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Internal Medicine Nephrology Expert Witness

Provides Opinion & Testimony In:

Internal Medicine, Nephrology, Academic, Electrolyte Disorders, Fluid Disorders, Kidney Disease

Expert Witness No. 5058

I am a physician-scientist, with approximately 50% clinical effort in nephrology, 30% effort in investigative research, and 20% effort in administration and teaching. Clinical activities currently encompass 6-7 months attending per year on the Renal Consult and Dialysis services at VABHS and BWH, in addition to weekly clinics at both BWH and VABHS and monthly weekend coverage of a private nephrology practice in Leominster MA. I have specific expertise in the management of glomerular disorders and fluid/electrolyte/acid-base disorders, with yearly listings in both Castle Connelly Top Doctors and Boston Magazine “Top Docs”. I fill the roles of Associate Division Chief and Director of Clinical Services for the Renal Division at BWH. I am also the Director of Dialysis Services and Medical Director of the Dialysis Unit at BWH, a hybrid inpatient/outpatient dialysis unit. In these capacities, I play a key role in the administration and strategic planning of clinical activities in the Renal Division at BWH. In particular, I play a major role in the expansion of Divisional clinical activities in Massachusetts’s South Shore area and expansion of our Interventional Nephrology program. Finally, I co-chair the Partners Healthcare System Chronic Kidney Disease committee, setting system-wide priorities in Renal and CKD care within the Partners healthcare system.

My investigative focus is the molecular physiology of ion and solute transport. My laboratory initially cloned several members of the cation-chloride cotransporter gene family, most notably the K- Cl cotransporters KCC3 and KCC4. Other gene families of interest include the sodium-solute (SLC5) transporters, SLC26 anion exchangers, SLC2 solute transporters, and organic anion (SLC22) transporters, particularly novel family members with a potential or proven role in renal urate absorption. Specifically, we have identified the renal sodium-lactate/nicotinate cotransporters that collaborate with URAT1 and OAT10 in renal urate absorption. We have characterized the effect of genetic coding variation on the activity of several urate transporters and have identified a novel urate transporter with genetic effects on both serum uric acid and CKD. We have also made major strides in characterization of the novel urate transporter GLUT9 and its associated proteins. The molecular physiology of renal re-absorptive urate transport and the molecular genomics of hyperuricemia are now the dominant focus of my research effort, aided by an international cohort of collaborators.

My educational interests include fluid/electrolyte disorders, acid-base disorders, hyperuricemia, hypouricemia, and gout. This educational effort has encompassed regular lectures to BWH and VABHS house-staff and Renal Fellows, HMS and HST students, and yearly involvement in the BWH and MGH CME courses in Nephrology. Several years ago I initiated a yearly 2-hour, “case-based” talk at the BWH CME course, on the pathophysiology, diagnosis, and clinical management of difficult and/or unusual acid-base, fluid and electrolyte cases. I have also developed an international reputation as a clinical educator in gout, fluid/electrolyte disorders, and acid-base disorders, with talks at EDTA in London, IMIN in Mexico City, ASN Satellite Conferences, the ASN Board Review Course, and the American Society of Rheumatology meetings. I am also a “community leader” for the ASN “Patient Q&A” and “Clinical Forum” sections on the ASN website, where nephrologists from around the world contribute clinical questions for expert input. I co-edited a textbook “The Molecular and Genetic Basis of Renal Disease” and edited the renal chapters for the 17th, 18th, and 19th editions of “Harrison’s Handbook of Internal Medicine”. I have also contributed textbook chapters for the last five editions of Brenner & Rector “The Kidney” and for the last three editions of “Harrison’s Principles of Internal Medicine”. I also contributed chapters for the MKSAP 17 Nephrology Section. Finally, I am a contributor, section co-editor, and peer reviewer for UpToDate, contributing in fluid/electrolyte disorders, urate disorders, and acid-base disorders; I maintain a total of ten cards in UpToDate.

