Autoimmunity; Immunology; Neurobiology
My research is aimed at understanding the roles of the innate and adaptive immune systems in health and disease. The organs of my interest are the two specialized filtration units, glomeruli and blood-brain barrier, of the kidney and brain respectively. Recently, our understanding of the immune system has undergone a substantial paradigm shift: researchers now recognize that the innate immune system, the body’s first line of defense, assesses the level of danger of a particular event and initiates an adaptive immune response that subsequently confers protection. My studies focus on the role of an important arm of the innate immune system, the complement cascade in inflammatory conditions such as glomerulonephritis and lupus. For both disease conditions, the perfect therapy remains an enigma. Using a gamut of techniques, we are attempting to define the molecular mechanisms involved and the resulting behavioral aberrations. Once molecular targets are identified, therapeutic strategies will be defined. I teach in UB’s Discovery Seminar Program, which is geared for first- and second-year undergraduates. The seminars are taught in a small-class environment to students who share common goals and similar interests, in ways that enhance their academic, civic and personal growth. I teach “The Yin-Yang of Biology” and “Brain: Day and Night,” and I teach as well in UB’s Honors College. I also mentor students through the CLIMB-PRO program. One of my recent students conducted research that resulted in a publication in the journal Kidney International.
My main research interests are in the areas of health economics and strategies to improve clinical reasoning skills among medical trainees. I am designing a study comparing strategies that improve cost consciousness among medical residents. I am also partnering with the School Management in using Information Technology to improve the ‘test ordering’ behavior by residents in the ambulatory care clinic. My other interests include techniques to improve clinical reasoning among students and residents.
Internal Medicine; Nephrology
I am the acting chief of nephrology services at the Buffalo VA Medical Center (VAMC). My clinical work includes caring for both inpatients and outpatients diagnosed with a variety of kidney diseases. I have expertise in caring for patients with chronic kidney disease (CKD) and acute kidney injury. I also direct dialysis services at the VAMC. In this role, I care for dialysis patients and oversee quality improvement activities to ensure the best possible care for our VAMC dialysis patients. I have a broad background in nephrology and specific training and expertise in key research areas such as CKD and acute kidney injury. My main research interest is to determine reversible factors to prevent acute kidney injury. I am also studying preventable causes of CKD and have expanded my research to include the care of elderly patients who have been diagnosed with CKD. I am committed to education, and I teach medical students, residents and fellows, primarily at the VAMC. I am one of the key faculty in the “renal module” for first-year medical students: I give four lectures and participate in six small-group sessions each year. During my inpatient consult service, I teach residents and fellows.
Internal Medicine; Nephrology
I am trained as a general nephrologist and as an epidemiologist. I have interest in kidney stones prevention and in dialysis in general. I did extra training in hemodialysis prior to working as a community nephrologist for 14 years. I have significant experience in caring for dialysis patients including in acute and chronic renal failure and in various settings comprising intensive care unit, emergency department, chronic outpatient and home dialysis (this includes both hemodialysis and peritoneal dialysis). I care for patients in my general nephrology clinics twice a week. In that clinic I see patients with acute kidney injury, chronic kidney disease (hereditary or acquired), complications of chronic kidney disease, hypertension, electrolytes anomalies, glomerulonephritis or kidney stones. I am an attending for the nephrology service provided at Erie County Medical Center and at Roswell Park Comprehensive Cancer Center. I oversee care for chronic outpatient hemodialysis individuals. I also provide care for patients on home hemodialysis and peritoneal dialysis both at Erie County Medical Center and Clevehill Dialysis Unit (DaVita). I am currently the medical director for the home dialysis program at Erie County Medical Center. My research interests are with infection prevention in dialysis patients including vaccination, kidney stone prevention, interventions to delay end stage renal disease in chronic kidney disease population. I am involved with clinical teaching while on inpatients rotation. Teaching is provided to medical students, residents and fellows. I participate also in the renal fellows’ longitudinal clinic.
