5 Questions with Dr. Ramy M. Hanna

Summary

Blood, Sweat and Smears - A Machaon Diagnostics Podcast
Episode: 5 Questions with Dr. Ramy M. Hanna
Release Date: April 18, 2025
Host: Dr. Brad Lewis
Guest: Dr. Ramy M. Hanna, Associate Professor in the Division of Nephrology, Hypertension, and Kidney Transplantation at UC Irvine

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Introduction

In this engaging episode of Blood, Sweat and Smears, host Dr. Brad Lewis teams up with senior director Bjorn Stromses to delve into the intricate world of nephrology with their esteemed guest, Dr. Ramy M. Hanna. Dr. Hanna brings a wealth of expertise in rare kidney diseases, thrombotic microangiopathy, and translational medicine, offering listeners a deep dive into the complexities and collaborative nature of nephrology.

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Nephrology as a Mathematical Discipline

Dr. Hanna opens the conversation by highlighting the profound mathematical underpinnings of nephrology. Drawing a parallel between the field and chemical engineering, he emphasizes the necessity of strong numerical skills in understanding and managing kidney function.

Dr. Rami Hanna [01:45]: "Nephrology is essentially a chemical engineer in a white coat... You have to have a very strong command of arithmetic and excel, of course."

He explains that nephrologists must adeptly handle calculations involving concentrations, gradients across the glomerulus, and the dynamics of electrolyte variables. This analytical approach ensures precise treatment strategies, as the kidneys' delicate balance requires accurate interpretation of numerical data to prevent detrimental outcomes.

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The Challenge of Medical Terminology

Addressing the complexity of medical jargon, Dr. Hanna reflects on the pronunciation and understanding of terms like "glomerulonephritis" and "glomerulopathy." He acknowledges these as daunting tongue twisters, especially in English, but finds some solace in the more phonetic nature of Spanish medical terms.

Dr. Rami Hanna [03:43]: "Glomerulonephritis, glomerulopathy. Are this a bit of a tongue twister?"

His affinity for ancient history and molecular genetics has equipped him to navigate these complex terms with ease, underscoring the importance of a strong linguistic foundation in mastering medical specialties.

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Collaborative Interactions: Rheumatology and Hematology/Oncology

When discussing his favorite departments to collaborate with, Dr. Hanna expresses a particular fondness for rheumatology and hematology/oncology. His admiration for the rheumatology division, especially under the leadership of Dr. Sheetal Desai, stems from their shared understanding and seamless communication.

Dr. Rami Hanna [04:50]: "It's just very collegial. You ever work with someone who you understand each other's fields so well you can finish each other's sentences?"

In contrast, his collaboration with hematology/oncology presents unique challenges due to differing primary objectives—renal preservation versus cancer eradication. Nevertheless, he values the innovative tools and experimental therapies emerging from this partnership, which often push the boundaries of traditional treatment modalities.

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Complement-driven Thrombotic Microangiopathies (TMAs): Insights from a Nephrology Perspective

A significant portion of the discussion centers around complement-driven TMAs, a complex intersection of nephrology and hematology. Dr. Hanna underscores the importance of nephrologists understanding the nuances of kidney filtration and creatinine trends, especially in hematology patients with reduced muscle mass.

Dr. Rami Hanna [06:29]: "Creatinine 1 could actually be a sign of great alarm in a hematology patient. It's all about the trend."

He advises hematologists to meticulously monitor serum creatinine levels and glomerular filtration rates (GFR), advocating for a trend-based analysis over rigid normal ranges. This approach allows for a more personalized and accurate assessment of kidney function, crucial for timely interventions.

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Cross-training and Interdisciplinary Knowledge

Dr. Hanna passionately advocates for a more integrated approach to medical training, where nephrologists, hematologists, and rheumatologists cross-train within each other's specialties. He envisions medical professionals resembling the versatile and knowledgeable characters like Dr. House, capable of navigating multiple disciplines to enhance patient outcomes.

Dr. Rami Hanna [08:08]: "We need people who speak across multiple different fields and people who are also able to coordinate teams and coordinate collaboration across different fields to generate those exceptional outcomes."

