High School Student Discusses Research, Interest in Nephrology

Introduction

As the pipeline of continued nephrologists continues to shrink, multiple efforts are currently underway to stimulate interest in careers in nephrology. During Kidney Week 2016 in Chicago I saw something different. I happened to run into the poster of Uma Alappan, a high school student from Georgia. Uma presented her poster in grand detail and passion. She was exploring the phosphate content and ph of various soft drinks. This kind of very early passion was something I have not seen before. She was thrilled to be right in the middle of all of the excitement. How can we as a society continue to foster this kind of enthusiasm for our field? Data from early career programs (undergraduate Student Scholars Grant Program) have fallen flat in regards to the payoff of eventual career path in nephrology. Should we abandon this? I don’t think so. While the hard data might not show us what we want it is still up to us to share our passion and pass it down to the next generation. I hope to see more high school students, undergraduates, and medical students engaged in our research and our field. In order to turn the tide we all need to band together in order to stimulate the next generation.

- Dr. Matthew A. Sparks, MD, Duke University School of Medicine

Tell us something about yourself and how you developed an interest in nephrology.

Both of my parents are doctors—my mother a pediatrician, my father a nephrologist—so I have always been interested in the medical field. As a child I joined my parents while they made rounds at the hospital or saw patients at their private practices. It was not until my sophomore year of high school that I realized I had an interest in nephrology. For my annual science fair project, I decided to analyze the acidity and phosphorus levels of several sodas and conduct a survey around my hometown, Columbus, GA, to identify a general pattern of soda consumption and use this information to help prevent future health issues. Through research I discovered that excess phosphorus consumption can lead to several fatal renal diseases—for example, calciphylaxis. During this research, I learned more about the general processes and functions of the kidney, and thus began my budding interest in nephrology.

For my junior year of high school, I realized that nephrology has a lot to do with both biology and chemistry, so I signed up for AP Biology and AP Chemistry—advanced placement college classes offered at the high school level. Upon returning from ASN Kidney Week 2016 in Chicago, I instantly felt a difference in my knowledge that helped me tremendously with these classes. For example, in AP Biology, I was able to easily learn the anatomy of the nephron and the absorption/secretion processes involved in it, including the filtration process in the glomerulus of the Bowman’s capsule and the facilitated diffusion/osmosis and active transport that occurs in the proximal tubule, loop of Henle, distal tubule, and collecting duct. Being able to confidently explain the process of the nephron to my teacher, Mrs. Lingo, and explore the exciting concept of the kidney, inspired me to pursue a career as a nephrologist.

As for my other interests, I am a rising high school senior at Brookstone School in Columbus. I sing in the school’s chorus, take piano and voice lessons after school, and compete in musical competitions. I am the captain of the Varsity Girls Golf Team at Brookstone and play in several golf matches/tournaments throughout the season.

Tell us about your experience attending Kidney Week 2016 in Chicago.

When I first submitted my study abstract, I did not expect it to be accepted by such a prestigious society, especially as I was competing with highly trained medical professionals. At the most I hoped ASN would publish my abstract online in JASN. I was completely shocked when I received an email not only congratulating me on my abstract’s acceptance to JASN, but also inviting me to Chicago for a poster presentation.

Because I am a high school student, my father called ASN to ensure my abstract was not accepted by mistake. It was not: ASN recognized that I was a high school student and generously granted me a free student membership and registration. I was going to Chicago.

From the moment I walked into the convention center, an academic vibe radiated from the well dressed, focused, sophisticated nephrology professionals. My father—an ASN member himself—said he could attend all the lectures while I stayed in the hotel room, but I insisted that I make the most out of the experience and joined him. During several lectures—including presentations by Mona Calvo, MS, PhD, on the changes in the FDA’s representation of phosphorus content in food labels; by Charles O’Neill, MD, on observation of the progression of medial arterial calcification in ESRD patients; and by Mariano Rodriguez, MD, PhD, on his study finding that calcimimetics maintain bone turnover in a PTH-independent manner in uremic rats—I had to look up key vocabulary terms, but once I deciphered the refined medical lexicon, I was able to fully grasp the concepts.

I was also intrigued by the various products displayed on the exhibit floor, as well as the study posters of nephrologists from many different countries, including Spain, Germany, Japan, Italy, Portugal, Argentina, Qatar, and Egypt. As for my own poster, presenting it was the most rewarding experience I have ever had. Because I was a high school student presenting to medical professionals, I was not sure if I would be able to accurately respond to every question; however, I prepared well beforehand and ended up answering questions without a problem. The feeling I had when I could finally share my knowledge was exhilarating. Over 250 people came to visit my poster—so many that I lost count—and it was a satisfying moment to realize that as a high school student from small Columbus, GA, all my hard work was being appreciated by medical professionals across the globe.

Tell us about your paper, how you developed the idea for doing the research, and what you learned.

When I was a child, my parents always told me not to drink sodas. As I grew older, my curiosity increased: What do sodas contain that makes them so unhealthy? I knew my parents were aware of the health issues caused by overconsumption of sodas, but I decided to investigate further on my own. For my annual science fair project, I decided to test the pH and phosphorus levels of various commonly consumed sodas, such as Coke, Pepsi, and Sprite, because this information is not readily available on product labels. I would also conduct a random survey in and around Columbus to determine survey participants’ general soda consumption pattern and knowledge of its long-term health impact. Questions included each participant’s favorite soda, their soda-consumption frequency, and their knowledge of soda contents. The nationally recognized Cott Beverages manufacturing company, located in Columbus, allowed me to estimate the pH and phosphorus content of various sodas using their precise instruments.