Internal Medicine; Nephrology; Bioinformatics; Molecular Basis of Disease; Cardiac pharmacology
I have a passion for challenge and an allergy to routine. This has driven my interest for research and clinical medicine, mainly internal medicine. I am currently a nephrologist at UBMD and a Faculty at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences. In my clinical practice, I manage all aspects of kidney disease, renal replacement therapies including dialytic therapies and kidney transplant, hypertension, as well as disorders of fluid and electrolytes. With my group, I also provide nephrology consultations at the Roswell Park Cancer Institute. I particularly favor this part of my clinical activity, considering the very specific and challenging nephrological problems arising in cancer patients. I have a passion for education and never say no for opportunities to teach or learn. At the expense of longer days, I always take opportunities to teach fellows, residents and students. I strongly believe in problem-based learning, in the sense that what is learned is best remembered as a solution to a problem. So far, my research has focused on cardiovascular disease, mainly cardiac and vascular mechanics. In this phase of my career in nephrology, I am moving towards issues interfacing the cardiovascular system and the kidneys.
Internal Medicine; Nephrology
My breadth of clinical practice is broad; I care for patients with a wide range of both acute and chronic renal diseases. This includes patients with electrolyte abnormalities, autoimmune and/or secondary glomerulonephritides and polycystic kidney disease as well as those who have undergone kidney transplantation. My training at the Weill Cornell Hypertension Center has provided me with focused training in the management of refractory, secondary and perinatal hypertension. Therefore, I also see patients with refractory or difficult-to-control hypertension even though they may not have kidney dysfunction. As medical director of the Erie County Medical Center (ECMC) Living Donor Kidney Transplant Program, I see many prospective living donor kidney candidates during their donor evaluation process, and I follow them in the post-operative period. I see patients in a variety of inpatient and outpatient settings. I serve as the nephrology attending physician on the inpatient Renal Medicine and Renal Consultation services at ECMC as well as the Renal Consult service at the Buffalo Niagara Medical Campus (BNMC). My outpatient clinics include my weekly general UBMD Nephrology and Transplant clinics at ECMC and my weekly general UBMD Nephrology clinic at the Niagara Falls Renal Office. I care for both in-center and home hemodialysis as well as peritoneal dialysis (PD) patients receiving services at numerous dialysis centers located throughout Erie and Niagara Counties. I work with national and global kidney care groups such as Fresenius and DaVita to provide care for my patients, and I serve as medical director for several of their Western New York dialysis centers. My clinical research interests are also wide-ranging. I have particular interests in medication, chemotherapy and toxin-induced kidney injury. I have worked on a project that investigated the long-term renal impacts of the chemotherapy agent ifosfamide in adult cancer patients. I also have a research interest in autosomal dominant adult polycystic kidney disease (AD-PKD). I am involved in a multicenter clinical trial to compare the efficacy and safety of the drug Tolvaptan to determine if it can help to slow, or even halt the progression of renal cysts and thereby delay or prevent progression of end-stage kidney disease in people with AD-PKD. I supervise and teach physicians at all stages of their training, including interns and residents from UB’s internal medicine residency program as well as fellows in UB’s nephrology training program. I supervise trainees on both the inpatient Renal Medicine and Renal Consult services and in the outpatient Renal and Hypertension Clinic and the outpatient Transplant Clinic. In addition to bedside teaching, I sometimes teach small group nephrology seminars for third-and fourth-year medical students rotating on their medicine clerkships. I also provide lectures for the internal medicine resident teaching program and for the nephrology fellowship teaching program.
I see patients primarily at the Erie County Medical Center (ECMC), caring predominantly for inpatients. I care for patients who have acute kidney disease and for patients who have received kidney transplants. I serve as the attending physician on the inpatient renal medicine and renal consultation services at ECMC. I also take care of patients with end-stage renal disease on chronic dialysis who have been admitted to the hospital with other medical problems. My research interest is acute kidney injury and chronic kidney disease (CKD). I supervise interns, residents and fellows during their inpatient rotations. I am also involved in teaching medical students.
