Why is the time ripe to focus magnetic resonance imaging on the kidney?
The figures from the health community are overwhelming: the incidence of renal diseases is rising, particularly for acute kidney failure and chronic kidney disease. Every third patient in intensive care is suffering from an acute kidney condition. Chronic kidney disease affects over 10% of poulations worldwide and is responsible for an estimated two million deaths per year. Mortality rates exceed those for most cancers, but patients are underserved by inefficient and unsuccessful treatments and drug development. Alongside a lack of good therapies, and most existing diagnostic methods are based on biomarkers that first arise when the disease has reached an acute stage.
MRI comes in because we can use it to assess renal oxygenation and haemodynamics. The kidney is always at the brink of oxygen insufficiency, which can become acute and trigger organ failure. Catching early signs of this would be invaluable for diagnosis.
What needs to happen for this to become a standard in medical practice?
MRI stands at this tricky interface between physics, physiology, biology, and medicine. Physicians are often unaware of the potential of new methods and the imaging community has been in the dark about the needs of nephrologists. Developing effective new medical applications for this type of imaging always requires real effort to transcend traditional disciplinary boundaries and develop a common language.
For us the first step has been to learn about renal physiology. If we don't understand an organ, we can't provide a physiological interpretation of imaging data. You're left with guesses and speculations.
We started looking at this problem about five years ago through funding from the DFG to establish an interdisciplinary research group (FOR1368). In a partnership with the Institute of Vegetative Physiology of the Charité, we brought over a technical setup from a physiology department and integrated it into an MR scanner. This allowed us to apply MR while simultaneously acquiring physiological data which we could use as a reference. That was a crucial step in turning an invasive technology into one that is non-invasive.
What was the outcome of the first meeting, and what are your hopes for this one?
The first international symposium on this topic took place in Bordeaux, France two years ago. The attendance was small but the event was extremely valuable. Putting everybody from all these disciplines in a room for two days is a way to ensure a common outcome and a consensus rather than trying to get things done by email.
This year we're expecting about 150 attendees from throughout Europe, America and Asia. The composition is about 50% from imaging, 25% from nephrology and most of the rest are physiologists. The meeting is co-organized by the, for which I am the German representative in the management committee. This cross-domain platform is an immediate result of the first meeting. This year the program has attracted both top clinicians, leading experts in imaging and first class physiologists; and it will help us better understand the physiological and molecular meaning of imaging findings and apply what we learn. With this in mind the symposium is a catalyst for the advancement of renal diagnostics and therapies and is creating an ever increasing number of opportunities for discovery. We are also nurturing the development of a new profession: renal integrative specialists (Renalists) who will build important bridges between physics, physiology, biology and medicine.