Sickle Cell and Renal Medullary Carcinoma, What Is the Relationship?
More Programs and Publications Featuring Dr. Kimryn Rathmell
In this program:
Does renal medullary carcinoma have a clear relationship with sickle cell? Watch as expert Dr. Kimryn Rathmell from Vanderbilt University Medical Center explains situations that can lead to RMC and what can occur with sickle cells in the tissues of the kidneys.
Transcript
Dr. Kimryn Rathmell:
The relationship between sickle cell hemoglobin and renal medullary carcinoma is definitely first still being worked out. But it's clear that even with sickle cell trait, that there's some change in oxygen-carrying capacity of those cells, and that there are tissues in the body where the level of oxygen or the stress of lower oxygen is more than in other places. So, for example, you could imagine that the lungs have more oxygen than deep somewhere in muscle, because there's a super thin layer of cells, we're all breathing in oxygen, and so they get the most...and then it progresses sort of deeper and deeper and deeper into the body as to where do we find the corners where there's the least amount of oxygen around. And one of those corners is the medulla of the kidney, so the medulla...let me tell you a little kidney physiology, just for fun The reason that there's this layered, it's like a cake of layers between the medulla and the kidney, is the way that you concentrate urine is by having very extreme gradients. Okay, so there are gradients of toxins, gradients of glucose, more glucose in the top in the cortex, and less in the medulla.
Gradients of salts, so your kidneys are all moving salts around and there's gradients of oxygen. So, there's lots of oxygen out at the cortex, and there's almost no oxygen down in the medulla, and the red blood cells have to pass through both of these. And so when they hit the medulla, they hit really ground zero for oxygen. Okay, and so if you have a red blood cell that's doing fine, because that's one sickle hemoglobin to one normal hemoglobin everywhere else, it does fine, but when it gets there, it has risk to sickle, so the hemoglobins form a, like a crystal, and that makes the red blood cells now no longer nicely round, but kind of...it's called sickle cell because of the sickle shape, so they become sort of more rigid and so they're not working and they get stuck. For example, when someone has an extreme period of dehydration will hit the kidneys, they will also decrease the amount of oxygen that's making its way to the kidneys, and so we know that that stress is at least linked to more episodes of renal medullary carcinoma, it's a long way around of saying these are cells that were mostly fine, they're most stressed when they pass through this really tunnel of no oxygen or low, low, low oxygen there, and probably periods of stress where it's even worse, and that stress of the red cells that are in there is probably damaging the kidney cells, so that's the long story of how we think this all happens.
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