Researchers - Renal Medicine
Peter Stenvinkel (PS) is a senior lecturer at Karolinska University Hospital and Professor of Nephrology at Karolinska Institutet (KI). His hirsh index is 79 (Google Schoolar). He has published about 410 peer-reviewed publication and 30 book chapters. In collaboration with basic research labs, Baxter Novum, geneticists, and epidemiologists PS conducts translational research with focus on risk factors for metabolic, cardiovascular and nutritional complications in chronic kidney disease (CKD). His research is funded by the Swedish Medical Research Council (VR), ALF, Westman Foundation, KI funds and others. He was the first (Kidney Int 1999; cited about 1600 times) to demonstrate that persistent uremic inflammation with retention of pro-inflammatory cytokines play a key role in the development of a syndrome including protein-energy wasting and atherosclerosis. Subsequent studies have confirmed key roles of inflammation, and its partner in crime - oxidative stress, in many of the complications that develop in the toxic uremic milieu. Large prospective and carefully phenotyped cohorts (i.e. MIA, MIA-Tx MIMICK-1, MIMICK-2, PRIMA, PRIMA-controls and Kärl-Tx) of CKD patients at various stages of disease serves as the basis for his ongoing studies. As CKD patients in MIA-Tx and Kärl-tx undergo renal transplantation (Rtx) it provide the group with an excellent opportunity to study the effects of normalisation of kidney function on vascular functions, ageing biomarkers etc. In detailed ex vivo studies of endothelial function of resistance arteries he and collaborators showed that uraemia has a strong impact on endothelial function. The role of uremic fat tissue has also been investigated and his group has demonstrated increased expression of various pro-inflammatory genes in uremic fat. PS showed 1997 that circulating leptin levels are exceedingly high in CKD and that the ob gene expression is down-regulated. Subsequent studies demonstrated novel links between leptin, inflammation, insulin resistance and body composition. His group has also published several Ms on the metabolic effects of other adipokines, such as adiponectin, resistin and visfatin in the uremic milieu. As part of the ARO group PS conduct epidemiological studies in dialysis pts and have as such published several papers in high impact journals. They recently showed that the obesity paradox only exist in inflamed dialysis patients. PS has published several Ms on the impact of gender in renal disease. His group was 2009 the first to show that low testosterone levels predicts poor outcome in male dialysis patients and that low testosterone levels independently predict resistance to ESA in male dialysis pts. In collaboration with other groups he have shown that testosterone deficiency is associated with endothelial dysfunction and low muscle strength. These findings motivated PS to initiate an ongoing randomized controlled trial on testosterone supplementation (DiaTest) in male dialysis patients. The impact of protein-energy wasting and anorexia have been the topic of several studies conducted by PS. His group was the first to show that low ghrelin values in wasted dialysis patients were linked to a markedly increased cardiovascular mortality risk. PS have been a member of several international consortia that have published well-cited consensus reviews, especially in the area of wasting. In an ongoing PhD project (PS main supervisor) the effects of inflammation and genetic variations in the CYP gene on pharmacokinetics is studied. The preliminary finding of a correlation between CYP3A4 activity and inflammatory biomarkers suggests that persistent inflammation down-regulate CYP3A4 activity. This could have major implications for drug dosing in persistently inflamed patients. Together with Dept of Microbiology his group presently study relations between the microbiota (i.e TMAO, choline and betaine) levels and renal function, inflammation, vascular calcification and outcome. Within the Diabetic theme Center at KI his group perform metabolic studies of fructose challenge in type-2 diabetes and CKD and study insulin resistance in CKD 2-4 pts. His group have been part of two collaborative Ms on the role if IgM antibodies in uremic cardiovascular disease. PS have been part of several genetic studies documenting the role of polymorphism in the ApoE, CCR5 and fetuin genes for the uremic phenotype. As part of international consortia PS have published four GWAS papers (Nature + Nature Genetics) on genetic loci associated with kidney function and blood pressure. His group were the first to demonstrate an association between inflammation and global DNA hypermethylation in the uremic milieu.
