Nephrology

Update from Section Chief Stefan Somlo, MD

The Section of Nephrology has extensive programs in patient care, research, and education. Led by Stefan Somlo, MD, and Clinical Chief Aldo Peixoto, MD, the section is committed to excellence with the expectation that both its faculty and trainees will be national and international leaders in academic nephrology.

Clinical Care

New Program

The section launched a new program in lower Fairfield County in the spring of 2021. Tinika Montgomery, MD, and Marcelo Orias, MD, PhD, provide outpatient services at Long Ridge Medical Center in Stamford, and inpatient care at Greenwich Hospital in Greenwich. With this recent expansion, Yale Nephrology brings its high-level care to people in three counties in coastal Connecticut: Fairfield, New Haven, and Middlesex.

Both Montgomery and Orias are general nephrologists, treating patients with kidney diseases and disorders. Montgomery specializes in chronic and end-stage kidney disease, and also sees patients in the Kidney Stones Program, a collaboration with the Section of Urology. Orias, an internationally recognized hypertension specialist, specializes in treating high blood pressure and is vice president of the World Hypertension League.

Renal Transplantation

Yale has the largest kidney transplant program in New England. Since the program began in the mid-1960s, 3,272 kidney transplants have been performed, of which 1,276 have been living donor transplants. The program, with clinics in New Haven, Stamford, Hartford, and Old Saybrook, is involved in research sponsored by industry and by the National Institutes of Health.

Richard N. Formica Jr., MD, is director of Transplant Medicine. Formica was elected president of the American Society of Transplantation (AST) in 2020 and is currently the AST’s past president. He also serves on the board of directors of the Organ Procurement and Transplantation Network. Nationally, the waitlist for kidney transplantation is almost 100,000 people. While the number of deceased donor transplants increases every year, there are still a significant number of people who die waiting approximately one person every two hours). Because of this situation, there are initiatives to expand living kidney donation safely and ethically, Formica says.

William Asch, MD, PhD, director of the transplant fellowship program, has served on the education committee of the American Society of Transplantation since 2020. Asch, who is also director of pre-transplant operations, was selected in the spring of 2021 to lead the Yale committee in reviewing the use of the eGFR race modifier, a modifier formerly used in estimated glomerular filtration rate calculations of kidney function.

Diversity, Equity, and Inclusion

Namrata Krishnan, MBBS, is the vice chief for Diversity, Equity, and Inclusion (DEI) in the Section of Nephrology. She works closely with the section leadership and the Office of Diversity, Equity & Inclusion in Medicine to advance workforce diversity, education, and ongoing DEI conversations in the section and the residency training programs.

Education

Lloyd G. Cantley, MD, received the Charles W. Bohmfalk Prize for teaching in the basic sciences during Yale School of Medicine’s (YSM) virtual commencement ceremony in 2020. The Charles W. Bohmfalk Teaching Prize is one of YSM’s highest faculty awards. This is the second time Cantley has received the prize, having been honored with the Bohmfalk Prize for teaching in the clinical sciences in 2012, making him the only Yale physician to have won the Bohmfalk Prize for both basic sciences and clinical sciences.

Nephrology’s Fellowship Director, Ursula Brewster, MD, received the 2021 American Society of Nephrology (ASN) Distinguished Educator Award. Brewster has a national role in supporting and training more junior fellowship directors, while working with ASN leadership to set policy for fellowship programs across the country.

For Namrata Krishnan, MBBS, the key to enhancing academic interest in nephrology and addressing the notable decline in internal medicine residents applying to the specialty lies in developing innovative ways to deliver nephrology education. In the last three years, Krishnan has focused on e-learning and developed two online interactive learning modules in hemodialysis.

Research

Several important studies were published recently in high-impact journals: Autosomal dominant polycystic kidney disease (ADPKD), a genetic disorder, causes fluid-filled cysts to develop in the kidneys, which can impair their function. The cysts cause the kidneys to become inflamed and develop fibrosis (scar tissue). The disease is most often caused by a mutation in one of two genes, PKD1 or PKD2, which can be passed down from parent to child. Stefan Somlo, MD, and his research team published a study in Nature Genetics showing that the damage caused by ADPKD can be reversed, demonstrating the surprising plasticity of the kidney. The study was also featured as a research highlight in Nature Reviews Nephrology, and was the subject of an accompanying News & Views editorial in the December 2021 issue of Nature Genetics.