Education

1986
B.Sc.
Biochemistry
University of Ottawa, Ottawa, Canada

1990
M.D.
Medicine
University of Toronto, Toronto, Canada

Postdoctoral Training

  • 1990-1993 Resident in Internal Medicine, Toronto General Hospital and Mount Sinai Hospital, University of Toronto
  • 1993-1997 Clinical and Research Fellow, Renal Division, Brigham and Women’s Hospital (BWH), Harvard Medical School
  • 2014-2015 Brigham and Women’s Leadership Course, Harvard Business School, Boston MA

Faculty Academic Appointments

  • 1997-1999 Instructor in Medicine, Vanderbilt University Medical Center, Nashville TN
  • 1999-2001 Assistant Professor of Medicine, Vanderbilt University Medical Center
  • 2001-present Assistant Professor of Medicine, Harvard Medical School

Appointments at Hospitals/Affiliated Institutions

  • 2001-present Associate Physician, Renal Division, BWH
  • 2001-2004 Physician, Renal Division, VA Boston Healthcare System
  • 2004-9/07 Physician, Division of General Internal Medicine, VA Boston Healthcare System
  • 9/07-present Physician, Renal Division, VA Boston Healthcare System
  • 8/12-present Director, Inpatient Dialysis Services, BWH
  • 8/13-present Associate Division Chief and Director of Clinical Services, Renal Division, BWH

Appointments at Non-Affiliated Hospitals

  • 1992-194 Physician, Department of Medicine: St. Joseph’s Hospital, Toronto, Ontario
  • 1994-1997 Physician, Department of Medicine: South Shore Hospital, Weymouth, MA
  • 1998-2001 Physician, Renal Division: Nashville VA Medical Center, Nashville TN
  • 1998-2001 Physician, Renal Division: Vanderbilt University Medical Center, Nashville TN
  • 2001-2008 Physician, Nephrology, Department of Medicine:
    • Norwood Hospital, Norwood MA Quincy Medical Center, Quincy MA Carney Hospital, Dorchester MA
      MetroWest Medical Center, Natick and Framingham MA Milton Hospital, Milton MA
  • 2002-2005 Physician, Nephrology, Department of Medicine:
    • St. Anne’s Hospital, Fall River MA Charlton
      Memorial Hospital, Fall River MA
  • 2006-present Physician, Nephrology, Department of Medicine
    • HealthAlliance Hospital, Leominster MA Clinton Hospital, Clinton MA
      Heywood Hospital, Gardner MA

Other Professional Positions

  • 8/06-7/08 Speaker Bureau (Conivaptan), Astellas Pharmaceuticals, Chicago, IL
  • 11/6/07 Medical Advisory Board (Pegloticase), Savient Pharmaceuticals, Brunswick, NJ Location, Boston, MA
  • 6/28/08 Consultant: Purgative-Associated Hyponatremia and Acute Phosphate Nephropathy Salix Pharmaceuticals, Morrisville, NC
  • 8/1/08 Consultant: Purgative-Associated Hyponatremia and Acute Phosphate Nephropathy Salix Pharmaceuticals, Morrisville, NC
  • 10/23/08 Speaker Faculty Meeting (Pegloticase), Savient Pharmaceuticals (Brunswick, NJ) San Francisco, CA
  • 2/9/09 Speaker Faculty Meeting (Pegloticase), Savient Pharmaceuticals (Brunswick, NJ) Short Hills, NJ
  • 5/20/10 Scientific liaison training program; “Uric Acid Homeostasis”, Boston, MA, Takeda
  • 6/8/10 Hospital Sales training program (Tolvaptan/hyponatremia), Otsuka America Pharmaceutical, Inc., Rockville, MD
  • 9/6-8/13 ZS Pharma Advisory Board (ZS-9), San Francisco, CA
  • 2/28-3/1/15 ZS Pharma Scientific and Development Advisory Consulting Meeting (ZS-9), Chicago, Ill
  • 1/20-21/15 ZS Pharma Advisory Board (ZS-9), San Francisco, CA
  • 10/29-30/15 ZS Pharma Hyperkalemia Steering Committee, Boston, MA
  • 9/22/16 Consultant, L.E.K Consulting; Gout therapeutics
  • 5/5/17 Relypsa Advisory Board (Patiromer), New York City, NY
  • 11/9/17 Kowa Advisory Board (Arhalofenate), San Diego, CA
  • 7/19/18 Nephrology Advisory Board, Horizon Pharma, Chicago, Il
  • 5/4/18 Relypsa Advisory Board (Patiromer), Chicago, Illinois

