Pediatric Kidney Pals - May 2021
In many ways, 19-year-old Brenna Kahlen is a typical teenager. She is living at home in Newport Beach working and going to college. But unlike most of her peers, Brenna is now a medical first. Brenna was born with a disease known as tuberous sclerosis, which affected her kidneys. At age 11, she had both kidneys surgically removed and was placed on dialysis until she could receive a donated kidney.

Brenna's creatinine levels were steady, but Dechu Puliyanda, MD, Cedars-Sinai's director of Pediatric and Transplant Immunology, decided to check further. She and her team requested permission to use a test designed to detect rejection in adult kidney transplant patients.

The adult test, known as Allosure, looks for the detection of donor-derived, cell-free DNA in the bloodstream of transplanted patients. A finding above just 1% is predictive for identifying kidney grafts at risk for rejection. Although the test is not FDA-approved for children, Puliyanda and colleagues were given permission to use the test on Brenna as part of a study on pediatric patients.

Brenna's test came back with high levels of donor-derived DNA. Next, a kidney biopsy showed signs of organ graft rejection. While this was very disappointing news for Brenna and her family, the test was a lifesaver.

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Levi Saldivar and Bryan Tinajero Cervantes have many things in common. They were born in Pomona, their birthdays are just over a month apart, they both needed dialysis and a kidney transplant from a young age, their kidneys came from the same donor, and they’re now best friends.

When the mothers of the boys, Maria Tinajero and Lidia Saldivar, got the call that there were kidneys for their sons, they were in shock and overjoyed. Both families rushed to get their sons ready and go to the hospital. Both boys wore their favorite pajamas — which happened to be matching “Paw Patrol” pajamas.

Rita Sheth, MD, a pediatric nephrologist at Children's Hospital, says the need for organ donors is growing. “Pediatric patients are waiting longer and longer to get kidneys due to our long waitlist,” she says. “There just aren’t enough donors. Clearly, organ donors make a big impact on people’s lives — these children are going to thrive compared to what they would have been on dialysis. The impact is a gift of life for the child and their whole family.”

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Hypertension and albuminuria commonly occur in pediatric patients with type 2 diabetes, a new meta-analysis finds.

Hypertension developed in 25.3% of 3463 patients aged 7 to 20 years with type 2 diabetes in 31 observational studies, M. Constantine Samaan, MD, MSc, of McMaster University in Hamilton, Ontario, Canada, and colleagues reported in JAMA Network Open.

Male patients had 42% increased odds of hypertension compared with female patients. By racial category, Pacific Islanders (26.7%) and Indigenous patients (26.5%) had the highest hypertension prevalence followed by White (21.0%), Black (19.0%), Asian (18.4%), and Hispanic (15.1%) patients. Hypertension was most commonly defined as systolic or diastolic blood pressure in the 95th percentile or greater for sex, age, and height.

Albuminuria prevalence was 22.2% among 2250 patients in 14 studies, with no sex differences observed, Dr Samaan’s team reported. Pacific Islanders (31.8%) and Indigenous individuals (24.3%) again had the highest prevalence, followed by Asians (23.0%), Hispanic (23.0%), Black (14.1%), and White patients (12.6%). Albuminuria appeared to worsen with age and duration of diabetes, according to the investigators.

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The best predictors of poor renal outcomes in pediatric patients with lupus nephritis (LN) include male gender, requiring dialysis at the time of diagnosis, and failure to achieve remission within 1 year after induction treatment, according to new study findings.

The study included 53 patients with childhood-onset systemic lupus erythematosus: 32 who were concurrently diagnosed with LN (median age 12.1 years) and 21 who later developed LN (median age 13.8 years). Patients with a concurrent LN diagnosis were significantly more likely to have arthritis (62.5% vs 33.3%) and a lower estimated glomerular filtration rate (eGFR; 110 vs 147 mL/min/1.73 m2) compared with patients who later developed LN. Renal biopsy results showed that 54.7% of patients with LN had class 4 and 22.6% had class 3 disease.

Among treated patients, 77.3% and 73% achieved complete or partial remission at 6 and 12 months, respectively, Rezan Topaloğlu, MD, PhD, of Hacettepe University in Ankara, Turkey, reported in Nephrology Dialysis Transplantation. Patients who attained complete response at 6 months after induction treatment had better renal survival than patients who did not respond to treatment. The risk for a poor renal outcome, defined as GFR less than 60 mL/min/1.73 m2 or dialysis), was a significant 8.6- and 13.8-fold higher for patients who did not attain remission at 6 and 12 months, respectively.

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