New treatment for kidney disease still has hurdles to jump

DEAR DR. ROACH » I recently read an article released by the Broad Institute that claims a breakthrough in the treatment of progressive kidney disease. It states that experiments with rats have resulted in the stoppage of disease progression, and in some cases, reversal. It further states that human trials are the next step. Do you have any additional information on this important news? — E.L.

DEAR READER » Thank you for writing. The article you reference was published in the prestigious journal Science. The researchers were able to identify a compound (called AC1903) that protected the kidneys in mice with a type of kidney disease that has similar characteristics to chronic kidney disease in humans. This is very exciting; however, it is likely to be years before clinical data could be available, and a decade or more before it is available for general use. Many promising drugs fail in human trials despite very good results in animal models.

Medications used to prevent problems need a very high level of certainty before they can be used widely, and demonstrating that one slows the progression of kidney disease will require a long clinical trial.

DEAR DR. ROACH » Back in June I read with interest the story of a 63-yearold woman who broke her wrist. I’m a consultant hand surgeon in the U.K., and this is how I would approach an answer:

A fracture is a break in bone complicated by injury of the soft tissue (skin, ligaments, nerves, etc.). The fracture must have been significant enough to need surgery to align the bones in the correct anatomy, but the soft tissues still must heal. A lot of these fractures are of soft, osteoporotic bone. Functionally, these fractures do quite well and are common.

The continued stiffness can be due to the scarring around the joint or indeed from the metal plates themselves. However, stiffness unfortunately is not uncommon; may take many months to resolve; and sometimes may be permanent. After wrist fractures, chronic regional pain syndrome may happen. This is pain, swelling, stiffness and skin changes that can last for a couple of years and sometimes requires intensive therapy and pain intervention.

The injection (a cortisone injection, which the reader received in her wrist) is a minimally invasive treatment that may help, but not in this case. Removal of the metal work and arthroscopic scar release may improve matters, based on the fact that her anatomy is normal and her regional pain is controlled. — G.S. DEAR READER » I thank Mr. Shyamalan for responding (in the U.K., surgeons are referred to as “Mr.”). Several other experts wrote in with the concern of chronic regional pain syndrome after fracture, and I should have mentioned this, along with a recommendation to consult a pain management specialist, especially since early intervention is key to a good outcome in this illness.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.

Keith Roach