I have always been interested in doing research and pursued a Master’s in Public Health to be able to critically review the literature and combine my passion for clinical care with scientific inquiry. To provide the best treatment options to our patients we need to constantly review the literature, be aware of, and participate in research initiatives. I also believe that clinical research and providing the best clinical care go hand in hand and cannot me considered mutually exclusive domains. Most of my research ideas stem from the challenges that our patients face during the course of their kidney disease.
My research career started during my Master’s in Public Health where for my final capstone project I evaluated the differences in treatments offered to patients with colorectal cancer based on race. This was my first interaction with big data and clinical research and I realized that I wanted to continue to pursue this once I finished my clinical training. During my fellowship, I was fortunate enough to train at a place where scholarship was greatly valued and nurtured. Under the mentorship of our fellowship director Dr. Frederick Kaskel I started pursuing research. I worked with Dr. Woroniecki on a research project using a New York State database to evaluate the prevalence of congenital anomalies of the kidney and urinary tract in children with congenital hypothyroidism. With Dr. Melamed, an adult nephrologist with interest in bone and mineral metabolism I started evaluating the prevalence of Vitamin D deficiency in children in the NHANES database. This paper was received well and has been cited more than 400 times. This led to me submitting and receiving a career development award (K 23 from NIDDK) evaluating the prevalence and determinants of Vitamin D deficiency and its effects on growth in children with chronic kidney disease (CKD) in the CKiD cohort. CKiD is the largest cohort study of children with CKD in North America and is now in its 15th year. It aims to determine the natural epidemiology and course of CKD in children and its effect on growth, cardiovascular and neurocognitive outcomes. During the course of this grant we published important data about the prevalence and determinants of vitamin D deficiency in pediatric chronic kidney disease.
Another area of research which is very close to my heart is kidney transplant outcomes. Specifically, I am interested in ways to better monitor allograft function and find markers of early allograft injury so that treatments can be instituted early to minimize allograft damage. I applied for and received funding from the Clinical and Translational Science Center for a pilot proposal entitled “Gut Microbiome, Vitamin D and Donor Specific Antibodies in Pediatric Kidney Transplant Recipients”. This proposal aimed to compare urine mRNA signatures, cytokine profiles and gut microbiome compositions in pediatric kidney transplant recipients with and without donor specific antibodies. We were able to show heightened T cell immunity (by urine mRNA assays) in pediatric kidney transplant recipients with circulating donor HLA-specific antibodies. Under the mentorship of Dr. Suthanthiran, (Chief, Division of Nephrology and Hypertension, Weill Cornell Medicine) I was able to further my interest in transplant research. Along with colleagues at the Children’s Hospital of Philadelphia we applied for and received a multi PI R01 grant from the NICHD for a study entitled “VIRTUUS (Validating Injury in the Renal Transplant Using Urinary Signatures) in Children”. This study is based upon the pioneering work done by Dr. Suthanthiran in identifying urinary messenger RNA signatures and metabolite profiles associated with acute cellular rejection, antibody mediated rejection and BK virus nephropathy in adult kidney transplant recipients. This multicenter, largest in pediatric kidney transplant study, aims to validate in children the urinary biomarkers found to predict allograft injury in adult kidney transplant recipients. This study’s results will advance the ability to identify and characterize early allograft injury in pediatric kidney allograft recipients through non-invasive immune surveillance. By doing so, we will create opportunities to better inform clinical decision-making and change practice paradigms to improve long-term allograft outcomes.
In addition, after seeing numerous consults for kidney injury and unresolved acute kidney injury in children at Memorial Sloan Kettering Cancer Center, I decided to study this problem systematically and applied for a CTSC Pilot grant. This proposal aims to evaluate urinary biomarkers of renal injury (Neutrophil gelatinase associated lipocalin, Transforming growth factor beta 1, Interleukin 18 and Kidney injury molecule-1) in neuroblastoma survivors to aid earlier identification of patients at increased risk for progressive renal damage. If these markers show significance in this pilot study, it will provide the basis for a larger, longitudinal, multi-institutional study of these markers to predict kidney injury and allow for evidence based guidelines to monitor for renal injury in this at risk and vulnerable population.
With all the above endeavors and more in the future I aim to be able to make a positive difference in the life of children with kidney disease.