Department of Internal Medicine
Nephrology Faculty
Victoria S. Lim, M.D.
Emeritus Professor
VS Lim got her M.D. degree from Far Eastern University
in Manila, Philippines. In the United States, she completed an internship
and residency program in Internal Medicine at the Graduate Hospital of
the University of Pennsylvania in Philadelphia, PA. She stopped working
for several years to raise her children. At the University of Michigan
in Ann Arbor, she worked in the Nephrology Division, first as a part
time laboratory technician and audit courses in Renal Physiology, and
then completed a one-year clinical rotation. After that, she moved to
the University of Chicago where she learned skills and knowledge about
dialysis and renal transplantation.
It was in Chicago that she started her career in clinical research, focusing on endocrine dysfunction in the chronic renal failure population. She described hypogonadism, localizing the defect at the hypothalamus. She found hyperprolactinemia, studied prolactin metabolism and kinetics, documenting increased prolactin production. She then moved to Michael Reese Hospital, a teaching hospital for the University of Chicago. There she was made Director of the Chronic Renal Failure Program. During this period, she studied the hypothalamo-pituitary-thyroid axis, discovered the "low triiodothyronine [T3] syndrome" in renal failure patients, performed thyroid hormone kinetics4 and described the defect in thyroxin, T, to T3 conversion. She then studied thyroid function in a chronic uremic rat model, documented low T3 in the liver, but normal T3 in the pituitary, suggesting that hypothyroid state is present only in the peripheral tissue. |
Medical School:
Far Eastern University
Manila, Philippines
Residency:
University of Pennsylvania
Fellowship:
University of Michigan |
After moving to Iowa, despite carrying very heavy clinical load year-round, she continues to pursue her research. She designed studies to explain the low T3 syndrome, and found that the low T3 state is a protective adaptation to minimize protein catabolism. She did a phase II clinical trial on recombinant human erythropoietin [EPO]. She was the first to publish results indicating that EPO is effective in raising hemoglobin [Hb] in pre-dialysis patients, and the first to document that EPO administration and improvement in Hb does not lead to more rapid progression of renal insufficiency. She showed that raising Hb does not affect urea clearance but impairs phosphorus removal during high efficiency hemodialysis. She learned the techniques of nitrogen balance and in-vivo whole body amino acid kinetics with the intention of proving that uremia and hemodialysis are catabolic, but all her studies indicate that, in the absence of acidosis and concomitant illness, uremia is not catabolic. Furthermore, hemodialysis is catabolic only because of amino acid loss and decreased protein synthesis; there was no evidence of enhanced whole-body protein degradation. Most of her studies challenge the prevailing view that uremia and hemodialysis engenders protein breakdown.
Lately Dr. Lim published data indicating that, in pre-dialysis and maintenance hemodialysis patients, insulin effectively down regulates protein degradation and insulin, together with amino acids, enhances protein synthesis. Most recently, she began to explore the mechanism of uremia-associated anorexia, profiling appetite-related hormones during fasting and refeeding.
Representative Publications
- Lim V.S., Yarasheski, K.E., Crowley, J.R., Fanman, J and Flanigan, M.J.: Insulin is Protein-Anabolic in Chronic Renal Failure Patients. J Am Soc Nephrology, 14: 2297-2304, 2003.
- Lim, V.S., Yarasheski, K.E., and Flanigan, M.J.: The Effect of Uraemia, Acidosis, and Dialysis Treatment on Protein Metabolism: a Longitudinal Leucine Kinetic Study. Nephrology Dialysis Transplantation, 13 :1723-1730, 1998.
- Lim, V.S., Bier, D.M., Flanigan, M.J., and Sum-Ping, S.T.: The Effect of Hemodialysis on Protein Metabolism: A Leucine Kinetic Study. J. Clin. Invest., 91 :2429-2436, 1993.
- Click here for additional publications.
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