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Q&A: Lyndsay Harshman
Pediatric nephrologist Lyndsay Harshman’s goal: Optimizing cognitive and psychosocial outcomes for kidney transplant patients
As a University of Iowa Carver College of Medicine student on her pediatric nephrology rotation, Lyndsay Harshman (11MD, 14F, 18MS) noticed something about her young patients. Many children who had undergone kidney transplant later struggled to adhere to their medications—a difficulty that could lead to devastating health outcomes.
Harshman, whose interest in children’s brain development began during an undergraduate research project, realized she wanted to build a career treating pediatric patients with kidney disease while also researching how to help them stay healthy for the long term. And she could do it all without leaving her home state of Iowa.
“At that point,” Harshman says, “I was signed, sealed, delivered.”
Today, Harshman is the medical director of pediatric kidney transplant at UI Stead Family Children’s Hospital and an associate professor of pediatrics–nephrology, dialysis, and transplantation. She was recently named to the second cohort of the Stead Family Scholars, a research program that recognizes and advances the development of outstanding early-career faculty.
“I want our UI undergraduates, medical students, and residents to see that they don’t have to leave Iowa to be exceptional,” Harshman says. “You can have top-notch training and become well respected in your field, all while staying in your own backyard.”
Medicine Iowa caught up with Harshman to learn more about her work as a clinician, researcher, and alumni advocate.
We can do an amazing job medically. Our surgeons are great. We have fantastic medications that do a great job to prevent rejection and help the kidney to be healthy. The complexity [of cases] continues to increase, so we have to think so critically about how we take care of these children. It necessitates a team approach.
As the only pediatric kidney transplant center in Iowa, we draw patients from across the state. For patients who live far away, keeping them as healthy as possible depends on community providers. We trust our strong network of primary care pediatricians across the state—many of whom were trained at Iowa—to help these kids become successful in their day-to-day lives. We work together to optimize their health outcomes. Overall, we have very good outcomes. If we transplant at age 2, our goal is for that kidney to last the child through high school and early adulthood.
Now our primary focus is making sure we can give these kids the tools they need to be successful adults. That’s my personal passion. Many times, our transplant families will come back to the clinic and say, “My child is struggling to remember to take his medication. It’s becoming an issue.” I’ve been interested in how we optimize brain outcomes—the cognitive and psychosocial outcomes for our pediatric kidney transplant patients.
Through neuroimaging, our team has noticed subtle brain differences in pediatric patients who have kidney disease, compared to healthy peers. Those differences seem to predict cognition, specifically related to executive functioning—our brain’s decision-making capacities. The unanswered question is: Disease or development? Is chronic kidney disease itself—the inability for kidneys to clean the blood—causing the cognitive differences? Or are the differences developmental in nature, as the brain and the kidneys develop at the same time?
The Stead Family Scholars award will allow me to translate research from my group backwards from humans into animals. We are now working with a mouse model of chronic kidney disease that results in renal hypoplasia, or small kidneys. This model is isolated to the kidneys, so we know the brains of the mice should form appropriately. This helps us tease apart the disease-versus-development component.
The information we get from that early chronic kidney disease process should inform how we, as a transplant team, help our patients optimize medication adherence. Adherence is a cognitive process. An individual has to pay attention to, remember, and plan to take medicines. If we find that, even early on, children with chronic kidney disease have trouble with attention, memory, and planning, we can find better mechanisms to support our patients when they’re transplanted.
With our high school and college-age patients, we talk through their day-to-day routine. We ask when they take their medications and what might get in the way of remembering. Our goal is to empower our pediatric patients to become successful adults. They have to be able to be independent and advocate for themselves.
I came from a small town in southern Iowa to the big University of Iowa. I was a psychology major as an undergraduate. In my second semester, Irwin Levin, PhD, the professor in my psychology methods class, asked if I’d be interested in doing research with him. His research interest was children’s judgment and decision-making. I had no experience, but I loved the idea that we could look at how kids make decisions and whether that predicts later decision-making. Decision-making is at the core of everything we do. I had an amazing experience with Dr. Levin and then got plugged in with the neuroscience team at the Carver College of Medicine.
I started working with Natalie Denburg, PhD, when I was in medical school. Dr. Denburg is interested in the effects of chronic disease, specifically chemotherapy, on decision-making. I loved that work, so I took a full year to do a research fellowship in medical school. Then in my clinical rotation in pediatrics, I saw kidney transplant patients struggling to adhere to their medications. I realized I could work in both the brain and the kidney.
The longitudinal mentorship is what makes Iowa so special. People are willing to help you grow where you are and then hand you off to the next person to grow a little more. It’s pretty amazing that all of this could happen at Iowa. But we have amazing pediatrics programs, amazing neuroscience programs, and amazing faculty. You’d be hard-pressed to find another place where you could have this many incredible mentors and have the outpouring of their mentorship be so robust. That makes it all possible.
One of my biggest joys as a member of the Alumni Leadership Council is being able to connect with students and say, “You can do this. You can be whatever you want to be. Maybe it requires a little extra elbow grease, but it’s totally doable. And there are people here to support you along the way.”