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RIMA KANG: Polycystic kidney disease is a systemic disease. So oftentimes patient have multiple organ involvement. We do have to collaborate with a lot of other disciplines. For example, they may have intracranial aneurysms, in which case, I would need the assistance of a neurologist. Cardiovascular disease, valvular heart disease, in which case I would need a cardiologist. And most commonly, we actually see liver involvement. And so I may need the assistance of a hepatologist as well.

At Ohio State, we have the unique opportunity, in that we have all the subspecialists at our fingertips, and the collaboration and communication is actually quite simple. Another unique feature of our clinic is that we have a specialized nurse for polycystic kidney disease. He actually has some background on the disease state, is knowledgeable on prescription of tolvaptan, and monitoring of patients once they're on the drug.

So we know that the underlying pathophysiology of polycystic kidney disease involves upregulation of antidiuretic hormone, or vasopressin. It also involves upregulation of the V2 receptor where ADH works. So the idea till now was really to maintain adequate hydration so as to suppress ADH and control the cyst growth and cyst formation. So what has changed the face of treatment of polycystic kidney disease was the approval of tolvaptan. And this was approved last year for the treatment. Clearly, this has been very important, because up until now, we haven't had any disease directed therapy, and now we have this new drug to offer to patients as treatment.

In terms of research, we've just submitted an IRB looking at imaging techniques for polycystic kidney disease. We know that the higher total kidney volume a patient has by imaging predicts higher risk for progression of the disease. As of right now, the gold standard for imaging is MRI, but our study aims to look at renal ultrasound compared with MRI or CAT scan in calculating total kidney volume, the hope is that if they're reasonably accurate in predicting total kidney volumes that we can proceed with ultrasound, as opposed to other imaging modalities that may expose the patient to radiation. And, of course, it is a more cost-effective modality as well.

My hope for the future of this clinic is to bring in more clinical trials that we can offer to patients. Not everybody is a candidate for tolvaptan. It's really indicated for individuals who are high risk for rapid progression of their disease. And if they don't fall into that category, we'd like other avenues by which they can get involved with clinical trials.

I think our clinic really has grown to that point. So we're really getting a substantial patient base, where we can start collaborating with other institutions that are PKD centers for excellence, and combine our patient populations, and get involved in multi-center clinical trials as well.