At present PS focus on uremic vascular calcification (VC) by careful pheno-, geno, and epigenotyping of uremic pts undergoing LD RTx. Studies of bone mass and structure is included as part of this project. As his group showed that VC is linked to hypothyroidism (low fT3) he currently study links between fT3, klotho and MGP and other biomarkers of ageing. Vascular biopsies are used for epigenetic, genetic analyses and staining for inflammatory and bone markers. PS also study uremic muscle wasting; muscle biopsies are analyzed for expression of factors involved in the imbalance of anabolic and catabolic mediators in the uremic milieu to identify gene regulatory networks affecting muscle mass. As part of the European consortium EuTox his group study biomarkers and effects of uremic toxins on vasculature. In collaboration with Lunds University his group studies the impact of increased glycation, oxidation and truncation of the apolipoprotien A1 in the uremic milieu.
PS have proposed that uremia could be regarded as a clinical syndrome of premature biological ageing. He collaborates with a cellular gerontologist for analyzes biomarkers of aging, such as telomers, CDKN2A and miRNAs in uremia and their changes following RTx. Much novel information are currently prepared for publications. PS plan to study, putative anti-ageing interventions in the context of uremia, such as anti-inflammatory agents, sirtuins (roles in mitochondrial biogenesis), testosterone (increase expression of klotho) and vitamin K (activates MGP). PS have launched the novel field of ”kidney biomimicry”. As part of the Scandinavian Brown Bear project PS study plasma, serum and muscle biopsies from brown bears to elucidate the extraordinary capacity of hibernating bears to maintain muscle and bone mass despite months of immobilization, starvation and anuria. In collaboration with Prof Rick Johnson in Denver, USA other biomimetic projects are ongoing. In collaboration with Astra Zeneca PS group try to find novel biomarkers and novel molecular targets for treatment of diabetic nephropathy and other glomerulopathies. In collaboration with transplant surgeons, he conducts a “first-in-human” study of selected renal cell implantation via hand-assisted laparoscopic technique directly in the kidney cortex of type-2 diabetic CKD stage 4 patients. Six patiens have so far been treated.
The ultimate goal for PS studies, which range from “safe” descriptive studies to more “risky” innovative interventions, biomimetic and “first-in-human” studies, is the translation of basic research into novel and improved therapeutic approaches to arrest premature ageing processes in CKD and to decrease the unacceptable high mortality and at the same time improve quality of life for this expanding patient group.
The research team
- Peter Stenvinkel, Senior lecturer, Professor
- Bengt Lindholm, Professor, head of Baxter Novum
- Louise Nordfors, PhD, Geneticist
- Anna Witasp, PhD, Researcher
- Tony Qureshi, MD, Statistician
- Peter Barany, Senior lecturer, Associate Professor
- Olof Heimbürger, Senior lecturer, Associate Professor
- Karin Luttropp, PhD student
- Hadi Molanaei, MD, PhD student
- Erik Nilsson, MD, PhD student
- Björn Anderstam, PhD, Chemist
- Matthias Haarhaus, MD, PhD
- Hannes Olausson, MD, PhD
- Sunna Snaedal, MD, PhD student
- Annika Wernerson, Senior lecturer, Associate Professor, Dean of education
- Marie Evans, MD, Postdoc
- Peter Bergman, Assoc Professor, Dept. of Microbiology, Karolinska University Hospital
- Lars Wennberg, Assoc Professor, Transplantation Unit, Karolinska University Hospital
- Torbjörn Lundgren, Senior lecturer, Transplantation Unit, Karolinska University Hospital
- Karolina Kublickeine, Associate Professor, Dept of Gynecology, Karolinska University Hospital
- Leif Bertilsson, Professor, Dept. of Pharmacology, Karolinska University Hospital
- Martin Schalling, Professor, Neurogenetics at CMM, Karolinska Institutet
- Jonaz Ripsweden, MD, PhD, Dept. of Radiology, Karolinska University Hospital
- Torkel Brismar, Associate Professor, Dept. of Radiology, Karolinska University Hospital
