Agnes Swiatecka-Urban, MD, (front center) and members of her lab at UVA Department of Pediatrics Child Health Research Center
Agnieszka (Agnes) Swiatecka-Urban, MD, joined the University of Virginia Department of Pediatrics in 2020 as a physician-scientist dedicated to improving care for children and young adults with chronic severe illness. As a pediatric nephrologist, her clinical work and research focus on improving outcomes for patients facing conditions that may lead to kidney disease or kidney failure.
Agnes Swiatecka-Urban, MD
During her career, some of Dr. Urban’s achievements include being nominated by NephCure Kidney International as a Nephrotic Syndrome Specialist, spearheading the International Nephrotic Syndrome Symposium, and serving as a principal investigator on NIH-funded research studies to better understand glomerular diseases and lung disease in people with cystic fibrosis. She is a fellow of the American Society of Nephrology and American Academy of Pediatrics
Dr. Urban is currently leading a multi-PI clinical/clinical translational grant project from the Cystic Fibrosis Foundation: Kidney Function in People with Cystic Fibrosis. We caught up with Dr. Urban for this installment of our series, “A Healthier Future — One Clinical Trial at a Time,” to learn more about her clinical research examining chronic kidney disease in People with Cystic Fibrosis (PwCF).
Q. What do you hope to learn from this study? Will the results potentially change the standard of care for future patients?
Swiatecka-Urban: Cystic fibrosis (CF) is a genetic condition presenting with devastating disease in the lungs. Until recently, respiratory failure was the primary cause of death, shortening the life expectancy in PwCF. Significant advances in treatment, including the expanded use of high-efficiency modulator therapies (HEMT), have dramatically increased both quality of life and life expectancy for PwCF. With these advances, long-term life-limiting manifestations in other organs, such as kidney disease, are more frequently recognized and merit further attention.
Kidney disease is surprisingly common in PwCF, but is often recognized only after advanced damage has occurred, and the causes are poorly understood. Kidney disease decreases the quality of life and carries a significant risk for premature death, primarily from cardiovascular complications.
I am leading a multi-PI team to address the gaps in early detection and mechanisms of chronic kidney disease in PwCF. Our team includes pediatric pulmonologist William (Tom) Harris, MD, from the University of Alabama Birmingham and immunologist Sladjana Skopelja-Gardner, PhD, from Geisel School of Medicine at Dartmouth.
In addition to the complementary expertise of the PIs and the teams at the outside institutions, the study benefits from the collaboration with the UVA experts below and their team members:
- Jennifer Charlton, MD, Department of Pediatrics, Division of Nephrology, an expert in kidney development;
- Uta Erdbruegger, MD, Department of Medicine, Division of Nephrology, an expert in urinary extracellular vesicles;
- Soutic Ghosal, PhD, Department of Public Health Sciences, Division of Biostatistics, an expert in diagnostic accuracy modeling and Receiver Operator Characteristic (ROC) Curves, spatiotemporal modeling, causal inference, and statistical design and analysis of clinical and translational research studies;
- Deborah Froh, MD, Department of Pediatrics, Pulmonary Division and director of the Pediatric CF Center;
- Dana Albon, MD, Department of Medicine, Division of Pulmonary Critical Care and director of the Adult CF Center.
Q. Does your trial give novel treatment or other opportunities to your/our patients?
Swiatecka-Urban: Understanding the mechanisms and focusing on the early detection of chronic kidney disease is critical to reducing the risk of premature death and allowing PwCF to have a healthy and fulfilled life. Specifically, we focus on identifying at-risk patients before standard laboratory tests can detect the disease.
Our investigations use cutting-edge tools and the leading animal models to identify targetable mechanisms of CF kidney injury and develop focused protective strategies to improve life expectancy and quality in PwCF.
Q. What is novel about your study design/treatment/intervention?
Swiatecka-Urban: We propose a novel hypothesis that the CF-causing mutations alter the kidneys during development and reduce their ability to respond to stress caused by systemic inflammation associated with CF, medications, dehydration, and other environmental causes.
We examine urinary markers of kidney injury in PwCF before chronic kidney disease occurs to identify those at risk. The urine provides a “liquid biopsy” window into the kidney. By analyzing the urinary protein profile, immune cell activation, and microscopic vesicles the kidneys shed, we will delineate the pathways predicting progression to chronic kidney disease.
We use both human biospecimens and the CF animal models to probe the vulnerability of the CF kidney to extrinsic stressors brought on by disease exacerbations with a focus on infection and exposure to antibiotics.
The care of nearly 850 Virginians living with CF is distributed between UVA, ANOVA Fairfax, Richmond, and Virginia Beach centers. At UVA, the accredited Pediatric and Adult Programs provide state-of-the-art treatments to approximately 150 patients. My long-term goal is to enhance basic and translational research in other extrapulmonary manifestations for all Virginians living with CF and implement the knowledge in clinical practice. Aging and metabolic disorders such as diabetes are independent risk factors for chronic kidney disease. Kidney stones are also more prevalent in PwCF. Although novel CF therapies reduce the morbidity and mortality associated with lung disease, leading to improved survival, little is known about the potential off-target effects of long-term medication use.
Q. How will you ensure inclusion of a diverse subject population?
Swiatecka-Urban: We enrich the patient population by recruiting patients with diverse ethnic backgrounds. The research team represents diverse scientific disciplines and research experience and is knowledgeable about the CF communities, guidance to staff, recruitment and retention process, and methods of study promotion. We work with a representative/liaison of CF communities to obtain ideas for enhancing communication and offer all study materials in relevant languages.
Filed Under: Research