Research Training Fellowship: Dr Thomas Hiemstra
This research was completed on 31 August 2011
Published on 3 June 2008
Investigating how kidney stones develop
Each year, Action Medical Research awards these prestigious grants to help the brightest and best doctors and scientists develop their career in medical research. Dr Hiemstra’s grant of £200,906 will fund his three-year investigation into the biological processes that lead to the formation of kidney stones.
Although kidney stones are so common, and so damaging to our health, we know very little about what causes them. Dr Thomas Hiemstra is determined to find answers, and hopes his work will eventually lead to new treatments.
At least one in ten people develop a kidney stone during their lifetime.1 They can experience severe, unrelenting and debilitating pain, often associated with nausea, vomiting and blood in the urine. In some severe cases, deteriorating kidney function can eventually lead to kidney failure, which is fatal without dialysis or a transplant operation.
He said: "I am immensely honoured and humbled by the opportunity I have been given by Action Medical Research. This is a charity with a fantastic track record of identifying and supporting often very ambitious research ideas, which ultimately yield a rich harvest of improving lives and alleviating suffering."
Progression to kidney failure
Kidney stones are very common, affecting 5% of the population at any one time, and accounting for up to one per cent of hospital admissions.2,3They can normally be treated once detected, but this is often too late to prevent damage to the kidneys. What’s more, very little can be done to stop kidney stones from forming in the first place, and many people suffer recurrent attacks – once a person has suffered a kidney stone, they have a 50% chance of developing another within the next five-seven years.2
‘Patients with recurrent kidney stones, who must battle with severe and debilitating pain, are often very demoralised,’ says Dr Hiemstra. ‘Even when well, they live in fear of the next attack.’ If kidney function begins to deteriorate, symptoms include extreme fatigue, loss of appetite and fluid accumulation in the body. Sadly, some people find their kidneys eventually fail, meaning their survival depends on regular hospital-based dialysis treatment or a kidney transplant.
‘Even after a successful kidney transplant, problems can recur and affect the new kidney,’ explains Dr Hiemstra. ‘This can prevent people from working and from living a normal life and, at the worst, reduces life expectancy.’
Seizing on recent discoveries?
Most kidney stones consist largely of calcium and can vary in size from barely visible to the size of a golf ball. Smaller, mesh-like deposits of calcium, which can only be seen with a microscope, can also lead to poor kidney function. The causes of this abnormal calcium accumulation – in stones and mesh-like deposits – are poorly understood and infrequently studied. Small spherical structures, called vesicles, have recently been discovered in human urine.
‘Nothing is known about the function of these urine vesicles,’ says Dr Hiemstra. ‘In blood vessels and bone, similar vesicles are known to influence the laying down of calcium. So, in this Fellowship, I am investigating whether the recently discovered vesicles in urine influence the formation of stones and other calcium deposits in kidneys.’
|Project Leader||Dr Thomas Hiemstra MB ChB MRCP|
|Location||Cambridge Institute for Medical Research, Addenbrooke's Hospital, University of Cambridge|
|Grant awarded||3 March 2008|
|Start date||1 September 2008|
|End date||31 August 2011|
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Paving the way for new treatments
Dr Hiemstra believes his work may eventually lead to major benefits. ‘Finding out more about how kidney stones develop may ultimately lead to new preventative treatments, which stop kidney stones from forming. This would be a fantastic prospect. It would alleviate suffering and prevent kidney failure for millions of people worldwide. For some, it might ultimately prove life saving.’ A new treatment that stops kidney stones from forming would have a significant clinical and health-economic impact. The lifetime risk of developing kidney stones approaches 10%, exceeding that of type II diabetes, stroke and epilepsy.1
On a more personal level, this Fellowship is a life-changing opportunity for Dr Hiemstra, allowing him to pursue his dream of dedicating his career to research. ‘Being given the chance to do the kind of work that stretches the boundaries of current knowledge, and has real potential for advancing the care of patients, is a privilege and an honour. I have always been fascinated by the complex functions of the kidney. I continue to be driven by our lack of knowledge of such a vital organ, and the extreme suffering its failure can bring. I must find answers.’
It’s long been known that kidney stones pose a threat to our health. ‘Kidney stones have affected people’s lives for thousands of years,’ explains Dr Hiemstra. ‘Kidney stones are specifically mentioned in the Hippocratic oath, which is taken by most doctors before or at graduation and is believed to originate from the 4th century BC. Kidney stones have also been identified in a 7,000-year-old Egyptian mummy.’ But modern medicine still cannot explain how kidney stones develop, and Dr Hiemstra is determined to put that right.
He is investigating the role of recently discovered structures in urine, called vesicles. ‘First, I am collecting urine samples from patients with kidney calcium problems, and from healthy volunteers for comparison. I am extracting the vesicles from the urine to study them – their number, size and their contents – comparing healthy volunteers with patients. Next, I intend to grow kidney cells in the laboratory and study their release of vesicles. Finally, I want to test the vesicles themselves to see if they can cause the laying down of calcium.’
Dr Hiemstra’s work will be supervised by two leading researchers from the University of Cambridge - Professor Fiona Karet, and Dr Kathryn Lilley. The outstanding multidisciplinary environment at the University gives Dr Hiemstra every chance of success. Dr Hiemstra is delighted that his ground-breaking work is being supported by Action Medical Research, saying, ‘Without Action Medical Research, many important ideas would remain confined to the drawing board, and a world of suffering would remain unchanged.’
- Amato M, Lusini ML, Nelli F. Epidemiology of nephrolithiasis today. Urol Int 2004;72 Suppl 1:1-5.
- Parmar MS. Kidney stones. BMJ 2004;328(7453):1420-4..
- Kreutzer ER, Folkert VW. Etiologic diagnosis of renal calculus disease. Curr Opin Nephrol Hypertens 1993;2:949-55.