I work primarily at the Buffalo VA Medical Center (VAMC) where I served as the chief of nephrology for many years. I care for patients with a variety of kidney diseases, including acute and chronic kidney disease, end-stage renal disease, glomerulonephritis, polycystic disease and hypertension. I have a particular interest in the treatment of patients with resistant hypertension. I also care for patients with advanced chronic kidney disease. Together with a team of other health care professionals at the VAMC, I help patients to decide the optimal modality of dialysis for themselves and, when warranted, to consider the possibility of renal transplantation. I care for inpatients as a consultant on the nephrology consultation services. I see patients at outpatient clinics at the VAMC, and I follow patients in the VAMC outpatient dialysis unit. I participate in clinical trials related to treatment of diabetic kidney disease, treatment of anemia in chronic kidney disease and hypertension. My past research focused on understanding the response of cells to conditions of hypo- and hyperosmolality. I have published on hyponatremia and hypernatremia, and continue to have a clinical interest in these areas. I am the program director for the nephrology fellowship program and have served in this role since 1997. I oversee the nephrology fellowship training experience at the multiple clinical sites of UB’s Division of Nephrology, and I contribute to the development of the curriculum. I also serve as the coordinator of the four-week, organ-based “renal module” for first-year medical students: I plan the curriculum, identify speakers, organize the case-based small group sessions and write test questions. I also give 12 lectures and participate in four small-group sessions each year. I am committed to teaching and devote significant time in the medical school teaching medical students. In addition, I hold an adjunct appointment in the Department of Pharmacology and Toxicology, and I give lectures on renal pharmacology, hypertension and adverse drug reactions each year to students in that department. I also teach pharmacology and toxicology students in a recitation session focused on discussion of a clinical research paper.
My clinical activities are focused on caring for patients with chronic kidney disease (CKD) and those with end-stage renal disease undergoing renal replacement therapy. I am the Chief Medical Officer of Erie County Medical Center (ECMC); as such, I am responsible for ensuring that the hospital has a high-quality, safe and efficient environment in which our health care professionals can render the best possible care for all patients. I also serve as the liaison between physicians and hospital administration, helping the latter to develop hospital policy and its strategic vision. My research is focused on addressing population health management. With the use of bioinformatics, my goal is to develop methods that will permit earlier detection of kidney disease and improved models for delivering extended care management for patients with CKD. My past research has included study of the diagnosis and treatment of viral diseases in transplant patients, vascular access problems in hemodialysis patients and the early identification and treatment of CKD.
I am the medical director of the hemodialysis program at Erie County Medical Center (ECMC). In this role, I am involved in all aspects of patient care, safety and quality. I also have an active outpatient practice and care for patients with chronic kidney disease (CKD), glomerulonephritis, hypertension, polycystic kidney disease, electrolyte abnormalities, anemia, secondary hyperparathyroidism and end-stage renal disease (ESRD). My clinical research is in two main areas: mechanisms of, and treatment options for anemia; and acid base disturbances in ESRD hemodialysis patients. In collaboration with UB’s Department of Pharmaceutical Sciences, I am involved in translational research investigating the mechanisms, risk factors and pathophysiology of erythropoietin dosing and resistance in ESRD patients. I am interested as well in understanding the development of metabolic alkalosis in patients with ESRD and the condition’s correlation to the risk of sudden cardiac death. I am conducting a clinical study investigating changes in bicarbonate levels post-hemodialysis using various concentrations of Fresenius’ Naturalyte bicarbonate/acetate dialysate and the effects on arrhythmias and cardiovascular hemodynamics. My involvement in clinical informatics includes serving as an adjunct faculty member and site program director for UB’s ACGME-accredited clinical informatics fellowship program. In this role, I provide medical leadership by assisting physicians in the delivery of patient care, medical education and research, and advancing clinical quality and safety initiatives through the use of clinical information systems. I am currently involved in projects studying methods to increase interoperability of electronic health records across hospital systems, optimizing dialysis-specific electronic health records and developing methods and procedures to reduce copying and pasting in medical documentation. I supervise nephrology fellows and internal medicine residents during their rotations in the inpatient nephrology consultation services at ECMC.