After analyzing the data collected, I came to the conclusion that many popular sodas contain a significant amount of phosphorus and have high acidity levels that may pose a great health risk if overconsumed. The survey results revealed that people are not aware of these adverse contents of soda, so they continue to overconsume it.

I felt it was crucial that my findings be released so I entered the Columbus Science & Engineering Fair. I won first place and the title “Best Overall Project,” allowing me to advance to the state level, where I won second place for my category and received the prestigious United States Metric Association (USMA) SI Metric System Award, which is presented to three students in Georgia with the most accurate experimental data, collected using precise metric system instruments.

These fairs still were not enough to inform the public of my findings, so I took it one step further. I spoke with my nephrologist father about other methods to convey my findings, and he suggested submitting an abstract to ASN, because the topic is important in dealing with fatal conditions such as calciphylaxis, a form of calcific uremic arteriolopathy resulting from calcium phosphate salt formed when there is excess phosphorus in the body. I worked to perfect my abstract and showcase my information at its best in hopes of acceptance. After receiving the email detailing my abstract publication in JASN and an invitation to Chicago for a poster presentation, I was ecstatic. I would finally be able to share my knowledge at the prestigious ASN annual meeting.

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Are there any individuals you would like to emulate in your career, such as family members, teachers, or mentors?

My parents, Drs. Raj and Devica Alappan, are two of the most motivated, hard-working individuals I know. They are always focused on their careers, yet still find time for their families and those they love. In the future I want to not only be a successful nephrologist, but also a successful mother and wife. Both my mother and father have always made time for my brother and me. Nevertheless, they have reached extraordinary levels in their medical careers, having received numerous accolades for their work, publication in several reputable journals, and expansion of their own medical practices over the years. If I become a nephrologist, I hope to not only attain their level of prestige as doctors but also to be as good a parent to my children as they have been to me.

I have always admired my older brother Harish. We are about as close as two siblings can get. Harish has long had a passion for soccer, and as a child I had to play along with him so he could practice his skills on an opponent. Harish has achieved much not only as a soccer player, but also as a student, maintaining “high A” averages while still pushing himself to new heights in soccer. Very few people can balance both academics and sports as well as he can, and I hope to emulate my brother and, like him, manage both my hobbies and my career as a future nephrologist.

Without my mentor, Mr. Prem Virmani, my statistical data analyst, Mr. Madhusudan Bhandary, and my teachers, Dr. Dorothy Cheruiyot and Mrs. Cynthia Lingo, I would not have reached ASN Kidney Week in Chicago.

Mr. Virmani generously allowed me to conduct my research in his Cott Beverages Laboratory in Columbus and was my mentor throughout the study. Mr. Bhandary assisted me in analyzing the statistical significance of my data. Without the guidance of my teachers, I would not have had the encouragement needed to pursue the research. In my future career I hope to be as generous, encouraging, and supportive as these four individuals have been to me throughout this experience.

Attending Kidney Week 2016 allowed me to make connections with several extraordinary people I would like to emulate in the future.

Everyone had conducted such complex research, offered valuable structural criticism of my own study and poster presentation, and generously offered connections for future research. They included Randy Hennigar, MD, PhD, Arkana Laboratories nephropathologist, who connected me with people who could help in future research; Mark Perazella, MD, FASN, Professor of Nephrology at Yale, who instilled confidence in me by eagerly listening to my poster presentation; Matt Sparks, MD, FASN, Duke Assistant Professor of Medicine, who tweeted a picture of my father and me posing in front of my poster board that went viral; Mona Calvo, MS, PhD, retired FDA Expert Regulatory Review Scientist, who offered me an FDA summer internship; Mariano Rodriguez, MD, PhD, Professor of Medicine at the Hospital Universitario Reina Sofia in Córdoba, Spain, who offered several ideas for future research and provided helpful criticism for my poster presentation; and Edgar V. Lerma, MD, FASN, Clinical Professor of Medicine at the University of Illinois at Chicago/Advocate Christ Medical, who generously connected me with ASN Kidney News to share my ASN experience. In my career as a nephrologist, I hope to be as successful, generous, and motivated as these individuals are.

I am building on the connections I made at ASN Kidney Week, and am trying to conduct future research with those I met in Chicago. I recently submitted both an abstract and research paper for the Kidney Week study to the Georgia Junior Science and Humanities Symposium (GJSHS) hosted at the University of Georgia in February. I was one of 50 students from the entire state of Georgia selected to give an oral presentation at this all-expense-paid, 3-day symposium.

After the ASN meeting, I was interviewed on the local NBC affiliate’s TV news segment “Straight Forward with Gloria Strode” to discuss my experience in Chicago and spread awareness and interest in the field of nephrology.

Where do you see yourself in the next 10 years?

In 10 years, I hope to have attended a prestigious undergraduate university that will have given me the opportunity to expand my knowledge, gain experience, and attend a well-respected medical school. I hope to have conducted advanced research and to be a resident physician with the intention of specializing in nephrology. I also hope to have settled down with a husband to start a family, while still balancing my professional career responsibilities. I also aim to have served as an inspiration to students like myself willing to work hard to expand their knowledge base and attain a successful career.

What advice would you give ASN leaders about how to reach out to young people and expose them to nephrology?

ASN might create a forum for high school students where they can present their studies to trained experts, develop presentation skills, and foster an interest in nephrology. Another possibility is a separate section at Kidney Week for high school students to give either oral or poster presentations. If ASN were the first to offer students this experience, it might start a trend, encouraging other medical organizations such as the American Heart Association or the American Academy of Neurology to help students develop their interest for other aspects of medicine as well.