The WorldCare Wire – Spring/Summer 2024
We are celebrating WorldCare’s 30th Anniversary!
Collaboration among experts has been the driving force for improving patient care since WorldCare began in 1994. Initially, radiology specialists at Massachusetts General Hospital formed a network of peers, sharing images and insights on cases using digital technology. However, the demand for specialists and sub-specialists to consult on complex cases snowballed and grew well beyond imaging to include validating pathology results and developing treatment plans.
Today, WorldCare provides medical second opinions (MSOs) for patients with serious and complex illnesses throughout the United States and internationally. Expert teams from top ranked hospitals and institutions within The WorldCare Consortium® review cases to confirm or change original diagnoses and provide cutting-edge guidance on the latest treatments, therapies, and clinical trials. Every patient is assigned a Registered Nurse Case Manager who advocates for them throughout the MSO journey.
Health IQ: Chronic Kidney Disease
Your kidneys are fist-sized, bean-shaped organs located below your rib cage on each side of your spine. They filter about half a cup of blood every minute, removing waste substances and extra water to make urine.1
Chronic kidney disease (CKD) occurs when the kidneys are damaged and cannot filter blood properly.2
Early-stage CKD typically has no symptoms. Later-stage symptoms may include foamy urine, urinating more or less than usual, itchy or dry skin, feeling tired, nausea, loss of appetite or unexplained weight loss. Individuals with more advanced CKD may also have difficulty concentrating, numbness or swelling in the arms, muscle aches or cramps, shortness of breath, trouble sleeping, vomiting episodes, and breath that smells fishy or like ammonia.3
Your doctor determines the health of your kidneys through blood and urine tests:
• Blood test: The level of a waste product called creatinine in your blood is used to estimate your glomerular filtration rate (GFR), a measure of how well your kidneys filter blood. A GFR of 60 or more is considered normal, whereas a GFR of less than 60 may indicate kidney disease. Individuals with a GRF of 15 or less have kidney failure.4 People with high blood pressure, diabetes, heart disease, or a family history of kidney disease have a higher risk of developing kidney failure than individuals without these conditions.4
• Urine test: A urine test checks for albumin, a protein that passes into the urine when the kidneys are damaged. A urine albumin-to-creatinine test compares albumin and creatinine levels to estimate how much albumin passes into urine within 24 hours. A result of 30 mg/g or less is considered normal and more than 30 mg/g may indicate kidney disease. 4
The goal of CKD treatment is to slow disease progression. Doctors will tailor treatment plans to address disease stage, CKD-related complications, and other conditions.5 They may prescribe oral medications: angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) to lower the blood pressure in the kidneys,6 and sodium-glucose cotransporter-2 (SGLT2) inhibitors to lower blood sugar.7 Patients with kidney failure require dialysis or a kidney transplant to stay alive.8
1 National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Accessed at https://www.niddk.nih.gov/health-information/kidney-disease/kidneys-how-they-work
2 NIDDK. Chronic Kidney Disease. Accessed at https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd
3 National Kidney Foundation. Chronic Kidney Disease: Signs and Symptoms. Accessed at https://www.kidney.org/atoz/content/about-chronic-kidney-disease#signs-and-symptoms
4 NIDDK. Chronic Kidney Disease Tests & Diagnosis. Accessed at https://www.niddk.nih.gov/health-information/kidney-disease/chronic-kidney-disease-ckd/tests-diagnosis
5 National Kidney Foundation. Chronic Kidney Disease: Treatment. Accessed at https://www.kidney.org/atoz/content/about-chronic-kidney-disease#treatment
6 National Kidney Foundation. Angiotensin-converting enzyme (ACE) inhibitors & angiotensin receptor blockers (ARBs). Accessed at https://www.kidney.org/atoz/content/angiotensin-converting-enzyme-ace-inhibitors-angiotensin-receptor-blockers-arbs
7 National Kidney Foundation. Sodium-glucose cotransporter-2 inhibitors. Accessed at https://www.kidney.org/atoz/content/sglt2-inhibitors
8 National Kidney Foundation. Kidney Failure. Accessed at https://www.kidney.org/atoz/content/kidney-failure
The WorldCare Consortium® Research Update: Massachusetts General Hospital Patient Received the World’s First Genetically-Edited Pig Kidney Transplant
Surgeons at the Mass General Transplant Center performed the world’s first genetically-edited pig kidney transplant into a 62-year-old man living with end-stage kidney disease (March 2024). The pig kidney, provided by eGenesis of Cambridge, Massachusetts, was genetically edited to improve its compatibility with the human body.
