Polycystic Kidney Disease
Dr. Steinman has been engaged in polycystic kidney disease research for the past many years. A study was completed which documented the relationship between cyst volume and glomerular filtration rate in patients with autosomal dominant polycystic kidney disease (ADPKD). He is now embarking on an NIH sponsored multi-centered study examining the inter-relationship between blood pressure, cyst volume, total kidney volume and renal blood flow (measured via an MRA technique) in ADPKD patients. Therapeutic interventions will investigate the renin-angiotensin axis as a factor in predicting progression of renal disease in the hypertensive ADPKD patient. The study will also examine the renin-angiotensin axis in the normotensive ADPKD patient, and determine if this humoral axis plays a role in progression independent of the blood pressure. Two groups will be studied, those with a calculated (via the modified MDRD equation) GFR of 30-60 cc/min and those whose GFR is >60 cc/min. Ancillary studies will also be conducted, depending on the total funding available. This 5 year project will allow a renal fellow interested in clinical research to be immersed in the clinical care of this study population, and understand the nuisances involved in doing detailed clinical investigation. At the same time, knowledge will be gained about the pathophysiology of ADPKD, the issue of genomics and therapeutic interventions in a field that is rapidly evolving. The HALT PKD study group is part of an NIH-sponsored therapeutic network. More cooperative studies will follow this initial investigation.