Over the past 30 years, my outpatient focus has been the care and management of patients with complex glomerular and autoimmune diseases. I serve as attending physician on the renal consult services for UBMD Nephrology at Buffalo General Medical Center, Roswell Park Cancer Institute and Erie County Medical Center (ECMC). I am also an attending physician on the inpatient Medicine A (General Medicine) and D (Renal Medicine) services at ECMC. My research concentrates on understanding mechanisms that underlie kidney disease, including the role of the complement system, a major factor in the body‘s immune response. My lab has developed and studied animal models of systemic lupus erythematosus, diabetic nephropathy, glomerulonephritis, obstructive nephropathy and acute renal failure. In addition to modeling disease in animals, we also have performed clinical studies both for promising new therapies and for those that focus on examining gene profiles from diseased renal tissue. To answer questions that arise in the course of our research, our work spans a number of disciplines and utilizes state-of-the-art approaches such as mouse kidney transplantation, 15-color flow cytometry and magnetic resonance imaging. My original degree is in mathematics, which remains a passion of mine. I also am interested in computational biology and founded the Computation Biology Core Facility at the University of Chicago. The core strength and emphasis of UB in the area of clinical informatics was a key factor in my decision to accept a position here so that I can continue to contribute to projects related to this field. In collaboration with leadership from other disciplines at UB, I helped establish one of the first clinical informatics fellowship programs in the United States. As a result, we accepted in 2014 the first joint nephrology/clinical informatics trainee in the country. As an educator, I am committed to the career development of the students, trainees and faculty working with me in my lab, in clinical research areas, in clinical informatics and in the clinical arena. Over the course of my career, I have mentored many outstanding students, fellows and faculty. Under my leadership and guidance, a number have received nationally competitive awards, and many have gone on to become academic leaders--including one who became a medical school dean. I serve on the Kidney, Urologic and Hematologic Diseases Subcommittee of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), which critically evaluates training in nephrology. Through this commitment, I help ensure continued quality improvement in nephrology training, both nationally and at UB.
I care for patients with a variety of renal diseases, including acute kidney injury, chronic kidney disease, and end-stage renal disease, that require renal replacement therapy and renal transplantation. My clinical interests include various glomerular diseases, hereditary kidney diseases, renal stone and various electrolyte and acid-base disorders. I also have a passion for taking care of patients with resistant hypertension and secondary hypertension, with a focus on renovascular hypertension. My clinical responsibilities are exclusively at the Buffalo VA Medical Center (Buffalo VAMC) where I take care of both outpatient and inpatient renal patients. The Buffalo VAMC is the medical destination for veterans in Western New York in need of renal services, including patients from Batavia, Rochester, Canandaigua and Bath, NY and Erie, PA. I see outpatients in the renal clinic and dialysis unit at the Buffalo VAMC and serve as the director of the renal clinic. I also provide electronic consultation to primary care physicians who need specialized counsel in managing the care of patients with renal conditions. I am involved in pretransplant testing, screening and consultation for prospective transplant recipients. I participate in pharmacy-sponsored clinical trials studying the efficacy of various drugs in kidney diseases. One of the multicenter studies for which I am the primary investigator is looking at the effects of canagliflozin. The goal is to assess whether canagliflozin has a renal and vascular protective effect in reducing the progression of renal impairment in patients with Type 2 diabetes mellitus. I also am the co-investigator studying the use of darbopetin alpha, a long-acting erythropetin stimulating agent, to avoid blood transfusion and its associated risks in patients with chronic kidney disease. As the resident program director of the Nephrology Fellowship Program at the Buffalo VAMC, I am responsible for supervising and providing guidance to the fellows in renal medicine when they are rotating at the medical center. I am also actively involved in lectures and small group sessions of the nephrology module for first-year medical students. I also participate in educating and training medical students, residents and renal fellows during their inpatient nephrology rotations.
I have practiced nephrology for over 40 years. During that time I have treated patients with virtually every aspect of kidney disease. I have directed dialysis and transplant programs as well. For many years, I pursued laboratory research into the mechanisms underlying hypertension and renal disease during pregnancy. Consequently, I developed a special interest in kidney-related complications in pregnancy such as preeclampsia, a particular form of hypertension in pregnant women. I have worked in collaboration with other members of the Erie County Medical Center (ECMC) transplant team and researchers from the University at Buffalo School of Pharmacy and Pharmaceutical Sciences to pursue clinical research in transplant recipients. The results of these interdisciplinary studies have helped us develop expertise in the use and complications of medications used in transplant immunosuppression regimens. In research supported by the National Institutes of Health (NIH), the University at Buffalo and various pharmaceutical companies, we have helped define the differences that exist between male and female, and between white and black patients in regard to the metabolism of kidney medications. The differences we have defined benefit our patients: we can identify the best treatment protocol for each individual patient we care for. In recent years, we have been involved in a research project on the use of the only medication that appears to specifically benefit patients with polycystic kidney disease (PKD). Indeed, we have become one of the largest loci in the United States for these studies. This research, along with the many patients with PKD that we have cared for, has helped us become more astute in the medical management of patients and has allowed us to render cutting-edge care to them. We are also developing special programs for patients coping with any form of chronic kidney disease (CKD). A large project funded by New York State and developed in conjunction with UB’s Institute for Healthcare Informatics (IHI) has aided our understanding of how CKD patients in Western New York are treated. The large database of the IHI has made it possible for us to identify areas where new programs can be focused, resulting in improved care for CKD patients. This dynamic interaction between clinical research and patient care is the model I strive for as an academic physician because it results in the best possible care options for my patients.