This interdisciplinary mindset, according to Dr. Hanna, is essential for advancing nephrology as a specialty, fostering collaboration that leads to innovative treatments and improved patient care.

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Future Vision for Nephrology: Emphasizing Outcomes and Kidney Success

Looking ahead, Dr. Hanna articulates a transformative vision for nephrology. He emphasizes shifting the focus from process-oriented care to outcome-driven practices, aiming to cultivate a "culture of kidney success." This entails prioritizing renal preservation and reducing long-term dialysis dependency.

Dr. Rami Hanna [09:46]: "We want to embrace the culture of kidney success, which is bringing native kidneys back online."

He critiques the existing "culture of renal failure," advocating for a renaissance in nephrology akin to advancements seen in cardiology and oncology. By investing in new tools and prioritizing patient-centric outcomes, Dr. Hanna believes nephrology can elevate its status and effectiveness, ultimately leading to better health outcomes and increased investment from medical bodies.

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Bonus Recommendation: Embracing Physical Activity Over Pharmacological Solutions

In a light-hearted bonus segment, Dr. Hanna offers a personal recommendation prioritizing physical activity over weight loss medications. He suggests running as a superior alternative to drugs like Wegovy for weight management, encouraging listeners to consult with their physicians before making health decisions.

Dr. Rami Hanna [10:46]: "Go for a run. A lot of people are on weight loss drugs and that's great. I think one of them is called Wegovy. I say we go Run is a better prescription, but that's just my personal opinion."

Additionally, he extends an invitation for colleagues to consider UC Irvine as a center of excellence for complement-mediated diseases, highlighting the institution's commitment to advanced patient care.

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Conclusion

This episode of Blood, Sweat and Smears offers a comprehensive look into the multifaceted realm of nephrology through Dr. Ramy M. Hanna's insightful perspectives. From the critical role of mathematics in kidney health to fostering interdisciplinary collaborations and envisioning a future focused on patient outcomes, listeners gain a thorough understanding of the challenges and innovations shaping the field. Dr. Hanna's passion for nephrology and his forward-thinking approach provide both inspiration and practical insights for clinicians and enthusiasts alike.

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Transcript

[Dr. Brad Lewis]

Hello and welcome to Blood, Sweat and Smears, your Macheon Diagnostics podcast with tag team hosts, including Our medical director, Dr. Brad Lewis, senior director Bjorn Stromses.

[Bjorn Stromses]

That's me.

[Dr. Brad Lewis]

And other guest hosts. We hope you find these podcasts interesting and informative. Thank you for listening.

[Bjorn Stromses]

And away we go. Hi, my name is Bjorn. Continuing our series 5 questions posing 5 questions to physicians in and around the disease areas we work in today. We ask you to drink when you're thirsty and trust your kidneys because our guest today is Dr. Rami Hana, Associate professor in the division of nephrology, Hypertension and Kidney Transplantation, and director for the Glomerular Nephritis program at UC Irvine.

[Dr. Rami Hana]

Thanks for the invite. And just so that our friend Will Flannery at Glaucoma Fleckin doesn't feel like we stole something from him. Yes, that's his Trust your kidneys. One of. One of my favorite people to listen to when I need a laugh. So my area of expertise is in rare disease, including thrombotic microangiopathy, things like AHOs, C3G, PNH. That's my.1 of my true loves. And then my other area is in translational medicine and onco nephrology. So, Bjorn, thank you and Brad, obviously for all the support over the years and I look forward to answering your five questions.

[Bjorn Stromses]

Yeah, absolutely. It's been a pleasure working with you. And we can go ahead with our first question, which is I've seen nephrology described as the specialty to go into. If you love math. Are you a math lover? And is that description fair?

