Four years ago, I interviewed you for Kidney News about your poster at ASN Kidney Week. You were a high school junior at the time. Can you briefly tell us how your research has developed since then?
I will always be grateful to ASN for giving me the opportunity to present a poster at Kidney Week 2016. This one presentation provided a jump start to my career.
In my research study, I quantified soda acidity/phosphorus levels and conducted a soda-consumption survey. As is known, the potential health implications associated with soda overconsumption include heart/bone disease and calciphylaxis. During Kidney Week, I attended an oral presentation by Mona Calvo, PhD, a retired official from the US Food and Drug Administration (FDA), who offered me the opportunity to conduct research at the FDA. In July 2017, I spent two weeks interning at the FDA in Washington, DC, under the mentorship of Beverly Wolpert, PhD, the FDA epidemiology branch chief, and then continued the research by telework from Columbus, Georgia. Throughout my senior year of high school, I continued my research with the FDA correlating beverage consumption to education, income, race/ethnicity, and age in 14- to 18-year-old participants in the 2009 to 2014 National Health and Nutrition Examination Survey. In July 2018, I presented my research to the entire epidemiology branch team. My research abstract, of which I was first author, was published in the 2018 JASN. I thank Dr. Calvo, Dr. Wolpert, and the FDA epidemiology branch team for supporting my research pursuits.
After my FDA epidemiology study, I began a new study that aimed to correlate uric acid level (hyperuricemia and gout) to cardiovascular disease (CVD), hypertension, and chronic kidney disease stage. This study abstract, of which I was first author, was published in both the 2019 JASN and the 2020 American Journal of Kidney Diseases and was accepted for a poster presentation at the 2020 National Kidney Foundation (NKF) spring clinical meetings.
Now an Emory University undergraduate, I am performing research with Dr. George Beck Jr., PhD, at the Emory School of Medicine, working toward publishing my work on dietary phosphorus intake, mice kidney/liver tissue, and gene expression.
Students may begin to view nephrology in another light if they are provided foundational support from the nephrology community from an early age.
Tell us about your personal and educational advancements since our 2016 interview.
I am currently a biology major on the premedical track and a Robert W. Woodruff scholar at Emory University.
Each month, the Woodruff scholars program holds networking events to help foster students’ connections with accomplished professionals across all disciplines—whether medicine, law, arts, or humanities. The program also provides scholars with travel grants to attend research conferences and summer internships, and it offers study-abroad programs.
Besides its strong academics and world-class research facilities, Emory also has an outstanding liberal arts program that allows me to take courses outside of my major—music, sociology, psychology—and actively participate in musical groups on campus. I sing in the Emory Concert Choir and serve as musical director of Emory Suri Bollywood Fusion A Cappella.
Congratulations on having another poster presented at the 2020 NKF spring clinical meetings. Tell us more about it.
I was ecstatic when I received the news that my poster was accepted for presentation because I was eager to share the study’s important findings. Elevated uric acid (hyperuricemia) is a common finding in both general practice (internal medicine, family practice) and nephrology practice patients. Recent studies have revealed associations between hyperuricemia and diabetic retinopathy, hypertension, and other comorbid conditions; however, the data is still insufficient to confirm these findings. In hopes of providing stronger evidence to help physicians decide whether or not to treat hyperuricemia, I conducted a research study with my father, Raj Alappan, MD, that aimed to correlate uric acid level to CVD, hypertension, CKD stage, and demographics in patients with hyperuricemia and gout.
Data analysis revealed that patients with hyperuricemia and gout experienced significantly higher CVD occurrence (p < 0.00001) than did patients from a previous study (all practice patients from 2014 to 2016; work presented by my older brother, Harish R. Alappan, during ASN Kidney Week 2017). Overall, in hyperuricemic, gout, and CVD disease populations, uric acid level and CKD stage showed a strong, positive, linear correlation. White individuals with CVD had higher uric acid than did black individuals with CVD (p = 0.03). Young men (<65) had significantly lower CVD occurrence (23.48%) than did older men (p = 0.031); yet CVD occurrence did not statistically differ between younger and older women.
I hoped that presenting these findings at NKF would encourage physicians to consider preemptive treatment of all hyperuricemic patients—or at minimum, gout patients with uric acid ≥10 mg/dL—to mitigate the potential development of gout, CVD, and hypertension. When I first received news that the 2020 NKF spring clinical meetings would be moved to a virtual format because of the COVID-19 outbreak, I was disappointed. I believed I would not be able to share my findings as efficiently.
Nevertheless, the NKF did a great job ensuring the success of the online format. Lectures and oral presentations were held using the Zoom online platform, allowing me to attend sessions and learn from medical professionals and nephrologists just as I had done at ASN Kidney Week. Soon after uploading my poster to the NKF 2020 abstracts and e-poster gallery, I was contacted by several organizations that hoped to feature my poster and research, including MedPage Today and Renal & Urology News. I was excited to share my findings with a large audience of physicians.
What do you hope to accomplish next?
Following in the footsteps of my brother Harish, I hope to continue research with my current mentor and publish a research paper before I graduate from Emory. Harish performs research with the Emory School of Medicine nephrology department under the mentorship of Charles O’Neill, MD. He has presented four different research posters at ASN meetings (2017, 2018, and 2019). Like Harish, whose article “Warfarin Accelerates Medial Arterial Calcification in Humans” was published in the April 2020 Arteriosclerosis, Thrombosis, and Vascular Biology, I hope that after graduating from Emory and before entering medical school I will have advanced my research and medical career by publishing a research paper.
I also hope to have further developed my musical abilities by traveling and competing with the Emory Concert Choir and Emory Suri A Cappella.
