Renal research in Edinburgh, and how it fits alongside the clinical service
Edinburgh was one of the earliest centres to introduce dialysis in 1959, and in 1960 was the location of the first kidney transplant in the UK. After this it became a major centre for research into kidney transplantation through the 1960s and 70s. Renal research has grown again since 1998, through a series of University appointments to joint research and clinical posts, so that it is now one of the biggest and best centres for renal research in the UK. At the same time, the renal and transplant units have also grown. We want it to be the place you’d like to come as a kidney patient, the place you’d want to work as a renal professional, and the place you should come to with research questions.
Little France. The Research Institute is to the left and the Royal Infirmary to the right
In 2005 our researchers moved into the Queen’s Medical Research Institute (QMRI) alongside the Royal Infirmary at Little France, as part of the Centre for Inflammation. This provides outstanding research facilities while keeping close to the clinical service, and enabling collaboration with the other top-quality scientists working in the building. We have 6 senior staff and over 20 other researchers working on renal projects. Some of the researchers are scientists at all stages from PhD student to senior posts, while others are doctors who do both clinical work and research.
What we are working on:
What causes kidney diseases, and how can we improve treatments? A large part of renal research in Edinburgh is laboratory research to find out the causes of kidney diseases, so that they can be prevented, or recognised sooner, or so that new treatments can be developed. Typically this kind of research seems to produce results slowly, over many years, even decades, but then it can make big differences. The areas we are focusing on in Edinburgh include:
- Inflammation and scarring – inflammation is involved in most kidney damage, and new ways of settling it down, or helping it to resolve without leaving scars, are the key to new treatments.
- Proteinuria – a sign that there is a high risk of kidney failure
- Autoimmunity – in autoimmune diseases, including many kidney diseases, the body’s own immune system makes a mistake and attacks itself. We are trying to find out why this happens and how it can be switched off.
- Diabetes – diabetes is one of the most common causes of renal failure in the world, and it is increasing. Some of our work is investigating this particular cause of kidney disease.
- Glomerular basement membrane (GBM) diseases – Some rare diseases affecting the GBM, including Goodpasture’s disease and Alport Syndrome. We are sometimes able to help with difficult cases of these and related diseases.
- Transplantation – things affecting how well transplants work and scarring.
We also work closely with research groups in the QMRI and elsewhere in the city on:
- High blood pressure and the kidney
- Small molecules such as endothelin that affect blood pressure and the kidney
- Genes causing problems with kidney development and kidney cancer
- Stem Cells as a way of encouraging healing and recovery
Other important collaborations are developing all the time.
Improving and testing new treatments for patients. We are involved in an increasing number of projects with patients, investigating new treatments as it becomes possible to bring them into use in humans. Some of these are driven by our own research, but in others we are testing treatments discovered elsewhere. These are just three examples:
- New blood pressure treatments that may slow down further deterioration after kidney damage.
- Possible treatments for polycystic kidney disease
- New anti-rejection drugs in kidney transplantation
How is all this paid for?
It is really difficult to obtain the money to undertake medical research over long periods. Our laboratory research is funded by grants from the Medical Research Council, the Wellcome Trust and Kidney Research UK, and by a number of other bodies. All of this funding is competitive – we are competing with research of other types, and into diseases affecting different organs. Most grants cover 2-3 year pieces of work, occasionally 5 years. A typical 3-year project costs over £250,000, although smaller projects can be done for less. We are helped by being in a centre where we have excellent facilities and collaborators, and by having excellent people.
What else is happening in renal medicine in Edinburgh:
We believe that you can’t develop an excellent research group in isolation. We need to be part of a unit that does everything well – provides the very best patient care and teaching as well as research. That means that other people will want to come and see it and we’ll persuade the best people to work here, to the benefit of patients, research, teaching, and the whole service. So here are some of the things that have been happening beyond research.
www.edren.org
In a collaboration between research and clinical teams since 2000, we have written hundreds of pages of patient information and medical protocols which have been published for all to see at www.edren.org. This now receives well over 1 million ‘hits’ per year, and our easy-to-understand information pages are read all over the world. They are written and kept up to date by members of the unit.
The clinical renal unit, teaching, and more:
In the last 10 years almost the entire senior clinical team has changed – and grown, from 3 consultants in 1996 to the equivalent of 7 in 2006. However this is to look after a much larger group of patients, a far busier transplant service, and to see many more outpatients. We now have 3 outlying dialysis units and clinics. We have a tremendous clinical team which has excellent relationships with the transplant team and with the academics involved in lab research.
There have been measurable improvements in the quality of service in recent years, but a number of developments that aren’t so easy to measure. Here are just a few recent highlights:
Online results for patients – hundreds of patients in Edinburgh are now enrolled in Renal PatientView (www.renalpatientview.org) so that they can use an Internet login to read their test results online, along with explanations of the tests, and of their diagnosis and treatment. They can also read letters sent to their GPs.
Email advice service for GPs – a service that saves many patients from needing to come to a renal clinic.
Specialist clinics – specialist clinics for adolescent transfer patients, for patients requiring management of difficult autoimmune diseases such as vasculitis and SLE, for issues around pregnancy, and others.
Conservative care programme – a dedicated service for patients who decide that dialysis and transplantation aren’t for them.
Transplantation - more live related transplantation, pancreatic transplantation – major developments and growth in the transplant service.
Teaching – many of the Edinburgh renal consultants are very involved in teaching medical students and others, and in writing international textbooks. There is also a very successful renal nursing course.
Can I help?
We have a local research fund that is used to support aspects of research in Edinburgh. Contact us at: renal@ed.ac.uk, or 0131 242 9167, or by post:
Renal Medicine (CIR E2.44)
Queens Medical Research Institute
47 Little France Crescent
Edinburgh
EH16 4TJ
Or you can make an instant online donation via Paypal.
Nationally, Kidney Research UK (www.kidneyresearchuk.org) is the largest funding body for renal research in the UK and decides where best to spend money, see their website for more details.
Further information:
About research – there is a Centre for Inflammation website with information on each of the research groups at www.cir.med.ed.ac.uk. It isn’t always very up to date.
EdREN – go to www.edren.org to see our patient information (under INFO), medical protocols (under Handbook), GP info, and education resources for students, doctors, nurses, and other professionals.
About the Unit and its history – at www.edren.org click on ‘Unit’ then ‘History’.
| How to << | (no next) |