[Dr. Rami Hana]

So the truth is 50% of my genes belong to an engineer. My father's a chemical engineer and I like to describe nephrology as essentially a chemical engineer in a white coat. So essentially we do the calculations that involve concentrations, looking at gradients across the glomerulus, being able to predict and prognosticate the rate of change of certain electrolyte variables like sodium, understanding the delicate interplay of pressure and renal perfusion. And these are things that while you can understand on a surface level and still be an effective nephrologist, you are definitely much better off if you understand algebra, basic calculus, definitely. You have to have a very strong command of arithmetic and excel, of course. So we are really representing the engineers in the field of medicine, and that's why so many of us are. So how shall I put this? On the obsessive compulsive side and also extremely numbers driven. Now, the benefit of that is More than other physicians. We tend to be very data driven. We don't do anything in general nephrology without number to back it up. And even in transplant nephrology and glomerular disease, which I've been doing now for the past six or seven years, biopsies serve as descriptive data, not necessarily numbers, but there's numbers that you can derive looking at these biopsies. So a nephrologist is essentially the analyst and the number cruncher and also the master of pathology who needs to know the final reason why something is happening before you can treat it. The kidneys are very unforgiving. If you treat the wrong thing, they will not get better. You have to find the cause. And if you can't find the cause, you're not going to work as a nephrologist.

[Bjorn Stromses]

All right, so question 2. Is glomerulouropathy the hardest word to pronounce in medicine or is that just me?

[Dr. Rami Hana]

Glomerulonephritis, glomerulopathy. Are this a bit of a tongue twister? I think it's just the rapid fire pace. But it's funny in Spanish, I think it's easier. It's glomerulonefritis. Right. So in Spanish, things are spelled like they sound. And of course, because Spanish is derived from Latin and a little bit of Arabic, a little bit of trivia for you there. You can actually, you know, certain words, if you sort of use the Latin spelling or the Latin pronunciation, you're able to spell it much easier. Unfortunately, medicine is half Greek and Latin anyway. And anyone who, anyone who wants to do this field better get comfortable with that. The reason I don't struggle as much is my other love, besides molecular genetics, is ancient history. So I've actually had to read quite a bit of these words over the years. And maybe in a different universe, in a parallel universe, I'm an Egyptologist, but here we are, and I have to say, this pays the bills much better. I'll bet it does.

[Bjorn Stromses]

All right, our third question. At your institution, which department is your favorite to work with? Either when you are asked to consult on one of their patients or you're asking others to consult on one of yours.

[Dr. Rami Hana]

So to be diplomatic, I have to choose two, but for completely different reasons. I love a rheumatology division de facto chief because there's an interim right now is the Chair of Medicine, Dr. Sheetal Desai, who is a world renowned expert on lupus. And it's just very collegial. And, you know, you Ever work with someone who you understand each other's fields so well you can finish each other's sentences? Now, as far as novelty and interest of the actual disease process, as much as I like the rheumatology folks, I love the hematology oncology folks. More challenging because we have different goals. Our goals is renal preservation, their goals is eradication of cancer. And many times they run counter to each other. But nothing beats the cool things we're seeing with all the amazing tools they're developing to literally change cellular physiology. And very frequently a case report, when you see some of these cases where there's on experimental chemotherapy or on new chemotherapy kind of in phase four before we know all the bad things it can do. But like I tell all my patients, including our onkin rheumatology patients, every drug does one thing right and three things wrong. So you have to make sure you press your physician who's treating you especially with powerful immunosuppressants, immunomodulators and things that target endothelium for all the side effects, because I guarantee you there will be side effects and you're going to be much happier if they tell you beforehand. Then if you find out after we.

[Bjorn Stromses]

Have worked with you mostly in the area of complement driven TMAs, that's something that tends to be handled in some joint way between hematology and nephrology. What do you think hematologists would benefit from understanding about how nephrology looks at those patients?

