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MHH research team aims to find biomarkers for underlying diseases in interstitial nephritis and receives half a million euros in funding.
Our kidneys have many functions, including detoxifying the body. Every day, thousands of filter units in the two bean-shaped organs cleanse around 1,800 litres of blood and excrete waste products and toxins in the urine. These so-called nephrons consist of a renal corpuscle and an attached renal tubule. When the kidney tissue between the fine renal tubules becomes inflamed, immune cells migrate into the kidneys. This disrupts kidney function and can lead to chronic kidney failure. The most common causes of this disease, known in medical terms as interstitial nephritis (IN), are reactions to medications – such as antibiotics or painkillers – and infections. However, rare diseases can also trigger IN. The diagnosis can be confirmed with the help of a kidney biopsy. In many cases, however, the tissue sample does not provide any information about the exact cause. This presents an opportunity for the early detection of a rare disease before further damage occurs. In their project ‘Rare Diseases with Interstitial Nephritis’, Prof. Dr Christian Hinze and Dr Vega Gödecke from the Department of Nephrology and Hypertension at Hannover Medical School (MHH) are now searching for biomarkers to close this diagnostic gap. The project is being supported with around half a million euros as part of the ‘Innovative Diagnostics and Therapy Approaches for Combating Rare Diseases’ call for proposals from the zukunft.niederachsen funding programme.
Faster and more reliable typing
‘Inflammation is often mistakenly attributed to medication as soon as infection can be ruled out,’ says Professor Hinze, senior physician at the clinic. However, it may also be caused by an unknown rare disease that should not be overlooked in the diagnosis. ‘It's a bit like automatically thinking of horses when you hear the sound of hooves, even though a zebra could also be the cause.’ The researchers are now looking for a way to distinguish the more common ‘horses’ from the rare ‘zebras’. To this end, they want to find biomarkers that enable faster and more reliable typing of different forms of IN and the presence of rare diseases in order to prevent the loss of kidney function in affected patients.
They aim to achieve this goal with the help of clinical data from IN patients, an extensive kidney biopsy programme, and molecular and bioinformatic methods. ‘In our outpatient clinics for rare kidney diseases, we have extensive and unique patient cohorts and a large kidney biopsy programme,’ notes the nephrologist. ‘We want to use biopsies from 60 IN patients.’ The researchers hope to discover biomarkers that will make it possible in future to distinguish between common drug-induced causes and inflammation caused by rare diseases simply by looking at tissue sections under the microscope.
Biomarkers for systemic autoimmune diseases
In a second step, the aim is not only to distinguish the ‘horses’ from the ‘zebras’, but also to differentiate the zebras themselves more precisely. Although they look similar, their coat patterns are individually unique. The situation is similar with rare diseases associated with IN. ‘There are currently around 8,000 known rare diseases, many of which are associated with kidney problems,’ says senior physician Dr. Gödecke. ‘It is important to consider rare systemic autoimmune diseases in particular as a cause of IN for the purposes of prediction, as these are the second most common cause of IN after infections and are treatable.’ These chronic inflammatory diseases can be difficult to diagnose, as they vary from person to person and the symptoms can occur with a time lag. What they have in common, however, is that the immune system mistakenly attacks healthy tissue in the body. This can affect the kidneys, among other organs. While some of the rare diseases can be identified by detecting antibodies, others must be confirmed with a tissue sample. In very rare cases, IN is caused by a congenital disease. Acquired autoimmune diseases that can trigger IN include sarcoidosis, an inflammatory disease that can affect the kidneys, and Sjögren's syndrome, a rheumatic disease of the salivary and lacrimal glands that can also affect the kidneys.
The project therefore focuses on these two autoimmune diseases as examples. The aim is to find specific biomarkers for rare IN triggers so that rare diseases can be considered at an early stage, even in cases of non-specific findings. ‘The kidney is the window through which we can recognise a rare disease in the IN,’ says Professor Hinze. ‘Now we want to use the biopsies to focus on the causes and thus enable faster access to appropriate treatment.’
SERVICE:
For further information, please contact Prof. Dr Christian Hinze, hinze.christian@mh-hannover.de, and Dr Vega Gödecke, goedecke.vega@mh-hannover.de.
Separating the common ‘horses’ from the rare ‘zebras’ in the search for the causes of kidney inflamm ...
Copyright: Karin Kaiser/MHH.
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