BWH Clinical Research Faculty
PRINCIPAL INVESTIGATOR: Theodore I. Steinman, MD
RESEARCH INTERESTS
Polycystic kidney disease Dr. Steinman and collaborators are working in two areas of clinical and translational research that involve polycystic kidney disease. While the gene defect is known in both PKD1 and PKD2, there is no effective treatment to date to halt the progression of disease. The HALT PKD Study is investigating the role of the renin-angiotensin-aldosterone axis in promoting cyst growth in patients with PKD. The purpose of this study is to investigate whether an ACE inhibitor alone or in combination with an ARB will decrease the rate of cyst growth, and is combination treatment more effective than a single agent. The effect of medication will be separated from the effect of blood pressure control since one group will be treated to standard blood pressure treatment (< 130/80) vs. a second group who will be treated to a BP of < 110/70. This five year NIH sponsored study is now in progress.
Another study in the PKD population will be the use of Tolvaptan (a V2 receptor antagonist). When stimulated, the V2 receptor upregulates the production of cAMP. The intracellular signaling via cAMP has been shown to stimulate cyst growth. Use of this V2 receptor antagonist, which is an aquaretic, in the experimental PKD animal has been shown to decrease the rate of cyst growth. MR imaging will determine total kidney volume and total cyst volume of the control and treated groups over the course of the study (two different dosages will be used in the treatment arm). In addition, renal blood flow will be measured by MRA, and this will serve as a surrogate marker for GFR. Renal blood flow has been shown to decrease before any detectable changes in GFR and is thought to be a sensitive marker of kidney function in the PKD population.
Selected Publications
Steinman TI. How a diagnosis of PKD is reached. Nephrology News & Issues 2006 (in press)
Bajwa ZH, Wootton J, Gopalani AF, Chopra P, Graves DE, Ahmad B, Steinman TI. Utilization patterns of antidepressants in a multidisciplinary pain center. Arch Phys Med Rehabil (in press)
Bajwa ZH, Sial KA, Malik AB, Steinman TI. Pain patterns in patients with polycystic kidney disease. Kidney Int 2004; 66:1561-1569
Bajwa ZH, Gupta S, Warfield CA, Steinman TI. Pain management in polycystic kidney disease. Kidney Int 2001; 60:1631-1644.
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