 different renal diseases. At the recent ASN meeting, we recently reported the results on the first 54 clinical samples that we tested and showed that a genetic diagnosis was made in 46% of cases demonstrating that KidneySeqTM can provide a rapid, cost-effective method to improve the diagnosis and subsequent care of patients with a variety of genetic renal diseases.
Carla Nester, MD (Assistant Professor of Pediatrics). Oral Presentation
Dr. Nester, a physician scientist in the Departments of Pediatrics and Internal Medicine was recently featured as the lead speaker in an American Society of Nephrology Educational Symposia (ASN – Chicago Nov 2016) entitled: “Complement – It’s Everywhere”. As the Director of the University of Iowa’s Rare Renal Disease Clinic and a world renowned expert in the treatment of complement mediated renal disease, Dr. Nester was invited to present her research in acquired dysregulation of the alternate pathway of complement and her lab’s experience (the Molecular Otolaryngology and Renal Research Lab – MORL) in the basic science behind identifying effective anti-complement therapeutics for patients with complement mediated renal disease. Dr. Nester’s work, in collaboration with Dr. Richard Smith, has been instrumental in establishing the University of Iowa as a world leader in both defining the underlying etiology and in the treatment of C3 Glomerulopathy.
Richard Smith, MD (Professor of Pediatrics, Internal Medicine, Molecular Physiology and Biophysics). Oral Presentation
Richard Smith presented a talk entitled “Precision Medicine for the C3 Glomerulopathies: Unraveling the complexities that drive this group of diseases”. Focused on a quadripartite evaluation that includes genetic testing, screening for autoantibodies, quantitating complement proteins, and assaying complement function, Smith described how this level of assessment makes it possible to quantitate the degree of on-going complement dysregulation in patients with this ultra-rare renal disease. In addition to C3G, the MORL is an international leader in aHUS research.