Junior postgraduate medical training was undertaken in the North West Deanery, before embarking on the Paediatric training rotation. Work at the Royal Manchester Children's Hospital (RMCH) triggered an interest in the use of corticosteroids among paediatric renal patients. He undertook a study looking at the impact of a new immunosuppressive corticosteroid regimen in the kidney transplant population at RMCH. Dr. McCaffrey's current study will focus on reasons behind the variability in response to corticosteroid therapy in nephrotic syndrome, which may lead to more targeted pharmacological management.
Epigenetics in childhood nephrotic syndrome
Nephrotic syndrome (NS) is a kidney disease found in children and adults. Sufferers experience body swelling when proteins usually kept in the blood stream flow out in the urine. It occurs when the barrier responsible for filtering blood in the kidney becomes abnormally leaky.
Children who present with NS are initially treated with high dose steroids. Although this is effective in most children initially, some children do not respond to steroid treatment at all. Those who do not respond to drug treatment have a high risk of requiring dialysis, and may eventually need a kidney transplant. The reasons for this clinical heterogeneity are poorly understood.
An important part of the kidney barrier is a cell called the podocyte which normally forms a tight seal. In children with NS, the podocyte changes shape and allows the large blood proteins to leak through. I plan to look at the podocyte to examine if steroids work by helping this cell regain its normal structure and function. Working out exactly how steroids work will help to develop more targeted medication, and suggest novel drug targets to treat those children for whom current treatment is ineffective.