- Johan Frostegård, Professor, Unit of Immunology, Karolinska University Hospital
- Juan Jesus Carrero, Associate Professor, Renal Epidemiology, Renal Unit, CLINTEC
- Stefan Arver, Professor, Dept. of Andrology, Karolinska University Hospital
- John Flanagan, Associate Professor, Dept of Andrology Karolinska University Hospital
- Kerstin Brismar, Professor, Dept. of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital
- Mikael Rydén, Professor, Dept. of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital
- Maria Eriksson, Associate Professor, Dept. of Biosciences and Nutrition, Center for Innovative Medicine
- Paolo Parini, Professor, Dept. of Medical Chemistry, Karolinska University Hospital
- Ole Fröbert, Professor, Örebro University, Örebro
- Per Magnusson, Professor, Linköping University, Linköping
- Bengt Fellström, Professor, Uppsala University, Uppsala
- Fredrik Erlandson, MD, PhD, Astra Zeneca, Mölndal
- Mats Gåfvels, Professor, Lunds University, Lund
- Jose Divino, MD, PhD, Diaverum, Munich, Germany
- Pieter Evenopoel, Professor, University Hospitals Leuven, Leuven, Belgium
- Jeroen Kooman, Professor, Maastricht University, Holland
- Christiaan Meuwesee, MD, PhD, Leiden University, Holland
- Paul Shiels, Professor, Cellular Gerontology Institute, University of Glasgow, UK
- Jurgen Floege, Professor, Aachen University, Germany
- Alp Ikizler, Professor, Vanderbilt University, USA
- Rick Johnson, Professor, University of Colorado, USA
- Peter Kotanko, Professor, Renal Research Institute, New York, USA
- Gustavo Nader, Associate Professor, Dept of Kinesiology, Pennsylvania State University, USA
The group work within the following consortia
ARO, EuTox, Scandinavian Brown Bear Project, Diabetic Theme Center, KaroKidney
Link to short biography (pdf)
I am an associate professor and senior lecturer at CLINTEC and a senior consultant in pathology (renal and transplantation pathology) at Karolinska University Hospital. I perform research in both renal medicine and medical education. The medical research project is focused on studies of the underlying mechanisms of different kidney diseases. The medical education research project aims to understand how emotionally difficult situations affect learning for medical, nursing, and teacher students. I am a member of the Pedagogical Academy at KI. I have received the KI Pedagogical Prize and a prize for clinical supervisors at Karolinska University Hospital. I have a longstanding, deep involvement in educational matters; I am teaching, I have been a member of the board of the medical program (PN) and a Director and Coordinator of the Centre for Clinical Education (CCE) and currently I am the dean of higher education at KI.
Teaching experience and interests
Since 1986, I have been teaching pathology in several educational programs and also been a director of studies and a course coordinator. For several years I was the director of studies (programstudierektor) at Karolinska University Hospital, Huddinge. I have developed courses and participated in the change of the medical program (LUT). Since several years, I perform educational development and research where I, among other things, have developed case seminars in pathology for students at several programs (medical- , dental- , nursing -, medical informatics and biomedical programs ), and have also participated in the development of new examination forms.
From 2008 -2015 I was one of four directors of the centre for clinical education (CCE). We, together with the employees, built up and established the centre and I had a coordinating role. The assignment of the centre is to improve quality of clinical education for all students at KI. Several tools have been developed, including a new model for evaluation of clinical evaluation. More than 600 teachers / clinical supervisors have participated in CCE's pedagogical course in higher education for teachers and supervisors in clinical practice, 7.5 hp.
2010-2015 I was in the board of the medical program.
Since 2015 I am the Dean of higher education and chair of the board of higher education.
