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Dana Fuhrman, DO, MS, assistant professor in the Division of Pediatric Nephrology at UPMC Children’s Hospital of Pittsburgh was recently awarded a National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) K23 career development award for a novel study of renal fitness in young adults with congenital heart disease (CHD). Dr. Fuhrman’s study will assemble a multidisciplinary contingent of investigators from critical care medicine, nephrology, and cardiac surgery to unravel the mysteries of kidney “fitness” and how it can be augmented in patients undergoing complex heart surgery.
“Patients’ kidneys can take a beating from disease and treatment. Understanding how some patients can endure kidney insults while others become injured is a key unmet need,” explains John Kellum, MD, director of the Center for Critical Care Nephrology in the Department of Critical Care Medicine at the University of Pittsburgh, who is an internationally recognized acute kidney injury researcher, and Dr. Fuhrman’s primary mentor. “The implications of her work will eventually be applicable to acute kidney injury which affects the lives of 4 million Americans each year.”
Children’s hospitals across the country face an exponential increase in the numbers of young adults with congenital heart disease (CHD) who require corrective surgeries since more and more children with CHD are able to survive into adulthood. Many of these patients are at high risk for poor renal outcomes, including acute kidney injury (AKI) and chronic kidney diseases, who require intensive intervention by nephrologists and intensivists.
“Unfortunately, we have had limited means to predict which patients will do poorly,” says Carlton Bates, MD, chief of the Division of Pediatric Nephrology at UPMC Children’s. “Dr. Fuhrman’s research has the promise of identifying new and innovative biomarkers to indicate those patients at high risk of poor outcomes, allowing clinicians to gauge their level of scrutiny and care following cardiac procedures.”
There are no readily available means to quantify renal fitness clinically, and there are no prior studies that have examined the long-term effects of glomerular reserve or preoperative tubular biomarker values in any patient group. Given this paucity of data, the goal of Dr. Fuhrman’s research is to establish an objective method to quantify renal fitness in young CHD patients ages 18 to 28. Dr. Fuhrman plans to quantify glomerular reserve by measuring estimated glomerular filtrate rate (eGFR) values using cystatin C before and after a protein load. Dr. Fuhrman piloted this easily replicated method during her nephrology fellowship years as a T32 NIH scholar at the University of Pittsburgh and UPMC Children’s.
On admission to the hospital for coronary bypass (CBP) exposure, young CHD patients will be assessed for AKI risk in order to determine:
Patients will be followed for one and two years in order to determine if preoperative glomerular reserve and tubular biomarkers estimate the risk of chronic kidney disease.
More information about Dr. Fuhrman’s K23 grant can be found on the NIH RePORT site. Visit the UPMC Children’s website to learn more about the Division of Pediatric Nephrology, and visit the University of Pittsburgh Department of Critical Care Medicine’s Center for Critical Care Nephrology.