Committee Service

National:

  • 2001 Renal Week Technology Subcommittee, American Society of Nephrology
  • 2010-2011 Program Committee for ASN Renal Week 2011, American Society of Nephrology
  • 2012 American College of Rheumatology Gout Quality Measure Task Force Panel
  • 2013-2014 MKSAP 17 Nephrology Section Committee, American College of Physicians
  • 2017- Community Leader, “Patient Care Q&A” website, American Society of Nephrology
  • 2016- Steering Committee, “G-CAN” – Gout, Hyperuricemia, and Crystal-Associated Disease Network

Regional:

  • 2006-2010 Medical Advisory Board, New England Chapter of the National Kidney Foundation

Institutional:

  • 9/06-9/09 Research Committee, VA Boston Healthcare System
  • 5/08-present Fellowship Training Committee, Renal Divisions, BWH and MGH
  • 5/10-present Steering Committee, T32 Fellowship Training Grant, Renal Division, BWH
  • 5/14-9/15 Department of Medicine, Epic Transition Leaders committee
  • 1/17-present Ambulatory Patient Experience Committee, BWH
  • 5/17-present Co-Chair, Partners Healthcare System, Chronic Kidney Disease Committee

Professional Societies

  • 1993-present Member, American Society of Nephrology
  • 2004-present Abstract Reviewer, Renal Week, American Society of Nephrology
  • 2000-present Member, American Physiological Society, Renal Section
  • 2002-present Elected Member, Northeastern Salt and Water Club

Grant Review Activities

  • 2004-2007 Review panels, Cardio-Renal section, American Heart Association National and Northeast Affiliate
  • 2/2007 CMBK Study Section, NIH, ad hoc member
  • 6/2007 Canadian Institute of Health Research (CIHR), Cell Physiology Study Section, External Reviewer
  • 9/2007 NTRC Study Section, NIH, ad hoc member
  • 7/10 Special Emphasis Panel/Scientific Review Group 2010/10 ZDK1 GRB-9 (O1)
  • 3/11 Special Emphasis Panel/Scientific Review Group 2011/05 ZRG1 DKUS-L (03)
  • 4/13 Small Business Innovation Research (SBIR) Awards ZRG1 DKUS-G (12) B

Editorial Activities

Honors and Prizes

  • 1984 NSERC (Natural Sciences and Engineering Research Council) of Canada, Undergraduate Research Scholarship
  • 1985 NSERC of Canada, Undergraduate Research Scholarship
  • 1987 Harry P. Ward Foundation Research Fellowship, Canadian Red Cross
  • 1988 Farquharson Research Scholarship, Medical Research Council of Canada
  • 1986-1989 Resident Junior Fellow, Massey College, University of Toronto
  • 1990 Samuel J. Streight Scholarship in Internal Medicine, graduating award 1st in class of 250 in Internal Medicine, Medical Alumni Association, University of Toronto
  • 1990 Merrill Pharmaceutical Award, graduating award in Internal Medicine, Faculty of Medicine, University of Toronto
  • 1991 Sopman Award, Internship in Internal Medicine, Toronto General Hospital
  • 1995-2000 NIH Physician Scientist Award
  • 1999-2000 Top Twelve Basic Research Citations: J. Biol. Chem. 1999: 274, 16355 Department of Medicine, Vanderbilt University Medical Center
  • 2000-2003 Advanced Research Career Development Award, Veterans Administration
  • 2002-2003 Top Twelve Basic Research Citations: Nature Genetics, 2002;32, 384
    Department of Medicine, Vanderbilt University Medical Center
  • 2017- Castle Connolly, Top Doctor, Nephrology
  • 2017- Boston Magazine “Top Docs”, Nephrology