Internal Medicine; Nephrology; Renal Transplantation
My main goal is extending and improving native kidney and renal transplant function. Over the last 15 years, I have focused my efforts on transplant renal management and acute kidney injury. I completed my nephrology and transplant training at Harvard in Massachusetts, and have been part of a busy group at The Ohio State University Transplant Center for the last 13 years as an attending and clinical researcher. I recently assumed the Medical Director of Transplant and Renal Services as part of the Erie County Medical Center/University at Buffalo, NY. Hot areas of clinical research concentrate on antibody-mediated rejection, new immune suppression and recurrent diseases post kidney transplant, and prevention and management of acute kidney injury and delayed transplant renal function. Through studies of immune suppression effects and impact on renal function and disease recurrence, we are hoping to improve early graft function and prevent disease recurrence. I have also been participating in novel pharmaceutical studies for management of transplant related injury and infections as well as artificial organ devices for bridge therapies including stem cells and pre-determined precursor kidney cells. My original PhD studies were in Neuroscience, at the University of Maryland Medical System, where I worked on growth factors for central nervous system (brain and spine) regeneration. Unfortunately, CNS injury repair continues to be under developed. The immune system plays a crucial role in the normal competition between true tissue repair and scarring. This recognition and the large population with renal diseases and transplant led me to transition in to kidney diseases and injury repair and transplant. While treatment and recovery from stroke have languished, chronic kidney disease and dialysis therapy have blossomed during the last 50 years, and renal transplant has become the gold standard for renal replacement therapy and live kidney donation has the best results. My research experience and publications span the fields of renal disease, transplant, and recovery. I contribute to national and international transplant meetings and educational efforts in transplant and nephrology in the American Society for Transplantation and the American Society of Nephrology for the development of new therapies and policies for better renal outcomes. Promoting renal transplant through education, clinical research and outreach are prime targets for transplant success. As an educator, I support nephrology and immunology lectures and conferences in medical school, graduate students and specialty fellowship training; working to develop the leaders of tomorrow in this field. Volunteerism and philanthropy are also important, passionate causes in raising awareness and funding for clinical studies, patient support and organ donation.
My clinical responsibilities include caring for patients coping with a wide variety of renal diseases, including but not limited to acute kidney injury (AKI), chronic kidney disease (CKD), glomerulonephritis and polycystic kidney disease. I also manage the care of patients who have resistant hypertension. I see patients at the bedside in Buffalo General Medical Center (BGMC) and in BGMC’s renal clinics. My research focuses on finding modifiable factors to reverse or halt the progression of CKD, through modifying the contents of gut bacteria (microbiota) and studying their correlation to disease states. Studies have demonstrated that gut microbiota can influence numerous aspects of human biology, and alterations in their function and composition (dysbiosis) suggest they play a role in the pathogenesis of diverse human illnesses such as chronic inflammation, diabetes mellitus, obesity, cardiovascular diseases and recently, CKD. I use both human and animal studies to explore the effects of gut microbiota dysbiosis on renal diseases. I have conducted clinical trials evaluating the diversities and population of gut bacteria in patients with different degrees of renal insufficiencies. I also have evaluated the role of diet on gut bacteria and inflammation, in patients with end-stage renal disease (ESRD) who are on dialysis. To confirm the findings and further explore the importance of gut microbiota on renal diseases and conditions, I am conducting animal experiments using different murine models of advanced and acute-reversible renal diseases. In addition to my research activities, I supervise and teach renal fellows, medicine residents and medical students in the renal inpatient rotation and in the renal outpatient clinic.