Local Journalism Initiative Reporter
Research at the University of Calgary has made a breakthrough into what may be the first treatment preventing acute kidney injury, and it all hinges on one molecule.
Commonly seen in those undergoing intensive care, acute kidney injury (AKI) can be caused by a myriad of factors, said Dr. Daniel Muruve, the senior researcher in the study. It’s commonly caused when interrupted blood flow returns to the kidney, and can happen in instances such as cardiac surgeries, transplants, blood loss, and infection.
Older individuals, individuals with diabetes or underlying kidney disease, or even dehydration can create greater risk for AKI, and currently, there is no treatment for the condition when it occurs, and medical professionals can only “watch and support,” said Muruve, as AKI increases the risk of heart attacks, chronic or end-stage kidney disease, and death.
However, the discovery of Muruve and his team may change this, as they’ve found one of the culprits behind the inflammation that is a prevalent part of AKI.
“We’ve been studying how inflammation contributes to acute kidney injury. The molecule that we discovered and then developed some therapeutic agents against regulates inflammation in the kidney, an inflammation that is a big part of acute kidney injury,” said Muruve. “We basically showed the basic science behind how kidneys get injured and how inflammation contributes to an injury.”
“When you have a loss of blood supply to the kidney, the kidney tissue obviously gets damaged. And because of that lack of blood supply, and then there’s, with that, a tremendous inflammatory response, that can make the damage worse,” said Muruve. “What we figured out was how that inflammatory response occurs. And so that’s really what we did, we identified a very important molecule that sort of regulates the inflammation after the blood supply, that kidney has been cut off. Interestingly, if you block that pathway, you get less inflammation, and you get less kidney injuries and a kidney doesn’t get as injured as if it had all those white blood cells and other cells going into the kidney as part of the inflammatory response.”
In pre-clinical models, two drugs have been shown to prevent kidney injury when tested in mice. Both of these drugs have already been used in humans before, which helps to streamline the process to a clinical trial, which Muruve and his team intend to do within the next 12 months. This research has taken place over only 5 years, a remarkable turnaround for work in medical research, but the results have been promising.
“We’re screening the effects in mice and animals. We need to see if it works well in humans. We know these drugs are safe in humans, and we know that they work in other conditions for humans,” said Muruve. “So now it’s time to test and see if they can at least improve acute kidney injury. We don’t need to cure it, we just need to improve it, you know, reduce it by 20 to 50%, for example, and I think that would have a huge impact on patients.”
Many individual who experience acute kidney injury are left with chronic kidney disease, which puts them at a higher risk for heart disease and stroke. When the kidneys don’t recover, many patients also require dialysis or transplant, which are costly for both the healthcare system and difficult for the patient and their families.
“If we can prevent some of that, it would be huge, because it’s so common already. Even a small improvement, like I said, 20% is a big number. So that would be great. And that’s our goal is to bend the curve a bit on this. And I think because there’s no other treatment, for this condition, there’s nothing really, it just happens. And we basically watch, right? And we support. And that’s not ideal,” said Muruve.
Muruve is hopeful that they will see results in the clinical trial. He notes that nephrology has had few breakthroughs like this in the past 30 years, and this could be a once in a lifetime chance for medical advancement in a common problem.
“I just think about my practice and my patients and how I think we need to improve what we do. And that’s what motivates us to do this kind of work,” said Muruve. “So I really, for the sake of the people that suffer from kidney disease, I really hope this works.”
Joyce Van Deurzen, Executive Director of the Southern Alberta Branch for the Kidney Foundation of Canada, shares his hope and excitement at the discovery.
“Acute kidney injury often comes as a complete shock. It’s not expected, it’s not anticipated. And it can lead to kidney, chronic kidney disease and kidney failure in the future, or immediate kidney failure, right, instant kidney failure” said Van Deurzen. “And when your kidneys fail, you need either dialysis or a kidney transplant to survive. So anything that can reduce or eliminate acute kidney injury is huge, and transformational for people. If we can prevent any patients from having to suffer from acute kidney injury, that is really tremendous, a tremendous way of preventing future kidney disease, kidney failure, and potential need for a kidney transplant.”
The Kidney Foundation is one of the funders of Dr. Muruve’s research, said Van Deurzen, and are thrilled to have contributed to a breakthrough that could potentially save so many lives.
This research may not only help prevent future kidney disease and need for transplant, but may assist both the healthcare system and those currently in need of a transplant as less people are added to the list.
“Kidney disease and kidney failure is a very, very costly disease to treat. It is a tremendous burden on people’s lives who are living with kidney disease,” said Van Deurzen. “So if we can prevent those things, it truly changes people’s lives. And we are really at the Kidney Foundation. We’re really proud to have funded this research here to have this done right on our own doorstep tab, this leadership team doing this research right here in Calgary. That’s very powerful for our province. And we’ll have an impact far, far beyond our borders.”