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21 WINTER/SPRING 2018 UNCOVERING THE UNKNOWN Researchers at UofL were part of a group that discovered an insidious new autoimmune disease that causes kidney failure. The discovery of anti-brush bor- der antibody (ABBA) disease was made in the UofL Core Proteomics Laboratory, led by Director Jon B. Klein, UofL School of Medicine vice dean for research and professor of medicine and James Graham Brown Foundation Chair in Proteomics. "It's the first time in my career that I've described a new disease. Most people in their career don't stumble on this," said Klein, who is interna- tionally recognized for his expertise in biomarker discovery related to kid- ney disease and practices with UofL Physicians-Kidney Disease Program. The UofL lab identified ABBA after analyzing biopsied kidney tissue from 10 patients who had devel- oped acute kidney injury, a sudden episode of kidney failure or damage that happens within a few hours or days. The con- dition causes a build-up of waste products in the blood and makes it diffi- cult for kidneys to maintain adequate bal- ance of fluid in the body. For the first time, researchers dis- covered that in the nephrons, the functional units of the kidneys, anti- bodies had coated a specialized part of cells called brush borders, which help reabsorb and process proteins. Further research will focus on defining demographics of patients with ABBA and the disease's prev- alence. Also, determining where on the protein megalin — which acts as a sponge to absorb proteins and other compounds that enter the neph- ron — the antibody binds is key to treating the disease, Klein said. Klein T hanks to medical advances and the dein- stitutionalization movement, the number of adults living in the community with intellectual developmental disabilities (IDD) has grown dramatically. These individuals require many of the same health care services as any adults. However, most physicians in adult medical specialties have not been trained to work with this population and may not be comfortable with the communication challenges or other unique needs these patients may have. Priya Chandan, assistant professor in the School of Medicine and in the School of Pub- lic Health and Information Sciences, has an older brother with Down syndrome. Through his experience, she understands the need for physicians to be comfortable and educated in the care of people with IDD to ensure they receive quality health care. Chandan is lead- ing a project to help medical students become more confident in caring for adult patients with IDD across their lifespan. "Physicians in every specialty will care for individuals with IDD. They need to under- stand their needs and to have communication strategies in the clinical setting," Chandan said. "This patient population is not just a pediatric population. All physicians need to be comfortable serving them." The National Curriculum Initiative in Developmental Medicine (NCIDM) is a partnership between Special Olympics Inter- national (SOI) and the American Academy of Developmental Medicine and Dentistry (AADMD) to ensure future physicians receive training in the field of developmental medicine,  the care of individuals with IDD across the lifespan. Over four years, 12 medical school partners will each design and implement their own curriculum enhancements. Uof L is among the first schools to initiate this training, along with Baylor College of Medicine and the University of Colorado. Beginning this year at Uof L, fourth-year medical students may complete an elective rotation at Lee Specialty Clinic, an interdis- ciplinary clinic that focuses on caring for adults with IDD. Through this experience, the students become more comfortable treating these patients. In addition, second-year medical students are having small group discussions, each led by a Special Olympics Kentucky athlete in the Athlete Leadership Program, to help them better understand the needs of patients with IDD. "Communication is a big part of it," Chandan said. "One of the main things these individuals want doctors to know is that doctors should speak to them directly and get to know them as people rather than rely solely on information from a caregiver." Confidence in lifetime care Students learn communication techniques for treating adult patients with IDD Priya Chandan, left, with patient Whitney Foster, middle, and Felissa Goldstein, medical director at Lee Specialty Clinic.

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