As part of our “Meet Yale Internal Medicine” series, today’s feature is on Dennis Moledina, MBBS, PhD, instructor, nephrology.
Q: What brought you to Yale?
A: I did two years of clinical fellowship at Yale. After fellowship, I decided that my true passion lies in improving the lives of patients with kidney diseases through clinical research. I realized that what we really need is to improve the diagnosis of kidney disease and find therapies. For me, something was lacking. I decided that the best way I can help patients is by doing research.
But I had no research training, so I joined the Investigative Medicine Program through the Yale Center for Clinical Investigation. The program is designed for people like me, fellows and residents who realize during the training that they want to do research. The program taught me about designing studies, analyzing the data, the ethics of clinical research, and more. At the end, you have a thesis project which I defended in September 2018. I received my PhD in January 2019.
Q: What was your thesis project?
A: I worked to find biomarkers for acute interstitial nephritis (AIN), a common kidney disease. One in five people with an acute kidney injury (AKI), a form of kidney injury that often happens in the hospital, is due to AIN. AKI affects about 10 - 20 percent of people admitted to the hospital. Most forms of AKI are self-limiting, or go away on their own. There are other forms that are not self-limiting, so you wait until the body heals itself.
AIN is a form of kidney disease that you can treat and is caused by common medications, like antacids or antibiotics. We diagnose AIN by doing an ultrasound-guided core needle kidney biopsy, which can cause complications in some patients.
If the diagnosis of AIN is missed, the kidneys may not recover due to scar tissue. Current treatment of AIN is to stop the drug causing the issue and prescribe steroids to decrease the inflammation.
About half of the patients who get AIN never fully recover because they haven't been diagnosed in time. They start off with having chronic kidney disease, then need dialysis and then eventually need a transplant. For our study, everyone who underwent a kidney biopsy at Yale since January 2015 was asked to participate in the study. We enrolled about 400 people. We collected a cup of urine and a tube of blood. Some of them have AIN and others have other causes of acute kidney injury.
We found a couple of proteins that are promising in the first phase of the study and are analyzing the second phase. Hopefully over the next few months, we will have all the results that we need and send out a manuscript.
Q: Why nephrology?
A: I, like many others, didn't come into internal medicine thinking that I wanted to do nephrology.
Science drives some people or having some interesting finding, but I think what drives me is this direct patient impact.
Dr. Dennis Moledina
I thought I wanted to do internal medicine. During my residency program, I had excellent mentors, and I got into nephrology because of them. Also, I liked that nephrology gives you a continuity of patient care which you don’t have in some of the other specialties.
Q: Why did you come to Yale?
A: That is a no-brainer. If you can train at Yale nephrology, you would not pick any other place in the country. I visited 17 places, some of the top institutions in the U.S., but when you go around, you see that most of the leaders are Yale-trained. Most of the people who’ve contributed in nephrology are Yale-trained. So, if you get a chance to come to Yale, you do.
Q: What gets you excited every day to come to work?
A: It all drives from my ‘why’; it's the promise that if I find something, it’ll directly impact patients. If I didn't choose this and chose something else, I know it would have direct impact on care. Science drives some people or having some interesting finding, but I think what drives me is this direct patient impact.
Q: What are your goals and dreams for your career and research?
A: I just got my Career Development Award, or K-23 award, from the National Institutes of Health (NIH). I have about five years of protected time where I can continue my work at the Yale Program for Applied Translational Research. In the future, I want to set up a lab that studies AIN.
As my independent research program, I want to set up a collaboration across the country at several different centers doing the same work. I also found a couple of very interesting targets for AIN. In the future, I want to set up a clinical trial to test out these targets to see if they are better than steroids.
One thing Lloyd Cantley [MD, C.N.H. Long Professor of Medicine (Nephrology)] always says is that the best studies that he's conducted have raised more questions than they have given answers. That is what the journey of science is.
I feel like nephrology is in this phase that there aren’t any specific therapies. This is what cancer was going through 20 years ago, but now cancer is at a point where everything has a very specific therapy.
We need to take nephrology there, we need to parse out the diseases better and have therapy for every subset of the disease. It would be good if we can take nephrology there in the next 20 years, that would be great for our patients.