Nephrology

For many years, the research group has been studying the pathogenesis and disease progression of IgA nephropathy (IgAN) and has built up one of Europe’s largest patient cohorts, with clinical follow-up data spanning several decades. International collaborations have been established in both Europe and the USA. In collaboration with the Departments of Nephrology and Rheumatology at Karolinska University Hospital, we have, since the 1990s, built up a biobank collection comprising blood, urine and tissue samples from all patients who have undergone a renal biopsy, with various underlying diagnoses, as well as follow-up samples from patients with IgAN and IgA vasculitis with renal involvement.

We are investigating inflammatory markers in blood, urine, at the cellular level and in kidney tissue that may be relevant to pathogenesis and disease progression in IgAN and other forms of glomerulonephritis, such as SLE nephritis. We will also investigate the relationship between gut microbiota, intestinal mucosal barrier function and glomerulonephritis (the Muco-Immuno-Renal project, MIR) and risk factors for the recurrence of kidney disease in transplanted kidneys.

We have actively participated in the creation of a national kidney biopsy register as part of the established Swedish quality register SNR, and now store research samples in a biobank in conjunction with the registration of clinical data in SNR. Major epidemiological studies on IgAN, based on over 4,000 patients from all of Sweden’s pathology registers, are being conducted in collaboration with researchers at the Department of Epidemiology, Karolinska Institutet, and the Department of Paediatrics, Örebro University Hospital.

In close collaboration with the Department of Clinical Immunology at Karolinska University Hospital, we have carried out a series of clinical and experimental studies of leucocyte function in renal failure and during dialysis. In addition to analysing soluble factors in the blood, we have studied the in vivo transmigration of leukocytes to induced inflammatory foci and, using advanced genetic technology, have also studied in detail various intracellular activation pathways using gene-pathway analysis, RT-PCR, Western blot and microRNA, as well as cell analyses by flow cytometry. We have initiated a collaboration with Science for Life Lab for specific studies of protein profiles in renal failure and the function of basophils at the single-cell level, in order to gain a better understanding of the chronic inflammatory state and increased susceptibility to infection in patients with kidney disease. 

We are studying the impact of protein profiles, soluble factors and genetic factors on the risk of progression of renal impairment in various patient groups, including those with known cardiovascular disease and those with known immunological kidney disease, such as glomerulonephritis, and in patients undergoing treatment to prevent the further progression of kidney failure or its complications, for example with statins and vitamin D analogues.

In collaboration with research groups in Örebro, we are also investigating how the breakdown products of nutrients in the gut may affect the function of kidney cells and the progression of chronic kidney disease. 

The Department of Nephrology at Danderyd Hospital has an established research collaboration with the cardiology departments at Danderyd Hospital, Karolinska University Hospital and Södersjukhuset, focusing on patients with myocardial infarction or acute coronary syndromes and varying degrees of renal failure. A biobank comprising mainly patients from Danderyd Hospital has been established, and in collaboration with SWEDEHEART, large datasets have been analysed and the results published in renowned international journals. Several PhD students are registered in this field, working on topics including the effects of vitamin D treatment, haemostasis in cardiorenal conditions, and more. In collaboration with Karolinska University Hospital, studies are being conducted on patients with diabetes and cardiovascular disease.

Our overall aim is to contribute to an evidence-based national clinical pathway for the management of acute kidney injury. The project aims to characterise patients with AKI, describe their comorbidities and their prognosis by examining short-term readmissions. A risk model is being developed to determine, in the long term, the risk of developing cardiovascular disease and progression to CKD with or without the need for dialysis.

We are investigating the mechanisms underlying the development of kidney failure and other small-vessel complications in type 1 diabetes by studying the link between different types of microparticles in the blood, their propensity to form clots, and the extent of small-vessel disease in patients with type 1 diabetes and healthy controls. We are also planning a long-term follow-up study. In addition, we are investigating whether non-invasive measurements of skin microcirculation can be used as a model to better understand the development of kidney failure and other vascular damage in type 1 diabetes.

The project is a collaboration between Danderyd Hospital, Skåne University Hospital, Sophiahemmet University College, Karolinska Institutet, Lund University and Linnaeus University, with Sophiahemmet University College acting as the lead organisation. The project involves the development and evaluation of an intervention designed to initiate discussions about the direction and content of end-of-life care with haemodialysis patients and their relatives. As a first step, a tool will be developed and evaluated with the aim of identifying when a patient is approaching the end of life, which can provide guidance on when such discussions may need to be initiated. In conjunction with this, staff experiences of, and attitudes towards, factors that hinder or facilitate the initiation of discussions about the focus and content of end-of-life care will also be studied. A training intervention will be designed and evaluated, focusing on conducting discussions about the content and focus of end-of-life care with these patients.