Advancing the Field of Nephrology
By Rianna Turner
By: Rianna Turner Photo by: Aaron Garcia
Nephrology comes from the Greek root “nephros,” which refers to kidneys. However, one does not visit the nephrologist when they have kidney stones or blockages — urologists are the surgical specialists who focus on anatomical or structural disorders of the kidneys. Nephrologists are more like chemists. These patient-oriented physicians study the composition of bodily fluids to reach a conclusion on how best to treat various kidney diseases, hypertension, diabetic kidney disorders, and electrolyte disorders. This tedious chemistry was what brought nephrologist Jack Cortese to the field.
Dr. Cortese was born in Memphis, Tennessee, and attended what he calls the “original UT” — the University of Tennessee in Knoxville. The rest of his medical studies carried him around the United States, from Harbor-UCLA Medical Center in Los Angeles to the Baylor University Medical Center in Dallas, and eventually to the South Texas area, in San Antonio and Corpus Christi. During his studies, Dr. Cortese always enjoyed the tediousness of the chemical and biological sciences, and found that nephrology was a specialty that allowed him to channel that enjoyment.
Many people who require the attention of a nephrologist like Dr. Cortese are in need of dialysis — the clinical purification of the blood. However, there are many cases in which patients are in need of the procedure, but are too ill to manage the treatment. To help alleviate this problem, Dr. Cortese has been working with a treatment called Continuous Renal Replacement Therapy (CRRT). CRRT is a gentler form of dialysis that is ideal for those who are too sick to manage other forms of dialysis. This treatment has become more common in Intensive Care Units, since the treatment runs 24 hours a day, and has proven to be useful in pre-operation for kidney transplants.
According to the CDC’s 2017 National Diabetes Statistics report, 9.4 percent of the United States population — which is about 30.3 million people — have diabetes. The high prevalence of diabetes in the United States also draws attention to the field of nephrology, as those who suffer from diabetes are prone to kidney disease. Dr. Cortese, an energetic man who plays bass in the rock band Hard Wired, likes to explain kidney disease using car analogies.
“Let’s say a patient has had diabetes for 20 years,” Dr. Cortese said. “That’s like a 1998 Mustang. Say I drive this Mustang to work every day for 20 years, and I park it outside, near the salty sea winds. That Mustang is going to start to rust.” In the human body, the sea winds aren’t salty, but sweet. Excess sugar consumption over long periods of time affects blood vessels, which creates the symptoms of diabetes, like numbness, increased thirst, and kidney function.
Dr. Cortese’s focus on accessibility sets his practice apart. When a patient is referred to him, and may be suffering from kidney disease or at risk of kidney failure, Dr. Cortese presents them with a kidney “speedometer.” This speedometer is a hands-on way of understanding one’s glomerular filtration rate (GFR) — a measure of how well kidneys are working. Instead of giving a patient a list of numbers, Dr. Cortese provides patients with a hands-on way of understanding their own bodies, thus helping them make their own decisions.
This focus on education is something Dr. Cortese hopes to see in the future of his field. Collective, accessible education will help with diabetes care, since the disease can be more effectively treated the earlier it is noticed. Education at other levels, from that of the young residents Dr. Cortese mentors, to that of aspiring biomedical engineers, will also advance the field of nephrology. Who knows — artificial kidneys could be the next CRRT.