onbueae: Age at asa | PD cout, | nie 90m Pn 282-082 Bcwei) ‘A publication exclusively for medical students and residents in Inernal Medicine by Nephrology On-Demand Stay connected with us through the NOD Plus App: knp:f/goo gi{SAQT A PIONEER IN KIDNEY TRANSPLANTATION: SAMUEL KOUNTZ "~~" In celebration of Blac History Month, it sems appropriate to discuss butions to the field nephrology ‘Typically, when the topics of African~Americans and kidneys thoughts are focused on 1 an Americ disproportionate number of | Disease (ESRD). In celebration of Black History Month, let's start this isue of Kidney Konnection with the important contributions made by one ro end kidney disease oun, MD (circa 1960) Ds, Samuel Kountz was an African-American who grew up in Arkansas and graduated from the University of Arkansas for ‘Medical Sciences in 1958, He first m: performed kidney transplant using a non ‘A true pioneer, Dr. Kountz also conducted the frst West Coast Kidney transplant in 1969 and the first kidney teansplant in the (Egypt) in 1966, While these kidney transplants made wughout the medical co Dz. Kounts did not consider a kidney transplant scientifically successful unless the recipient for 20 years the abil headlines in 1961 when he he first ev Koi treat the rejection of trans discovered th committed cells ofthe host destroyed small blood vessels of the transplanted kidney, Overtime, this process would lead to ki death from a lack of blood~supplied oxygen. To counteract phenomenon, Kountz helped uncover the effectiveness of| methyiprednisolone in reversing acute rejection of the transplanted Kidney. search resulte Before this discovery, only 5% of kidney transplant recipients + longer thaa two years. Dr. Kounts also aided the kidney transplant process by developing the Belzer kidney perfusion machine! a machine that pres outside of the donor's hody. survived up to 50 hours Aesctbed by Folker Belzer é Samel Kounte gery 19101723 knowledge of the kidneys, sw York mes obituary, Kounta was described as having "had a deep social drive beyond his scientific interest in advancing transplant surger (http://g00.gl/NwhLPl). He demonstrated compassion and sensitivity ‘especially those suffering with ESRD and the sociceconomic challenges involved in receiving treatment. Dr. Kountz was an aggressive advocate of organ donation and reportedly motivated 20,000 kidney donations following a live kidney ‘which be conducted on The Today Show on February 26, Dz. Oz..20p that!” (http://goo g/NIGOON), Furthermore, Dr Kountz sought the position of chief of the Downstate Medical in Brooklyn a the black commu for Medicare coverage alysis and transplants cowards all “enter medical care for the hospital, Dr. Kountz lobbied of ESRD to bring equity in patient access to cegardless of financial means ans 3s. Kounte was a brilliant surgeon still impact nephrology generations after his passing. His passion for serving and healing those in the shadows of society ‘which taly set Dr, Kountz apart, Unfortunately, to the shadows: and many of these patients are minorities ‘who suffer from kidney disease, We can honor his lega by working tzelesly to lessen the disparities faced by minority patients, d discovered techniques that y everyday on H ethylprednisoloneNephrology On-Demand myFellowship@ecu edu htep:/goo.glfSAQT —_brtps// dtr To es | Gl Gi Cin THE APOL1 GENE IN AFRICAN-AMERICANS by fae Ded hin ed If you ask the NKF (National Kidney Foundation), they'd tell you that Aérican~Americans have 4~ to 5~ fold higher risk of end stage renal failure than European Americans & this group constitutes more than 32% of all patients in the USS. receiving dialysis for kidney failure, That may not alarm you, but consider that Aftican~ Americans represent 13% of the overall USS, population. Add to that the fact ‘hat African~Americans ate 1,7 times more likely to have diabetes than non-Hispanic whites, Most frightening is the rate of hypertension-associated end stage renal disease. In the US,, the incidence of ESRD due to HTN exhibits the largest racial difference (black )) white) than any other etiology of ESRD. For decades, socioeconomic factors were blamed for all of these racial disparities. But a group of kidney investigators never fully bought into the idea that environment alone was the cause of the racial differences. ‘And now, genetic studies have confirmed those initial suspicions! and the blame lies atthe feet of the APOLL gene. yy “Whol? APOLI?? Never beard of it” ‘Oh dut you have...youve heard of APOLI but, like many others, never knew i existed APOL! sits on chromosome 22 and encodes apolipoprotein 1, circulating protein whose job it is to kill Trypanosoma brucei and various other trypanosomes. Why would a person have a built-in gene to kill one specific ‘micro-organism? In areas with high sleeping sickness burdens (culprit: trypanosomes), homozygotes for APOL1 have an evolutionary survival advantage. But in the US, where trypanosomes aren't prevalent, there if no apparent selective advantage of having the APOLI gene product. In fact, in these non~endemic areas, the APOLI gene confers a negative (deleterious) effect! increasing the risk of having kidney disease, This strong “selective pressure” on the Jnuman genome is similar to that seen with sickle cell trait ‘against malarial infection in endemic areas, ‘We now know that the gene product of APOLI exerts a pathologic effect in black patients w/HIVAN, FSGS, & CKD due to HTN, It remains to be seen if APOLI increases the risk of diabetic kidney disease, but with its track record, ‘we wouldn't be surprised if di. So tell us: do you consider APOLL more of a friend or a foe? Tweet us @kidney_md &for @nephondemand I THINK THEREFORE I KNOW - IT'S TUBE 3! Last month we introduced our first photo quiz, The history was about 3 46 year old asymptomatic individual who had a serum sodium concentration returned at 112 mEg/L with an LDL of 120 and triglycerides (TG) of 10,800 mg/dL. ‘We asked you which test tube belonged to the patient and to tweet or email your answets to us, The answer ie tube 3 (Grom the left) ‘The patient is sufering from pseudohyponatremia, a condition in which the elevated (ur winners will each receive a 100%-off discount code to publish their next scientific ‘manuscript with Peer} (@xhePcer)). a, 4 Side Ninners are. ~~ e, Maliner Paar: @wiyKidney Dr, Harie Mobeen: @bamrap De. Fran! @enoguahangee De, Si Sha avis triglycerides confuse the laboratory machine into measuring the [Na"] lower than it actualy i, A serum sample with loads of TGs looks milly in appeazance, OOPS! In the December 2014 issue (H6) we stated that the only kidney stones that dissolve are uc acid stones, Wel, stone guru David Goldfarb (@weddelite) of New York University & the Rare Kidney Stone Consoztium (rarekidneystones org) reminded us that “cystine stones can dissolve, High urine pH, with some thiol, they can dissolve, I've seen it happen, Not as easy as uric acid,” Thanks for setting the record straight!