On World Kidney Day 2020, Dr Christopher Lawrence, Consultant Nephrologist, looks forward to what the next decade will bring to renal medicine.
A proportion of patients with kidney problems will need to have a kidney biopsy. The need for a kidney biopsy is determined by a number of factors, including the ‘story’ of the kidney problem, the ultrasound appearances, the kidney function blood tests and the urine tests.
Dr Lawrence has performed more than 25 native and transplant kidney biopsies at One Hatfield Hospital. A kidney biopsy is a relatively minor day case procedure where a tiny core of kidney is removed with a special needle and sent to specialists in Cambridge for analysis.
The kidney histopathologists in Cambridge are amongst the best in the world and give an excellent opinion as to what is going on in the kidney, using the three key techniques of light microscopy, electron microscopy and immunohistochemistry. The nature of kidney diseases are that they are identified by pattern recognition, i.e. (in very simple terms) what they look like under the microscope, and what the pattern of damage is. This system of naming kidney diseases (i.e. in Focal and segmental glomerulosclerosis (FSGS) there is scarring (sclerosis) of the blood vessels (glomeruli) which occurs in a ‘segments’ of the glomeruli and is ‘focal’ in the kidney (rather than occurs universally throughout the kidney). Whilst this pattern recognition allows the histopathologist to help categorise the kidney disease and put people in to groups whose diseases may behave similarly and may respond to certain treatments it does not necessarily allow a full understanding of the mechanisms of disease.
Recently it has become possible to analyse the RNA expression in kidney transplant biopsies, a service we can provide through One Hatfield Hospital. What this allows us to do is analyse the ‘molecular signal’ within the kidney transplant, i.e. it is possible to establish a pattern of kidney transplant injury by understanding which genes are up, and down, regulated at the time of the biopsy.
Whereas the traditional way of analysing a kidney transplant biopsy allows the pathologist to state that damage has occurred it does not necessarily identify what caused the damage and whether it is ongoing.
Just as cancer medicine is becoming more and more personalised, by understanding the underlying mechanisms of kidney transplant dysfunction it should be possible to more accurately target treatment. Dr Lawrence expects that in the next decade molecular diagnostics will become a mainstay of diagnostics in both transplant medicine and kidney medicine generally. So that many kidney diseases, which are currently treated empirically, often with blunt tools, should be amenable to precisely targeted personalised treatments. At One Hatfield we are at the forefront of this revolution in kidney medicine.
Disclaimer: Dr Lawrence as well as being a consultant nephrologist will imminently take on the role of Director of Medical Affairs for the Transplant Diagnostics division of Thermo Fisher Scientific, a provider of molecular assays and tests.
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