The U.S. Food and Drug Administration greenlighted the single procedure on compassionate use grounds for the patient, identified in a news release as Richard Slayman of Weymouth, Massachusetts. Previously, Mr. Slayman had undergone many years of treatments for end-stage kidney disease, including seven years of dialysis, a human kidney transplant that stopped working well, and experienced recurrent complications after resuming dialysis that required frequent surgical revisions. After the procedure, Mr. Slayman received two recently developed immunosuppressant drugs to reduce risk of organ rejection.
If successful, this groundbreaking approach to kidney transplantation could help address the critical shortage of donated human kidneys and help more patients with kidney failure leave dialysis behind.
Postscript:
After this article was written, Mr. Slayman passed away from causes not believed to be related to his transplant. His story is inspirational and offers hope to many who struggle with kidney disease. His family expressed gratitude to the team at MassGeneral, and the team will continue their groundbreaking work to address this acute medical need.
The WorldCare Consortium® Research Update: Northwestern Medicine Scientists Developed the First Device for Monitoring and Detecting Signs of Rejection After Kidney Transplantation
Northwestern Medicine scientists have created the first electronic device for monitoring the health of transplanted kidneys in real-time.
The wireless bioelectric implant is tiny, about the size of your pinky fingernail and as narrow as a single hair. In small animal studies, the device detected small changes in temperature that may indicate transplant rejection up to three weeks earlier than traditional methods involving blood and urine tests or biopsies.
The investigators recently published the findings of their lab research in the journal Science. They are now testing the device in a larger animal model and evaluating ways to improve battery life. Faster identification of rejection issues is critical for treating patients with anti-rejection drugs aimed at preventing them from losing the donated organs. Ultimately, this groundbreaking concept could be applied to other organ transplants, such as livers and lungs.
WorldCare Consortium® Provider Research News
Jefferson Health: Robotic Bronchoscopy Detects Lung Cancer Earlier When It’s Easier to Treat
While less than 5% of lung nodules found on imaging scans are cancerous, it’s essential to identify and treat lung cancer early, at more treatable stages.
At Jefferson Health, pulmonologists perform minimally invasive biopsies of suspicious lung nodules using robotic bronchoscopy. The FDA-approved technology allows them to navigate a thin, flexible scope to previously inaccessible areas of the lung. The entire outpatient procedure is performed under general anesthesia and takes about 60 to 90 minutes.
Robotic bronchoscopy provides faster results than standard biopsies and can be used to diagnose other lung conditions. Earlier detection leads to more effective treatment options and improved prognoses.
Northwestern Medicine Researchers Discover Potential Biomarkers of Environmental Exposures in Parkinson’s Disease
Growing evidence suggests that environmental factors increase the risk of developing Parkinson’s disease. Environmental exposures can add marks to DNA in a process called methylation. The marks change how DNA’s master instructions are read during gene expression, the production of essential proteins in the body.
Researchers at Northwestern Medicine recently discovered altered DNA methylation and gene expression patterns in the blood of Parkinson’s patients when compared to individuals without Parkinson’s. For example, they found methylation differences within the CYP2E1 gene,which provides instructions for building the protein CYP2E1. This protein plays a role in how the body processes foreign substances, like pesticides.
Understanding the complex interactions between the environment and the development of Parkinson’s disease may one day lead to personalized treatments. The research team is now planning to study DNA methylation patterns in blood from patients at risk of developing Parkinson’s disease but do not yet have symptoms. They will also study how DNA methylation patterns change over time.
Our Member MSO Experience
“We are proud to have pioneered life-changing, clinically rigorous expert medical second opinions. As the gold standard in MSOs, it is an honor to help our members on their journey to wellness as we celebrate our 30th anniversary.”
— Hassan S. Sharif, MD, FRCR
Chief Medical Officer and Chief Executive Officer
As a covered member, if you or a loved one is diagnosed with a serious and complex illness, contact WorldCare.
WorldCare is the benefit that saves lives.
