Chasing the cause of chronic kidney disease
After listening to a story on NPR about a “mysterious kidney disease” killing farmworkers, Stanford Assistant Professor of Medicine Shuchi Anand, MA’12, was so intrigued that she wrote to the medical professionals investigating the epidemic to learn more.
Today, Anand, who specializes in kidney health as a nephrologist, is one of those medical professionals leading the research in Sri Lanka on the disease, known as chronic kidney disease of unknown etiology, or CKDu.
Anand’s team includes epidemiologists on the ground in Sri Lanka, collaborators at other U.S. and Canadian universities, and two computer science specialists who are in the early stages of their careers in medical research. Very early stages.
Stanford sophomore Kaitlin Harold ’23 and junior Mustafa Khan ’22 joined Anand’s team after learning about her research through their membership in Stanford’s CS + Social Good organization, which aims to use computer science as a tool to help solve the world’s most pressing problems. Both were prepared to donate their time and energy to Anand’s project as volunteers, but they didn’t have to: Their work is funded through the King Center on Global Development’s Academic Year Undergraduate Research Assistant Program, a unique model that compensates undergrads for their research with King Center faculty.
Since starting with Anand in January, Harold and Khan have helped create a survey for use in a pilot study that will follow about 100 healthy Sri Lankans over time to see who develops kidney disease and, hopefully, why.
“They’re fantastic,” Anand says of her student researchers. “With very little direction, Kaitlin and Mustafa were able to dig through complex environmental epidemiology and health sciences literature. They selected and adapted questions for a completely different audience and setting. This is fantastic and pragmatic training for future academic careers.”
The survey is designed to help Anand’s team and other international collaborators identify potential causes of CKDu. Khan researched factors that contribute to the contamination of well water, including the surrounding soil, well depth, and whether the well is seasonal or produces water year-round. Harold focused mostly on measuring people’s exposure to agrochemicals, for instance, how far the fields they work in are from their homes and which kind of personal protective equipment they wear, if any. The survey also tracks medical histories, heat stress, and alcohol and tobacco use.
Both students had an interest in medical research prior to working with Anand. As a high school student in Lahore, Pakistan, Khan worked on development of a portable MRI device that could be deployed in emergency situations; at Stanford, prior to working with Anand, he took a class called Big Data for Biologists: Decoding Genomic Function.
“That class sparked my interest in how we can use modern tools in data processing and algorithms in the health-care space,” he says.
Harold’s passion for research and working with people led her to start a pre-med path.
“Working with Dr. Anand sealed the deal,” she says. “I realized how much fun research is.”
Harold and Khan will continue their work with Anand during the 2020-2021 academic year.
“We’re still in the data collection phase,” Khan says. “The most exciting part for me personally is yet to come—actually being able to analyze things.”
Both students call Anand a mentor and say the opportunity to work with her—and to receive funding through the King Center to do so—has been hugely positive and influential.
“Before I got to Stanford, I did not know for a fact that I wanted to do computer science,” Khan says. “My personal interests have always been in the realm of health care and education. Now I realize how powerful this is as a stepping stone to new frontiers in understanding. Computer science enhances the work that’s being done in these fields.”
Harold says the biggest takeaway for her so far has been understanding how the research process works.
“Dealing with the uncertainty of research was the most intimidating factor for me,” she says. “This has been a learning experience for how to communicate with faculty, when to ask for help, how much I can do on my own. It’s opened up a lot more confidence.”
The King Center’s support of Anand’s research is in line with its broader mission to improve the lives of low-income people around the world. In Sri Lanka and elsewhere, CKDu strikes mostly men who support their family by working as farmers.
“It is devastating because their whole occupation is built around farming—the men are the breadwinners,” Anand says. “If they cannot function, they lose their place in the world for their family.”
In 2019, Anand published a study of 600 patients in Sri Lanka that supports the use of non-invasive methods to identify people with CKDu. Related work includes a 2020 study that links groundwater nitrate levels to hot spots of CKDu in California. Anand also studies kidney disease in urban settings in India and directs and treats patients at Stanford’s Center for Tubulointerstitial Kidney Disease. She says all her work serves the broader goal of improving nephrology around the world.
“We don’t have a good handle on the distribution of the causes of kidney disease in different regions of the world,” Anand says. “Investigating kidney disease in diverse cohorts, in diverse regions is critical to that particular region, but also to the overall understanding of kidney disease. That certainly feeds back to our work as practicing nephrologists.”