[Dr. Rami Hana]

I think the mathematical approach to filtration is very important. I mean, it's not hard to identify when people have proteinura hematuria. But the concept of normal range for creatinine is one of the most destructive ones I've seen, especially when it comes to hematology and oncology patients because they already have hampered muscle mass so they produce less creatinine. So creatinine 1 could actually be a sign of great alarm in a hematology patient. It's all about the trend. If someone starts at 0.2 and they're at 1, they're in deep trouble. If someone starts at 0.9 and they're at 1, that's a different story because you're normalizing it to the patient. The other thing I would probably like the hematologist to kind of go over with patients is when it comes to AHUs is the importance of following their parameters, especially when people are talking about discontinuation. I'm very lucky that we have a great hematologist at UCI Lisa Lee, who's on our thrombotic microangiopathy assessment team. We have almost three dozen people on complement blockade for hematological reasons besides the ones who are on it for other indications that are novel and coming up and anybody follows, the FDA sees this. So I think I would want them to understand how the kidney filters and rather than seeing a 0.1 increase as a catastrophe or ignoring completely a doubling of creatinine from 0.5 to 1, understanding that if you just draw, plot out the serum creatinines, plot out the GFR and look at the trend, you're able to much better appreciate where filtration is going.

[Bjorn Stromses]

And the reverse of that is. What do you think your nephrology colleagues would benefit from understanding from hematology perspective for those patients?

[Dr. Rami Hana]

I think it's incumbent on every nephrologist to just simply accept the fact that everything in the blood is our responsibility now, I think so. That's why I'm interested in rheumatology and hematology and oncology, because I think those things all affect the blood. And I think you have to be a little bit of infectious disease doctor. Rheumatology and nephrology and oncology all have to cross train within each other's fields. Someone like Dr. House, minus the cane and the Norco addiction, would be very useful to have in a hospital. Now, I don't think I'm Dr. House yet, but I think if you give someone in this field 20, 30, 40 years, they become almost divine in their knowledge and their wisdom. And that's what we need. We need people who speak across multiple different fields and people who are also able to coordinate teams and coordinate collaboration across different fields to generate those exceptional outcomes. I'm not a believer that medicine should be looked at as a process, meaning you meet your standard of care just by meeting your process. I believe. And then maybe this is sort of a little bit extreme that I believe we should really look at outcomes, sort of like how the surgeons and the transplant nephrologists do. Of course, I say this in nephrology, which has the sickest patients and probably like some of the hardest outcomes when it comes to people on dialysis and people glomerular disease and electrolyte disorders. But I think that we're not asking for perfection. We're just asking to look at how people do and then make sure that the outcomes improve every year. We want to embrace the culture of kidney success, which is bringing native kidneys back online. There are other corporate interests who prefer the culture of renal failure which people get stuck on dialysis for an indefinite amount of time. I believe glomerular disease and transplant nephrology are key in order to embrace as a specialty the culture of kidney success so that we can see a renaissance like other specialties have done when they've done this like cardiology and oncology. Right. When we really invest in the brand new tools in order to bring people the outcomes they want, we will be reborn as a specialty rather than essentially being relegated to specialty that sees a lot of volume and sadly is not have a lot of investment in it either from CMS or from the pharma sector. Luckily that's changing, but it's not changing because people are being put on dialysis. It's changing because people don't want to be put on dialysis and people are sick and tired of these bad outcomes and they want better outcomes.

[Bjorn Stromses]

Great. If you're keeping score at home, that is five questions. Which brings us to our bonus question which is what is something you'd recommend? And it can be anything.

[Dr. Rami Hana]

If your joints are up for it, go for a run. A lot of people are on weight loss drugs and that's great. I think one of them is called Wegovy. I say we go Run is a better prescription, but that's just my personal opinion. Consult with your physician. This has been fun. And if you guys ever need anything for complement mediated disease, please keep UCI in mind as your local and regional center of excellence.

[Bjorn Stromses]

Fantastic. Well, thank you very much for your time today, Dr. Hannah, and sure we'll be talking in the future.

[Dr. Rami Hana]

Indeed. Thank you Bjorn. Bye bye.

[Dr. Brad Lewis]

That's it for us here at Blood, Sweat and Smears, a podcast produced by Matrian Diagnostics, your reference lab and CRO specializing in thrombosis, hemostasis and rare disease. Thank you for listening and if you have a question or comment or there's a topic you'd like Dr. Lewis to speak to, please send us an email to blood, sweat and smearsatriondiagnostics.com that's machine. You can follow Macheon at Twitter at matriondx. Be sure to subscribe to stay in the know. Share this podcast with clinicians you think might appreciate it and we hope you'll join us next time here at Blood, Sweat and Smears.