I’ve been reading about the kidney for the last few weeks as part of medical school and so far so good. It’s interesting stuff honestly.
It’s also funny, because the kidney is actually really important. Without kidneys you die. In fact, you die pretty quickly too. And a miserable death at that.
Kidneys act as the filter for the body. The urine that you get rid of is full of stuff that realistically you don’t want in your body. Urination is how your body maintains its’ weight, the pH of your blood, and a good balance of all of the nutrients, proteins, and other stuff that you shouldn’t ordinarily have floating around.
Kidney failure, a.k.a the thing that leads to a miserable death, is essentially a problem with the filter. In many cases, it’s because of something stuck to the filter that keeps other things that are supposed to go through the filter from doing so.
Trauma, and its’ complications (hypotension, hypoperfusion, cytokine storms) can lead to kidney failure. I’m wondering if the kidney failure has anything to do with the cytokine storms and immune system function almost immediately post-trauma. If you think about it, cellular sloughing from the kidney that makes its’ way back into the systemic circulation could be seen as some type of antigen that is then recognized by T-cells and a rather fast T-cell mediated response could then go and “gunk up the machinery” in the kidney. This could quickly lead to renal failure by virtue of the combined hypoperfusion/hypotension and the increased thickness of the glomerular basement membrane.
Crazy huh? Well get this…One of the problems with gene therapy nowadays is that the genes’ begin to work but then they stop working after a short period of time – usually a few months. What if we could target the glomeruli of the kidneys to selectively take up a viral construct that enhanced their plasma membrane turnover and then – like the rest of the kidney does when it chews up proteins – degrades what ever is stuck to the membranes. This could in effect be a self-cleaning filter. Since the glomeruli don’t normally do this – it could be harmful after the initial storm of immune-complexes have cleared, so you would want to have a kill switch.
Here’s where it gets elegant – the “problem” of the gene therapy not working after a month or so will lead to the genes being turned off – which would lead the glomerular cells to revert back to working like normal. And right there it is… Trauma induced renal failure solved…
Not really, but it’s at least an idea…
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