In a new paper published in the Journal of the American Society of Nephrology, researchers led by Gary V. Désir, MD, share findings that indicate that for the first time, there is a potential targeted treatment for kidney injury caused by cisplatin, a widely used anticancer drug. One in four patients treated with cisplatin develop chronic kidney disease. Désir and colleagues found that by using an agonist peptide derived from the secreted survival protein renalase and encapsulated in nanoparticles specifically designed to be taken up by the proximal tubules of the kidney, the principal site of cisplatin cytotoxicity, they could mitigate cisplatin-induced chronic kidney disease in mice.

APOL1 G1 and G2 variants are established risk factors for nondiabetic kidney disease. The presence of two APOL1 risk variants in donor kidneys has a negative effect on kidney allograft survival. However, the role of APOL1-G1/G2 in kidney transplant recipients was not known. An important study led by Madhav Menon, MBBS, MD, in The Journal of Clinical Investigation showed that these genetic variants in transplant recipients increase the rate of kidney rejection and lower transplant kidney life. The study is also featured in Nature Reviews Nephrology as a research highlight and was the focus of a commentary in the American Journal of Kidney Diseases. The paper was also named editor’s pick in the JCI for December 2021.

The Yale Kidney BioBank

The Yale Kidney BioBank began enrolling participants undergoing kidney biopsies in August 2020, with samples included from a previous study from 2015-2018. The goal of the BioBank is to create a data and biological sample bank to support research in kidney diseases. To date, 594 participants are enrolled in the study. The BioBank is a program of the George M. O’Brien Kidney Center at Yale, which was established to facilitate translational and clinical research to advance the understanding and treatment of kidney diseases. “Our goal is to create a resource whereby interested investigators may obtain access to human samples and clinical data for use in sound biomedical research in order to advance our understanding of the pathophysiology of and develop therapies for various kidney diseases,” said Dennis Moledina, MBBS, PhD, the BioBank’s director.

Grants

Lloyd G. Cantley, MD, has long had a scientific interest in polycystic kidney disease (PKD). Now he is taking this work to the next level. He is principal investigator of a $11.577 million multidisciplinary study funded by the U.S. Department of Defense (DoD). The study, titled “Polycystic kidney disease: a disorder of glomerulotubular synchronization,” brings together five senior investigators at Yale, including Nephrology Section Chief Stefan Somlo, MD, to develop effective therapies for PKD.

Section faculty were among the winners of the Department of Internal Medicine’s Quality & Safety Process grants:

• Acute Hemodialysis Catheter Registry” (Nephrology). Project lead: Jeffrey Turner, MD.
• Optimization of Laboratory Monitoring of Home Self-administered Therapy with Erythropoiesis-stimulating Agents.” Project lead: Ravi Kodali, MD.
• Improving Pre-transplantation Immunization for Solid Organ Transplantation Candidates through the Implementation of a Novel Pre-transplantation Immunizations Review Process” (Infectious Diseases, Cardiology, Hepatology, Nephrology, YNHH Pharmacy).

New Faculty

The Section of Nephrology welcomed several new faculty members:

• Madhav Menon, MBBS, MD, is director of research in kidney transplantation. An important recent study by Menon and colleagues showed that genetic variants APOL1-G1/G2, in transplant recipients increase the rate of kidney rejection and shorten transplant kidney life.
• Tinika Montgomery, MD, specializes in chronic and end-stage kidney disease; she also sees patients in the Kidney Stones Program, a collaboration with the Section of Urology.
• Marcelo Orias, MD, PhD, specializes in chronic and end-stage kidney disease and is an internationally recognized hypertension specialist.

COVID-19

F. Perry Wilson, MD, has discussed the COVID-19 pandemic on social media, during media appearances, and on his regular series of educational videos on Medscape (The Impact Factor), where he analyzes the strengths and weaknesses of a variety of published studies with real-life implications. Wilson believes that science and the scientific method can help push back against popular misconceptions, especially during a pandemic. Wilson, the director of Yale’s Clinical and Translational Research Accelerator (CTRA), has been featured during the pandemic on PBS's Amanpour & Co., CNN, Healthline, the PBS News Hour, PolitiFact, Vox, WebMD, WTNH, Yahoo! News, and YaleNews.

Awards

Congratulations to the Yale Nephrology faculty for receiving the following awards:

• Mark A. Perazella, MD, won the 2021 Donald W. Seldin Award from the National Kidney Foundation (NKF).
• Shuta Ishibe, MD, won the 2020 Distinguished Researcher Award from the American Society of Nephrology (ASN).
• Whitney Besse, MD, won a Clinical Scientist Development Award from the Doris Duke Charitable Foundation.
• Madhav Menon, MBBS, received the Kidney International Early Career Researcher Award from the International Society of Nephrology in 2021, and the AST Award for Achievement in Basic Science, Early Career, from the American Society of Transplantation.

To learn more about the Section of Nephrology, visit medicine.yale.edu/intmed/nephrol/.