But my main priority now is to support those in need during the COVID-19 pandemic. After Emory announced that the remainder of the spring 2020 semester would be held online, I returned to my hometown, Columbus, GA. My parents, Drs. Raj and Devica Alappan, have worked very hard to see patients and coordinate with our local city leadership to determine what our family can do to help. After our local MercyMed nonprofit organization in Columbus created a COVID-19 testing clinic, we offered to analyze the data of over 1200 patients to determine potential comorbidities, symptoms, and other factors associated with the virus. I have been working remotely with the Emory/Atlanta MedSupplyDrive to help redirect unused personal protective equipment from idle research laboratories, institutions, and local businesses to hospitals, emergency rooms, and clinics. Because clinicians are running out of personal protective equipment, they are putting themselves at high risk through their contact with and treatment of COVID-19 patients. This puts their own lives and their patients’ lives on the line.
In our last interview, I asked where you saw yourself in 10 years. Now, where do you see yourself in another 10 years? Is there a particular aspect of nephrology that interests you?
In my previous ASN Kidney News interview, I stated that in 10 years I hoped to have “attended a prestigious undergraduate university [and] well-respected medical school…conducted advanced research…settled down with a husband to start a family [and] served as an inspiration to students.” Hopefully, in another 10 years I will be 1 year away from becoming a kidney specialist, will have published several research papers, and will be settled down with a family. I also hope to still have time for my hobbies: voice, piano, dance, and golf. Although my aspirations have not changed since my initial ASN Kidney News interview, I believe my experiences over the past 4 years have helped me to more clearly define my goals and rationale for pursuing a medical career in nephrology.
During the time since our last interview, I have become heavily involved in mentoring programs in hopes of sharing my research/science knowledge and serving as an inspiration to students. As a senior in high school, I visited Lonnie Jackson Academy, a local inner-city elementary school, to give a lecture on the importance of proper nutrition as it relates to soda acidity/phosphorus levels, beverage consumption, and hidden food/beverage phosphorus preservatives. My goal was not only to educate and promote proper nutrition in the younger generation but also to spark an interest in science and research. A few months later, my brother and I created an official ASN podcast to share our experiences as the “youngest Kidney Week presenters” in order to encourage other young scientists to pursue a career in medicine and nephrology. Now at Emory, I help teach chemistry and hold learning/mentoring sessions. I also serve as an undergraduate research programs research ambassador, helping students become involved in undergraduate research and assisting them in creating abstracts, drafting research proposals, presenting posters, and more.
Since 2015 I have served as a volunteer for Piedmont Columbus Regional Hospital in my hometown. In 2019, I shadowed several physicians and surgeons and observed more than 11 surgeries. This firsthand experience in the medical/surgical environment was pivotal in solidifying my interest in pursuing medicine. At the time, I was in the process of completing the uric acid study that was accepted as a poster presentation for the 2020 NKF spring clinical meetings. Before this study, my previous nephrology-related research concerned dietary phosphorus as it relates to nutrition, beverage and phosphorus consumption, hidden phosphorus in food/beverage preservatives, and potential adverse health implications (calciphylaxis, heart/bone disease). I had hoped to diversify my nephrology interests by performing a study centered on new topics, such as uric acid and gout. But I somehow drifted back to the topic of phosphorus and kidneys after the conclusion of the uric acid study. Now in the laboratory of Dr. George Beck at the Emory University School of Medicine, I perform research concerning dietary phosphorus intake, mice kidney/liver tissue, and gene expression. After 4 years, I have determined that I am passionate about nephrology, especially in relation to dietary phosphorus.
As you know, the nephrology workforce is shrinking. Not many people are interested in going into nephrology today. As someone who is very young in your career, yet with a lot of motivation and a strong interest in the field of nephrology, what would be your advice to your peers? To leaders in nephrology?
The best advice I can give is to seize every opportunity and resource as it comes, especially early in life. At age 16, I was exposed to many opportunities that were crucial in my career development, including the FDA internship and opportunity to present my poster during ASN Kidney Week 2016. My experience at Kidney Week also led me to other medical professionals who have provided me with considerable support, resources, and opportunities, including Matthew Sparks, MD, assistant professor of medicine at Duke University, and Edgar Lerma, MD, FASN, of the ASN Kidney News editorial board. Most important, it gave me the confidence and support to continue to pursue nephrology-related research and a career as a kidney specialist.
Since 2016, I have been in contact with many current and past ASN presidents and ASN Council members about ways to foster a similar interest in nephrology in other young scientists. For example, ASN could create a high school/undergraduate research forum for students to present their research at ASN meetings, where they could also meet other medical professionals and nephrologists and receive constructive feedback. Students could submit a research abstract or brief study description by way of application for the forum, and those selected would be invited to present their poster or oral presentation at the meeting. Alternatively, ASN could create a virtual forum by Zoom or Skype.
Another idea is to create an ASN Twitter or Facebook group chat for high school and undergraduate students to discuss nephrology-related topics, share personal research accomplishments, and network with the ASN community. Further, to inform high school and undergraduate students of new developments in nephrology, we could create a newsletter featuring nephrology research performed by students all over the world. The newsletter could showcase various nephrologists and medical professionals willing to allow students to meet or shadow them and provide information about upcoming nephrology research internships and summer research programs. Just at Emory alone, I know of several peers who would benefit from the opportunities these programs could provide.
Students may begin to view nephrology in a different light if they are provided foundational support from the nephrology community from an early age. Perhaps implementation of these ideas would provide just the impetus we need to boost interest in the field of nephrology.
KN Editorial Board member Edgar Lerma, MD, FASN, interviewed pre-med student Uma D. Alappan about her poster at the recent National Kidney Foundation’s (NKF) Spring Clinical Meetings. Lerma first interviewed Alappan in 2016 upon her presentation of a poster at ASN Kidney Week.