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
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.
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.
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.
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.
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.
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.
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.
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.
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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