“Homage to thee, O my heart! Homage to you, O my kidneys!”
Egyptian Book of the Dead circa 1500 BC
Over 3000 years ago the ancient Egyptians considered that the kidneys had mythical qualities. How right they were. These two small organs, each about the size of a fist, are exquisitely designed life support systems; constantly, quietly working 365 days of the year, 24 hours of the day. And in each day they filter, clean and reconstitute 180 litres of blood; impressive as we only have about 8 litres of blood. So, each drop of blood is treated over 20 times a day. This is measured in millilitres/minute and is called Glomerular Filtration Rate GFR. So in healthy young adult the GFR would be approximately 120 ml/min.
Consequently, when our kidneys don’t work properly trouble builds for the whole body and if they stop working all together we would die without life sustaining therapies.
After more than 3000 years there is still much we don’t know about our kidneys and kidney failure remains a life threatening disease without a cure.
At the SWT Institute for Renal Research (SWTIRR) we are completely dedicated to research and education into kidney disease. Unfortunately, we cannot study every feature of the kidney; hence we specialise, focus and collaborate.
Chronic kidney disease (CKD) is a prolonged deterioration of our kidney function and like most things the earlier we spot the problem the more we can do to treat it. Yet, in general, we don’t diagnose CKD until someone has lost nearly 50% of their kidney function, by which time the disease is quite advanced. It has always been one of the priorities of SWTIRR from the start to develop better tools for diagnosing kidney disease. In 2006 we published our first version of our “Finger-Prick” GFR method. Since then we have refined it for greater sensitivity.
GFR remains a good standard measure but to understand the nature of the kidney injury requires more detail. Hence, we continue to research markers that will identify the site and nature of the kidney damage. We are studying urinary proteins that will discriminate, functional impairment structural damage and the development of fibrosis.
The idea of “repair” in chronic kidney disease is controversial, certainly, with our current diagnostic tools. However, tissue and organs can be repaired or repair themselves even if they don’t return to precisely the same state they were in before injury. So, we are interested in tipping the balance back towards a healthy state. Our work in collaboration with King’s College London on the CCN proteins, particularly CCN2/CTGF and CCN3/Nov expression suggest that this may be possible. Even, if you cannot induce the kidney to repair itself, stopping the scarring that causes fibrosis should mean that patients don’t progress to kidney failure. SWTIRR has been developing pioneering work on guiding the kidney away from the vicious cycle of fibrosis by restoring a healthy gene expression. We have focussed on the early scar protein fibronectin and have some promising results.
Preventing Collateral Damage:
It was not only the Egyptians who showed prescient insight into the importance of kidneys. In ancient Hebrew ‘medicine’ they believed that kidneys were needed to provide advice to the heart. CKD can cause cardiovascular disease; in fact cardiovascular disease is probably the leading cause of death in patients with CKD. Cardiovascular disease itself is, of course, a major health problem in Europe and the USA, however the nature of the cardiovascular disease is different in renal patients. In collaboration with colleagues at St George’s, University of London, SWTIRR is investigating the nature of cardiovascular disease in renal patients and how it might be targeted with new or existing medicines.