Report of Funded Projects
Available on full CV

Report of Local Teaching and Training
Available on full CV

Teaching of Students in Courses

  • 1986 Teaching Assistant, Second-year Biochemistry course, University of Ottawa
  • 1998 Lecturer, Pharmacology 360, Vanderbilt University Medical School Seminar Title: “Molecular Physiology of Diuretics”
  • 1998-2000 Tutor, First-year Physiology, Vanderbilt University Medical School
  • 2001 Lecturer, Clinical Management Course, 4th year medical class,
    Vanderbilt University Medical School Lecture title: “Diuretics and diuretic resistance”
  • 3/25/2002 Lecturer, Human Systems, HMS, Module II-B: “Genetic Disorders of Renal Salt Transport”
    Preparation time – 5 hrs; Contact time – 2 hrs; Presentation time – 1 hr.
  • 3/2004 HST 110, Renal Pathophysiology: “Calcium and phosphate homeostasis”
    • Preparation time – 5 hours: Contact time 1.5 hr; Presentation time – 1 hr.
  • 5/04/04 Examiner, Year II OSCE, HST Preparation time – 1 hrs; Contact time – 3 hrs
  • 3/2005 HST 110, Renal Pathophysiology: “Calcium and phosphate homeostasis” Preparation time – 5 hours: Contact time 1.5 hr; Presentation time – 1 hr.
  • 3/2006 HST 110, Renal Pathophysiology: “Calcium and phosphate homeostasis” Preparation time – 4 hours: Contact time 1.5 hr; Presentation time – 1 hr.
  • 3/2007 HST 110, Renal Pathophysiology: “Calcium and phosphate homeostasis” Preparation time – 3 hours: Contact time 1.5 hr; Presentation time – 1 hr.
  • 12/5/07 Medical Sciences 220, Pathophysiology, HMS: “Renal Tubular Physiology” Preparation time – 3 hours: Contact time 2 hr; Presentation time – 1.5 hr.
  • 3/2008 HST 110, Renal Pathophysiology: “Calcium and phosphate homeostasis” Preparation time – 2 hours: Contact time 1.5 hr; Presentation time – 1 hr.
  • 3/2009 HST 110, Renal Pathophysiology: “Calcium and phosphate homeostasis” Preparation time – 2 hours: Contact time 1.5 hr; Presentation time – 1 hr.
  • 2004-2012 HST 110, HMS, Renal Pathophysiology, Tutorial leader
    Preparation time – 5 hrs; Contact time 6 hrs; Presentation time – 6 hrs.
    11/2&4/09 BCMP235/MCB235, “Principles of Human Disease”
    “Glomerular filtration and tubular physiology”, “Potassium and acid-base homeostasis”
  • 4/2010 HST 110, Renal Pathophysiology: “Calcium and phosphate homeostasis”
    Preparation time – 2 hours: Contact time 1.5 hr; Presentation time – 1 hr
  • 10/10 BCMP235/MCB235, “Principles of Human Disease”
    “Potassium and acid-base homeostasis”
    4/2011 HST 110, Renal Pathophysiology: “Calcium and phosphate homeostasis” Preparation time – 2 hours: Contact time 1.5 hr; Presentation time – 1 hr
  • 4/12/2012 HST 110, Renal Pathophysiology: “Hereditary Renal Tubular Disorders” Preparation time – 2 hours: Contact time 1.5 hr; Presentation time – 1 hr
  • 3/07/2013 HST 110, Renal Pathophysiology: “Hereditary Renal Tubular Disorders” Preparation time – 2 hours: Contact time 1.5 hr; Presentation time – 1 hr
  • 5/2/13 HST 110, Renal Pathophysiology: “Renal Dialysis”
    Preparation time – 2 hours: Contact time 1.5 hr; Presentation time – 1 hr

