The Kidney Foundation of Canada

Dr. Heather Reich 

Dr. Heather Reich

University Health Network, Ontario
Co-Applicant: Paul Boutros

Non-invansive markers of outcome and treatment response in the MENTOR study


2017-2019:  $100,000  |  Biomedical Research Grants  |  Category: Glomerulonephritis

Biography

Dr. Reich is a graduate of McGill University Faculty of Medicine. She completed her post-graduate clinical training and PhD at University of Toronto where she is an Associate Professor and holds the Gabor Zellerman Chair in Nephrology Research. She works as a nephrologist-scientist at the University Health Network and is passionate about improving the clinical care and outcomes of patients with glomerulonephritis.

Dr. Reich's research objective is to identify clinical and molecular markers of progressive glomerular diseases, and she is scientific director of the Toronto GN Registry. Her translational research program focuses on the study of human biologic samples to elucidate the mechanisms responsible for progression of kidney disease towards kidney failure. This molecular work is complemented by studies to identify clinical risk factors for disease progression in glomerulonephritis. She enjoys teaching and is the co-director of the annual educational pre-course in glomerulonephritis for the American Society of Nephrology.

Lay Summary

Membranous glomerulonephritis (MN) is one of the most common causes of glomerulonephritis which are a group of diseases affecting the filters of the kidney. Patients with MN are at high risk of life-threatening complications including blood clots, infections, and heart attack and stroke.

The outcome of patients with MN is variable; up to 40% of patients with MN will develop kidney failure, half of the remaining patients will have chronic kidney disease, and the remainder may have spontaneous remission. The varying outcome of patients with MN and potential toxic side effects of treatment make the utility of predicting patient response to treatment of clear benefit. Clinical markers available to doctors (creatinine, urine protein) lack sensitivity and often do not reflect the severity of progressive kidney injury.

Furthermore, long-term treatment of MN with agents such as cyclosporine carries a risk of treatment-related kidney toxicity. Urinary biomarkers (measurement of specific proteins) can provide a window into the molecular processes within the kidney. We propose to evaluate the relationship between a panel of urinary biomarkers and treatment-specific response a in patients with MN enrolled in the MENTOR study.

This is the largest study ever performed in patients with MN, and is a multicentre randomized controlled trial of cyclosporine versus rituximab. The identification of urinary biomarkers that are associated with disease and treatment response will allow personalized tailoring of treatment to minimize drug toxicity and optimize outcomes of patients with progressive kidney disease.