When the National Institute of Diabetes and Digestive and Kidney Diseases published the most comprehensive atlas of the human kidney in summer 2023, it included information contributed by the Johns Hopkins Precision Medicine Center of Excellence for Kidney Disease.

Precision Medicine at Work

“This is a major advance in the kidney disease world, to have the first atlas of healthy and injured cells — people were awaiting this for several years,” says Chirag Parikh, M.D., Ph.D., director of the Division of Nephrology and of the precision medicine center. “This should stimulate lots of innovation in terms of identifying new therapeutic targets or diagnostic tests for kidney disease.”

The new resource allows scientists to compare healthy kidney cells with those injured by kidney disease. It includes maps of:

• 51 main kidney cell types
• 28 kidney cell states that represent injury or disease

The atlas demonstrates the biology of individual cells in various parts of the nephron (a structural and functional unit in the kidney) and its surrounding tissue, and shows how they are defined by their position in the kidney and by the “signatures” of genes and proteins active within them. 

Parikh and colleagues contributed biopsy tissues to the atlas from a Johns Hopkins biobank of some 500 kidney tissues. The biobank, which is linked to detailed clinical data from Johns Hopkins’ electronic medical record, is a powerful tool nephrologists at Johns Hopkins have been developing for several years. Kidney tissues taken for study undergo state-of-the-art processing, including genetic sequencing to identify meaningful cellular pathways and proteins linked to disease patterns, Parikh said, toward the goal of more personalized therapies for patients.

“People didn’t know that so many cell types exist in the kidney,” Parikh says. “It shows the variety in the kidney, that it’s a complex organ. It shows the various transition states and molecules of the cells.”

In another avenue of research, the precision medicine center has begun a pragmatic clinical trial called COPE-AKI (Caring for OutPatiEnts after Acute Kidney Injury) to develop best practices in caring for patients following hospital stays for moderate to severe acute kidney injury. At discharge, participants will be randomized to receive either multidisciplinary care recommendations from a team of providers, including a study nephrologist, nurse navigator and a pharmacist, or the usual standard of care.

“We’re looking to see if the people who get more support after discharge will have fewer readmissions,” Parikh says.

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