Center Hopes to Change the Future of Kidney Disease

The development of research programs aimed at the prevention and treatment of diseases of the kidney has taken a big step forward with the creation of the Kidney Disease Center at the Medical College of Wisconsin.

Using a multidisciplinary approach fostered by having investigators contribute their varied expertise in a shared facility, the Center will focus primarily on hypertension and diabetic nephropathy, kidney stones, and the renal toxicity associated with the immunosuppressive drugs used following renal transplantation.

"The role of the center is to facilitate the translational research in kidney diseases," said Richard J. Roman, PhD, Medical College Professor of Physiology and Director of the Kidney Disease Center. "Clinicians and basic scientists independently do research, but they haven't been working together. The big problems that we face in kidney diseases need coordinated effort between the clinicians and the basic scientists, and we have to work together with shared resources."

Dr. Roman has been a Medical College faculty member for 22 years and is internationally recognized as a leader in the area of the role of the kidney in hypertension and mechanisms involved in hypertension and diabetic-induced renal injury.

Goals of the Kidney Disease Center, said Dr. Roman, include greatly increased funding for kidney disease research in the short term, with expanded staffing and access to state-of-the-art equipment, and new therapies created in the longer term that may ultimately play a role in reversing some manifestations of kidney disease that have until recently been considered irreversible.

Research programs in the Center will initially focus on the pathophysiology of renal tubular and glomerular injury in hypertension and diabetic renal injury; prevention of kidney stone disease; and prevention of renal compromise following organ transplantation.

"One of our major areas is going to be in the area of hypertension and diabetic nephropathy," said Dr. Roman. "Those are the two major causes for end-stage renal disease. The government pays $15 billion a year for dialysis services for the treatment of those, in direct costs. It's the only government insurance program that we have."

Reducing the Cost of Care
Dr. Roman said he is confident that the high health care costs associated with trying to prevent end-stage renal disease, and treating it when it occurs, can be reduced if a sufficient investment is made in new research and development.

"If you lose your kidney and go on dialysis, the government pays for it out of Medicare. As our population ages and becomes more obese and the incidence of hypertension in diabetes rises, it will break the bank. The cost for hypertension treatment to prevent end-stage renal disease is $40 billion a year. And the health care cost for the twenty million Americans with diabetes is higher. So that's one major area that we're going after.

"Another area in which we have strength here is renal stone disease (kidney stones). The people at the VA (Veterans Administration Zablocki Medical Center) are longstanding experts, and we're going to facilitate that work. The third area is improving transplant outcomes, and the fourth will be polycystic kidney disease, which is a genetic disease that leads to end-stage renal disease."

The Kidney Disease Center will help establish the Medical College as a national center of excellence in the field, Dr. Roman said, and attract new research as the "hub" of investigation grows larger. "It makes sense," he said. "We need shared resources in animal research, large pieces of equipment and imaging technology that several labs can share. We need proximity, so if one researcher is an expert in immunostaining, and I'm an expert in hemodynamics, and another person can do something else, we can write a grant that has all the components and we're more competitive."

New Pathways, Improved Outcomes
Preventing disease from reaching the end stage of kidney failure is now a real possibility, Dr. Roman said, as the pace of investigation accelerates and the prospect of new products inspires the marketplace. "Hopefully the things that we're working on will translate into therapeutics," he said. "We have several compounds and drugs that we think are very promising and if the ideas work they might translate into spin-off companies that may be in Southeastern Wisconsin.

"At the very least, if we're doing state-of-the-art research and exploring new pathways to prevent these outcomes, we would hope some of the ideas and compounds that we're working with will lead to new therapeutic pathways. When will it help people? Five to ten years down the road.

"I didn't think that it was possible to reverse kidney disease, but with newly emerging technologies I strongly believe that there is new hope. I now believe that if we can stop the disease process and add these new therapies, there's a possibility that instead of progressing to end-stage renal disease and dialysis, you could have a sick kidney, take the right treatment, and actually recover and never have to go on dialysis. And that is what we're going to work for."

Dan Ullrich
HealthLink Contributing Writer

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.