I am the principal investigator of research in kidney diseases and in medical education.
My current research in kidney diseases is mainly funded by ALF. The project aims to gain a better understanding of the causes of different types of renal diseases. By close collaboration between several clinics, we carefully characterize patients undergoing renal biopsy. The aim of the project is to prevent disease and to improve methods for diagnosis, treatment and follow-up. ICMC and AZ are important collaborators. As part of this project I collaborate with researchers in Central America and Sri Lanka to find out why young men working on sugar cane plantations suffer from chronic renal failure.
Renal biopsy group:
Annika Wernerson, Associate professor
Kjell Hultenby, Associate professor
Peter Barany, Associate professor
Peter Stenvinkel, Professor
Carl-Gustaf Elinder, Professor
Annette Bruchfeld, Associate professor
Maria Herthelius, Associate professor
Lars Wennberg, Associate professor
Karin Lindström, Associate professor
Anna Witasp, PhD, Research assistant
Anneli Ring, Laboratory technician
Annika Nilsson, Research nurse
Jarmo Henriksson, Research nurse
Jia Sun (co supervisor)
My current educational research is funded by the Swedish Research Council (VR) and ALF. My colleagues and I are studying how emotionally stressful situations affect learning for medical, nursing and teacher students. The project is performed in collaboration with Linköping University and aims to get a better understanding of students´ development and socialization into their professional roles and what the educational programs can do to better support the students for their future profession.
The educational research group:
Annika Wernerson, Associate professor
Håkan Hult, Professor
Astrid Seeberger, Associate professor
Post Doc: Maria Weurlander, PhD
Annalena Lönn, MD
Adjunct Professor Carl-Gustaf Elinder (CGE) is interested in Nephrology, epidemiology and environmental issues. Started as a young bird watchers and medical student at Karolinska Institute in the 1970s to study heavy metal accumulation in the body caused by cadmium and health effects. Went on to become occupational and environmental medical student and taught and examined the various environmental and occupational exposures relevant to disease and health. Eventually became professor of occupational medicine in 1985. Then made a bit of a shift, and began to train as a kidney medicine. The research area was then renal epidemiology and toxicology. After nearly 10 years as Head of the Department of Renal medicine at Karolinska University Hospital CGE in 2010 became head of the Department for evidence-based medicine at the Stockholm county Health Care Administration and adjunct professor of Nephrology.
CGE has published a few hundred scientific articles and book chapters and supervised over 10- PhD students at Karolinska Institutet. Current interest and research areas is the Mesoamerican nephropathy, a recently identified kidney disease in Central America possibly related to environmental exposures, and another project using a large cohort of any person who have submitted a renal function test (P-creatinine) within the SLL (a population of close to a million!) in order learn more about the prognosis and risk factors for chronic kidney disease. CGE is co-supervisor of two graduate students working in these areas.
Recent publications (pdf)
Tobias Larsson, MD, PhD, is an associate professor in experimental medicine and a staff physician in internal medicine and nephrology and a member of the scientific board at the Nephrology Unit in Karolinska University Hospital.
He received his medical degree 2002 and subsequently presented his award-winning thesis the role of FGF23 in phosphate homeostasis 2004 at the Department of Medical Sciences, Uppsala University. He performed parts of his PhD-studies in the Endocrine Unit, Massachussets General Hospital, Harvard Medical School, Boston, USA and completed a post-doctoral fellowship at the Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, USA
General internal medicine, metabolic bone disease and renal disorders
Dr Larssons research interest mainly includes bone- and mineral metabolism with particular focus on the molecular physiology of FGF23 and Klotho and its regulation in chronic kidney disease (CKD). He is the principal investigator of several grants, including the Swedish Research Council, Swedish Kidney Foundation, Swedish Society of Medicine and the Novo Nordisk Foundation to study the role of FGF23 in phosphorous metabolism, secondary hyperparathyroidism and cardiovascular disease related to CKD.