From KERA-News, Dallas, TX, By SAM BAKER
Polycystic kidney disease — or PKD — causes numerous cysts to grow on the kidneys. It's the fourth leading cause of kidney failure. There is no cure, but a researcher at UT Southwestern Medical Center believes treatments are about 10 years away.
A genetic condition, polycystic kidney disease runs in families from one generation to the next.
Dr. Vishal Patel, an assistant professor of internal medicine at UT Southwestern, is one of several researchers at various institutions working to find a way to slow progression of the disease.
Interview Highlights
About PKD: The clinical hallmark of this disease is the massive enlargement of both kidneys. A normal person's kidney should be the size of their fist. In people with polycystic kidney disease, each kidney can grow to be as large as a football.
You can have PKD and not know it: The most common variety is adult-onset. Even though the patients are born with the mutation, they don’t feel any symptoms. The disease actually can go undetected for years until people reach their 40s or their 50s.
About PKD and kidney failure: Not everybody who inherits the mutation will develop kidney failure. About 50 percent of people with the mutated genes end up getting kidney failure, requiring dialysis or transplant. The other 50 percent will have cysts in their kidneys, but their kidneys will continue to have some level of function, not requiring dialysis or kidney transplant.
Treatments for PKD: We instruct our patients to maintain a generally healthy lifestyle, which includes adequate hydration, nutrition, not smoking, exercise - the usual things. Unfortunately, in the United States there isn’t any approved treatment specifically for polycystic kidney disease.
One possibility: Recent clinical research data shows a drug called tolvaptan seems to slow polycystic kidney disease growth in patients. Authorities in Japan, Canada and the E.U. have approved this medication. The Food and Drug Administration in the United States has not approved the medication yet because of concerns that it may have side effects. Additional research on tolvaptan is going on, and in a couple of years after reviewing newer data, the FDA will probably approve this medication for treatment of PKD in the U.S.
You can have PKD and not know it: The most common variety is adult-onset. Even though the patients are born with the mutation, they don’t feel any symptoms. The disease actually can go undetected for years until people reach their 40s or their 50s.
About PKD and kidney failure: Not everybody who inherits the mutation will develop kidney failure. About 50 percent of people with the mutated genes end up getting kidney failure, requiring dialysis or transplant. The other 50 percent will have cysts in their kidneys, but their kidneys will continue to have some level of function, not requiring dialysis or kidney transplant.
Treatments for PKD: We instruct our patients to maintain a generally healthy lifestyle, which includes adequate hydration, nutrition, not smoking, exercise - the usual things. Unfortunately, in the United States there isn’t any approved treatment specifically for polycystic kidney disease.
One possibility: Recent clinical research data shows a drug called tolvaptan seems to slow polycystic kidney disease growth in patients. Authorities in Japan, Canada and the E.U. have approved this medication. The Food and Drug Administration in the United States has not approved the medication yet because of concerns that it may have side effects. Additional research on tolvaptan is going on, and in a couple of years after reviewing newer data, the FDA will probably approve this medication for treatment of PKD in the U.S.
Dialysis Research
From Phys.Org, by Colin Smith
AI and aerospace models used to optimise blood flow in veins
Sean Sun Receives Award to Support Research in Polycystic Kidney Disease
This model shows an improvement in blood flow, thanks to Imperial prototype technology. Credit: Imperial College London
Artificial intelligence has been trained to use aerospace simulation software to design a device that may ultimately improve dialysis for patients.
The team from Imperial College London and their colleagues have used computer modelling techniques - normally employed to simulate how unsteady air pockets flow over a plane - to model how unsteady currents in blood flows in the veins of patients undergoing dialysis.
The study, published in the journal Physics of Fluids, was carried out in conjunction with researchers from Hammersmith Hospital, Northwick Park Hospital, and St Mary's Hospital.
When the kidneys stop working properly dialysis can be used to remove waste products and excess fluid from the blood by diverting it to a machine to be cleaned. To connect this machine to the patient a special junction must be formed between an artery and a vein in the patient's wrist or upper arm. This junction is called an arterio-venous fistulae (AVF).
However, due to abnormal and very unsteady blood flow patterns, approximately 50 per cent of AVFs block up and fail within months of their creation because the artery walls inflame, which is known as intimal hyperplasia. This means patients have to undergo another procedure and in some cases repeated procedures. Often patients can run out of regions on the arm where AVF can be carried out, preventing them from using the lifesaving dialysis procedure.
The team have used modelling techniques from the aerospace industry to train a computer, using machine learning algorithms. Machine learning is an application of artificial intelligence (AI) that provides systems the ability to automatically learn and improve from experience without being explicitly programmed.
The AI then went ahead and optimised the shape of an AVF so that the unsteadiness in the blood flow could be suppressed. The prototype device that they have developed to hold the AVF in the optimal shape has so far undergone preliminary tests in pigs, which have been successful.
The next step will involve carrying out trials with pigs for several months at a time to further test the effectiveness of the AVF device. Even if these trials are a success they will be several years away from carrying out clinical trials with patients.
Artificial intelligence has been trained to use aerospace simulation software to design a device that may ultimately improve dialysis for patients.
The team from Imperial College London and their colleagues have used computer modelling techniques - normally employed to simulate how unsteady air pockets flow over a plane - to model how unsteady currents in blood flows in the veins of patients undergoing dialysis.
The study, published in the journal Physics of Fluids, was carried out in conjunction with researchers from Hammersmith Hospital, Northwick Park Hospital, and St Mary's Hospital.
When the kidneys stop working properly dialysis can be used to remove waste products and excess fluid from the blood by diverting it to a machine to be cleaned. To connect this machine to the patient a special junction must be formed between an artery and a vein in the patient's wrist or upper arm. This junction is called an arterio-venous fistulae (AVF).
However, due to abnormal and very unsteady blood flow patterns, approximately 50 per cent of AVFs block up and fail within months of their creation because the artery walls inflame, which is known as intimal hyperplasia. This means patients have to undergo another procedure and in some cases repeated procedures. Often patients can run out of regions on the arm where AVF can be carried out, preventing them from using the lifesaving dialysis procedure.
The team have used modelling techniques from the aerospace industry to train a computer, using machine learning algorithms. Machine learning is an application of artificial intelligence (AI) that provides systems the ability to automatically learn and improve from experience without being explicitly programmed.
The AI then went ahead and optimised the shape of an AVF so that the unsteadiness in the blood flow could be suppressed. The prototype device that they have developed to hold the AVF in the optimal shape has so far undergone preliminary tests in pigs, which have been successful.
The next step will involve carrying out trials with pigs for several months at a time to further test the effectiveness of the AVF device. Even if these trials are a success they will be several years away from carrying out clinical trials with patients.
PKD Research
From John Hopkins Institute NanoBio Technology
PKD causes uncontrollable growth of fluid filled cysts, ultimately leading to kidney failure. However, the underlying disease mechanisms are unclear and no well-established medical treatments exists. The award will help Sun and Ikbal Choudhury, 2nd year PhD student, study fluid pumping mechanisms of kidney cells in the early stages of PKD. Choudhury created an organ-on-a-chip device that simulates fluid pumping in the same manner as specific kidney cells reabsorb important nutrients such as ions and water. This research could provide direct insights about the disease and therefore create more efficient treatment methods and a way to test new drugs.
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