Meet Count Bertram, a nobleman among kidney researchers

Once dubbed 'the Count' because he loves counting, what Professor John Bertram and his team count has made Monash a world leader in kidney research. They tally tiny kidney parts, whose number, fixed before birth, can influence our chances of getting kidney and other chronic diseases as adults.

John began counting nephrons and glomeruli about 20 years ago, when few others were, even though the numbers of these basic kidney-filtering units had been identified as likely indicators of high blood pressure, kidney damage and other chronic diseases as we mature.

His trailblazing work, in conjunction with Australian and overseas researchers, has made Monash the world leader in quantitative kidney pathology - the careful measurement of kidneys and their essential components.

"We've analysed 10 times more human kidney samples than any other group in the world," he says. "We've analysed more than 400 kidneys collected from Australia and around the world and sent to Monash for analysis."

Glomeruli are tiny spherical filtration units in the kidney that filter the blood. They're part of larger structures called nephrons. Together, glomeruli and nephrons help regulate the balance of salts and water and acids and bases, such as urine and blood, in our bodies. They also make vital hormones.

John and his team's painstaking, gold-standard counting methods have confirmed that the traditional estimate of an average one million glomeruli per human kidney was about right but masked a huge variation among people, who could have as few as 200,000 or two million or more.

The variation is significant because a low glomerular count is seen as a major risk factor for high blood pressure, which can lead to stroke, cardiovascular disease, kidney disease and other serious health issues. Just as significantly, our count is fixed for life in our first 36 weeks in the womb.

"If you're born with a low number, that's it," John says. "It's believed that no more are made after a term birth."

Armed with this knowledge, John has tried to work out why some people are born with less glomeruli than others and if we can improve the chances of having a high count at birth.

His work has the potential to save millions of dollars now spent on managing the explosion of high blood pressure and related diseases in adults, especially kidney disease, which has reached epidemic proportions in many groups around the world, including Australia's aboriginal community.

Over the past decade, John's team and national and international collaborators have analysed almost 1000 kidney tissue samples, collected through biopsies, from Aborigines and whites in neighbouring communities in northern Australia.

The Indigenous sample had 20 per cent fewer glomeruli and much more kidney disease.

His team has also examined kidney tissues from white and black Americans in Mississippi and Africans in Dakar, Senegal, from where many black Mississippians' ancestors came as slaves.

The results of all these studies suggest that environmental as well as genetic factors can influence glomerular numbers as the kidney develops in the womb.

John's research was the first to show that low birth weight and overuse of alcohol, and even antibiotics, can lead to a low glomerular count at birth.

With the help of a National Health and Medical Research Council grant, his group is now applying their counting skills to podocytes - tiny octopus-shaped cells that form part of the critically important glomerular filtration barrier.

For decades, podocytes were considered incapable of dividing and, therefore, being replaced if injured. But glomerular stem cells have recently been identified that seem capable of replacing podocytes.

Knowing the numbers of podocytes and stem cells, and how known kidney-disease risk factors alter their number, will provide new insights into the causes and possible treatments of many debilitating conditions, John says.

John is bursting to start using Monash's new magnetic resonance imaging (MRI) unit, due to operate from February 2012, which will give him a full three-dimensional view of a kidney, the progress of disease and the response to new treatments in the same subject over time.

"I want to be in there on day one, and start doing what we've been doing - the world standard, for which we're internationally known - five times faster," he says. "We'll be able to do bigger, smarter and more experiments, which have never been done before because of the time and cost."