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BRAD ROVIN: Our GN clinic, which has now been going on for about seven years, attracts patients that have glomerular diseases or autoimmune diseases.

So we're seeing patients with systemic lupus who have kidney involvement. We're seeing patients with vasculitis who have kidney involvement. And then there's a whole host of primary glomerular diseases that we now know are mediated through the immune system and are most likely autoimmune disease like igA and primary membranous nephropathy.

If these diseases continue unchecked, then they will wind up, most of the time, causing chronic damage to the kidneys such that the kidney doesn't function and the patient may need kidney replacement therapy.

So we like to intervene. Because of our many types of kidney disease, these diseases are most amenable to treatment. We try very hard to get the disease to go into remission-- either complete remission, ideally, or even partial remission. And even patients with partial remission usually have an extended lifetime of their kidney before they would need a kidney transplant or dialysis.

I think one of the failings in nephrology has been that we have not really progressed with new therapeutics like some of the other sub-specialties. And so we arranged this clinic to interface very closely with our clinical trials unit.

So my idea when we started developing this clinic was to model it after oncology where all oncology patients are offered a clinical trial to participate in. And that's how oncology has discovered many new therapies for a lot of the cancers that we hear about.

So our clinic now offers clinical trials of novel, cutting-edge therapies for almost all glomerular diseases. And not just one clinical trial-- for example, at the present time for lupus nephritis, we have four clinical trials.

We work closely with the rheumatologists. So for example, if I have a lupus patient who has kidney disease and they're coming to see me, but they have extra kidney manifestations-- rash joint involvement, it can even affect the neurologic system-- and I have a question, I can pull over one of the rheumatologists. And they'll come into the room with me and see the patient.

And then they'll often want to see the patient back in followup. But then we can discuss recommendations, therapies, et cetera.

By the same token, if the rheumatologist-- and they often are the first people to see new lupus patients. If they're seeing the new lupus patient and they detect that the patient has kidney disease, they'll pull us over and say, hey, could you look at this urine with us? What do you think? Do you think the patient needs a kidney biopsy?

I think the biggest pushback we get is that patients-- and I would be too-- are a little bit uncertain about taking a drug that nobody knows anything about.

And then a lot of patients don't like the idea of us doing an experiment on them. I understand that. And I guess I don't ever use the word we're doing experiments on you. Yes, this is a type of research. But these are as controlled conditions as possible.

A lot of patients also think about how this may benefit other people in society or even their own family. Because in many families with autoimmune disease, lots of people are affected.

I think we have a very good rate of getting patients interested in trials. We're trying to do everything we can to bring this sort of practice to as many people as possible so that we can really understand how these drugs work.

We have very good relationships with our nephrology colleagues in the community. And when we get a new clinical trial or a series of clinical trials, we actually call our colleagues and say, look, if you have patients-- and here are the criteria-- you may want to have them come and see us. Because we may be able to offer them a clinical trial that you may not have in your repertoire.

Now, we're starting to see some of our trials have positive results. And so the patients who have participated in those trials-- and have received not the placebo but the active drug-- have shown improvement. And once we can get these drugs through the FDA, which is not a small process, then I think we can bring them back to the other patients.

Someday, it may be very interesting when these new drugs get approved and we learn more about them, could we get rid of standard of care and just have these novel drugs?

The reason I say that is because a lot of the newer therapies have very, very low side-effect profile compared to what we give patients now. And a lot of the newer drugs are very targeted drugs. They go to specific immune processes that we know from our laboratory work and the work of, really, many other investigators throughout the world. They're important in the pathogenesis of many of these diseases.