Shivani Garg, MD, MS | Improving Outcomes and Health Equity in Patients With Lupus and Lupus Nephritis
Dr. Shivani Garg is a rheumatologist researcher and the founding director of the UW Health Lupus Clinic, the first of its kind in Wisconsin, and the UW Health Lupus Nephritis Clinic, the nation’s fifth multidisciplinary lupus nephritis clinic. She is strongly committed in advancing patient-oriented research to improve outcomes and disparities in lupus and lupus nephritis, and through these clinics, she has created and is maintaining a lupus data- and bio-repository.
Improving Lupus Disease Outcomes
One of Dr. Garg's research interests is to examine early predictors of poor outcomes in diverse patients with lupus nephritis and lupus to close knowledge gaps regarding heterogeneity in lupus outcomes, identify subsets at-risk for poor outcomes and test targeted prevention to improve outcomes and equity in lupus and lupus nephritis.
Dr. Garg is also investigating the role of medication blood levels and has partnered with patients and healthcare stakeholders to develop feasible interventions to improve adherence and outcomes in lupus and lupus nephritis. Her research that highlighted significant racial disparities in cardiovascular disease in lupus was selected for plenary presentations at the 2019 and 2020 Annual American College of Rheumatology Conferences.
Dr. Garg is collaborating with Dr. Christie Bartels, Dr. Miriam Shelef, Dr. David Beebe, and Dr. Yun Liang to better understand the pathophysiology of various presentations of lupus and to improve outcome disparities as they relate to premature kidney failure, cardiovascular disease, and mortality in patients with lupus.
Dr. Garg is also collaborating with Dr. S. Sam Lim at Emory University/Grady Hospital in Atlanta, one of five CDC-funded lupus centers of excellence, to assess and target health disparities in lupus and lupus nephritis outcomes.
Early Predictors of Poor Outcomes in Lupus Nephritis
Patients with lupus nephritis (LN) face 42-fold higher risk of cardiovascular disease (CVD) and 10-fold higher chronic kidney disease (CKD) risk than peers. However, traditional risk estimates and CVD risk calculators developed in non-LN populations fail to predict CVD and CKD progression in young LN patients.
We are testing innovative risk predictors, such as renal arteriosclerosis and circulating monocytes at the time of LN diagnosis, of poor CVD & CKD outcomes in LN to improve LN outcome risk prediction and reduce CVD & CKD risk trajectories.
Therapeutic Drug Monitoring in Lupus
Lupus disproportionately affects Black women, and is the leading cause of chronic kidney disease in young women. Physiologic and social determinants could influence medication levels and lead to poor outcomes in lupus.
We are investigating predictors of changes in medication (e.g., hydroxychloroquine) levels and clarifying clinical thresholds of medication (hydroxychloroquine) levels to predict adherence, efficacy, and identify patients at-risk for toxicity. These findings will inform practice change and increase use of targeted therapy in lupus.
Developing Novel Methods and Interventions to Target Nonadherence in Lupus
Targeting HCQ nonadherence is an important health priority to improve health outcomes disparities and survival in lupus. We have partnered with patients with lupus and clinicians to develop novel and feasible methods to assess and target nonadherence to improve outcomes in lupus patients from diverse backgrounds.
- Garg S, Raval AN, Hansen KE, Zhong W, Huang Y, Smith M, Panzer SE, Bartels CM. Association of Renal Arteriosclerosis With Atherosclerotic Cardiovascular Disease Risk in Lupus Nephritis. Arthritis Care Res (Hoboken). 2022 Jul;74(7):1105-1112. doi: 10.1002/acr.24552. Epub 2022 Apr 13. PMID: 33421305.
- Garg S, Bartels CM, Hansen KE, Huang Y, Semanik M, Zhong W, Smith M, Panzer SE. High burden of premature arteriosclerosis on renal biopsies in incident lupus nephritis. Arthritis Care Res. 2021; 73(3):394-401. PMCID: PMC8162670
- Garg S, Unnithan R, Hansen KE, Costedoat-Chalumeau N, Bartels CM. Clinical Significance of Monitoring Hydroxychloroquine Levels in Patients With Systemic Lupus Erythematosus: A Systematic Review and Meta-Analysis. Arthritis Care Res (Hoboken). 2021 May;73(5):707-716. doi: 10.1002/acr.24155. Epub 2021 Mar 30. PMID: 32004406.
We are actively seeking undergraduates, graduate students, or research interns interested in clinical and translational research in lupus and lupus nephritis using patient samples and/or analyzing clinical data.
If you are interested in joining our team, please send your CV and a brief description of your research experience and interests to Dr. Garg at email@example.com.
Dr. Garg is funded by University of Wisconsin’s Clinical and Translational Science Career Development Award and the Department of Medicine.
Make a Gift
Help support research by making a gift to the Department of Medicine's Rheumatology Fund for Excellence.