Formal Teaching of Residents, Clinical Fellows, and Research Fellows

Available on full CV

Clinical Supervisory and Training Responsibilities

  • 1998-2001 Attending physician, Nashville VA Medical Center, Nashville, TN General Medicine Wards, 2 months/year: Renal Consults, 2 months/year
  • 2001-2007 Attending physician, Division of General Medicine, VA Boston Healthcare System General Medicine Wards, 2 months/year: General Medical Consults, 2 months/year Daily didactic and clinical rounds with one Year III HMS student, two interns,
    and one BWH, BI, or BUMC resident, 2-6 hours/day
  • 2001-2004 Attending physician, Renal Division, VA Boston Healthcare System Nephrology Consult Service, 2 months/year
  • 2007-present Attending physician, Renal Division, VA Boston Healthcare System,
    Nephrology Consult Service, 4 months/year, precepting a BUMC and Partners Renal Fellow
  • 2007-present Attending physician, Renal Division, VA Boston Healthcare System,
    Renal Clinic, 1 morning/week, precepting a BUMC and Partners Renal Fellow and one BU medical student per week
  • 2001-2012 Attending physician, Brigham and Women’s Hospital, Boston, MA
    Nephrology Consult Service, 2-6 weeks/year, precepting a Partners Renal Fellow, and one or more HMS students, elective medicine students, and/or BWH house-staff
  • 2012-present Attending physician, Brigham and Women’s Hospital, Boston, MA Nephrology Dialysis Service, 8 weeks/year, precepting a Partners Renal Fellow
  • 2012-present Director of Dialysis Services, Brigham and Women’s Hospital Medical Director of the BWH Dialysis Unit

Laboratory and Other Research Supervisory and Training Responsibilities

  • 2001-present Daily Supervision of 1-4 post-doctoral research fellows,
    Laboratory of Molecular Transport Physiology, Renal Division, BWH

Formally Supervised Trainees and Faculty
Available on full CV

Report of Regional, National and International Invited Teaching and Presentations
Available on full CV

Report of Clinical Activities and Innovations
Available on full CV

Current Licensure and Certification

  • 1991 General Medical License, Province of Ontario, Canada
  • 1994, 2001 Massachusetts Medical License
  • 1994 Fellow of the Royal College of Physicians and Surgeons of Canada (FRCPC),
  • 1995, 2005 American Board Certification in Internal Medicine
  • 1996, 2006 American Board Certification in Nephrology 1997-2001 Tennessee Medical License

Practice Activities

  • 1993-1994 Assistant in Medicine, St. Joseph’s Medical Center, Toronto, Canada
  • 1994-1997 Medical Staff, Nephrology coverage for Commonwealth Nephrology Associates: MetroWest Health Center, Framingham/Natick, MA
    Norwood Hospital, Norwood, MA Carney Hospital, Dorchester, MA
    New England Baptist Hospital, Boston, MA
  • 1998-2001 Attending physician, Nashville VA Medical Center, Nashville, TN General Medicine Wards, 2 months/year: Renal Consults, 2 months/year
  • 2001-2008 Medical Staff, Nephrology coverage for Commonwealth Nephrology Associates
  • 2002-2005 Medical Staff, Nephrology coverage for Fall River Nephrology:
    Charlton Memorial Hospital, Fall River, MA St. Anne’s Hospital, Fall River, MA
  • 2004- Medical Staff, Nephrology coverage for North County Nephrology Associates: Health Alliance Hospital, Leominster, MA
    Clinton Hospital, Clinton, MA Heywood Hospital, Gardner, MA
  • 2001-2007 Attending physician, Division of General Medicine, VA Boston Healthcare System General Medicine Wards, 2 months/year: General Medical Consults, 2 months/year
  • 2001-2004 Attending physician, Renal Division, VA Boston Healthcare System Nephrology Consult Service, 2 months/year
  • 2007- Attending physician, Renal Division, VA Boston Healthcare System, Renal Clinic, 1 morning/week: Nephrology Consult Service, 4 months/year
  • 2001- Attending physician, Brigham and Women’s Hospital, Boston, MA Nephrology Consult Service, Dialysis Service 2-8 weeks/year
  • 8/2012- Director of Dialysis Services, Brigham and Women’s Hospital, Boston, MA Medical Director of the BWH Dialysis Unit
  • 8/2013- Director of Clinical Services and Associate Division Chief, Renal Division, Brigham and Women’s Hospital, Boston, MA

Report of Technological and Other Scientific Innovations
Available on full CV

Report of Scholarship

Available on full CV

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