College of Graduate Studies

Fatimah Kareen Khalaf, a PhD candidate in the Department of Medicine, writes a Special To The Blade medical article July 3, 2017 – “UT studying methods to prevent cardiorenal syndrome”


Joint heart and kidney disorder is called cardiorenal syndrome, which occurs when damage to one of these organs causes injury to the other one.

Your heart relies heavily on your kidneys to control the correct amount of salt and water within your body. In turn, your kidneys rely on your heart for correctly regulating your blood pressure.


Fatimah Kareen Khalaf is a PhD candidate in the department of medicine in the University of Toledo college of medicine.

Therefore, when one of these organs begins to fail, the other often follows closely behind. For example, patients undergoing heart failure frequently develop a rapid decline in kidney function. This combined decrease in organ function contributes to longer hospital stays, more frequent re-admissions, and increased rate of death.

Scientists have not yet figured out what causes cardiorenal syndrome. However, intense research is ongoing to devise new methods aimed at the prevention and treatment of this medical syndrome.

At the University of Toledo, we are focused on understanding the mechanisms causing cardiorenal disease. We are developing new tools that physicians can use to help patients survive.

We are investigating specific molecules that the body makes. These molecules, called cardiotonic steroids, normally help to regulate the amount of salt and water in your body, when present at low levels. However, in cardiorenal syndrome, these hormones often become chronically elevated, which stresses the heart and kidneys.

We have found that chronic high levels of these hormones can cause an inflammatory reaction of the body’s immune system that, in turn, causes scarring of heart and kidney tissue. Furthermore, we have found that patients with cardiorenal syndrome who also have increased levels of cardiotonic steroids are more likely to experience heart attack, stroke, or death.

We are investigating how the body produces and regulates these molecules, so that we can develop new ways to avoid the heart and kidney damage that elevated levels can cause.

My role in David Kennedy’s research laboratory is to understand the first steps within the body to produce this syndrome. It turns out that this damaging process begins with our own immune cells interacting with injured kidney cells.

Immune cells are quiet in times of health, but become active during injury. As an army is built to fight during times of war, immune cells increase to fight against any harm to the body. I have found that high levels of cardiotonic steroids cause activation of immune cells that, in turn, leads to organ injury. Therefore, constant activation of immune cells leads to organ damage rather than protection.

I have been able to show that the first steps of inflammation and scarring that normally occur in cardiorenal syndrome can be stopped by exposing immune cells or kidney cells, in culture medium, to different drugs that block the action of cardiotonic steroids. In addition, I am developing experimental methods to discover more molecules that the body produces that may help to control the levels of cardiotonic steroids. We will then work to enhance these molecules when cardiotonic steroids levels get too high.

A lot remains unknown about the function of cardiotonic steroids in the kidneys. We have worked hard to find answers to some of these important, unanswered questions. However, still more research needs to be done before physicians can safely apply our findings in the clinic. We will continue to work hard to discover appropriate treatments that can improve the outcome of patients with cardiorenal syndrome.

Fatimah Kareen Khalaf is a PhD student in the department of medicine in the University of Toledo College of Medicine and Life Sciences Biomedical Science Program, formerly the Medical College of Ohio. Ms. Khalaf is doing her research in the laboratory of David Kennedy. For more information, contact or go to​med/​grad/​biomedical.

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