In this episode of the podcast we focus on recurrent urinary tract infections, looking at how we diagnose UTIs, the diagnostic challenges, the causes of recurrent UTIs, and the management. We interview Dr. John David Spencer the division chief of pediatric nephrology at Nationwide Children's Hospital and Dr. David Hains the division chief of pediatric nephrology at Riley Children's Hospital who are both experts on the topic with extensive research into this arena and numerous publications. 

Marsh MC, Junquera GY, Stonebrook E, Spencer JD, Watson JR. Urinary Tract Infections in Children. Pediatr Rev. 2024 May 1;45(5):260-270. doi: 10.1542/pir.2023-006017. PMID: 38689106.

Hains DS, Starr MC, Schwaderer AL. Glomerular Filtration Rate Changes Following UTI in Children With Vesicoureteral Reflux. JAMA Pediatr. 2024 Dec 1;178(12):1366-1368. doi: 10.1001/jamapediatrics.2024.4546. PMID: 39446735; PMCID: PMC11581724.

A NephMadness special episode on minimal change disease in kids, supported by the AJKD and NKF. Guests include Dr. Alvarez Elias, who is an AJKD executive team member, pediatric nephrologist and research scientist at Fresenius, and Dr. Mallory Downie, a pediatric nephrologist at McGill University with her own lab studying genetics behind kidney disease in kids, specifically nephrotic syndrome. We discuss the exciting pathophysiology breakthroughs in MCD and treatment of relapses. Please participate in NephMadness 2025 by following this link: https://www.tourneytopia.com/AJKD/NephMadness/SubmitPicks/Picks.aspx 

For more details on MCD in kids see this commentary: https://ajkdblog.org/2025/03/07/nephmadness-2025-minimal-change-disease-beyond-idiopathic-redefining-nephrotic-syndrome-for-the-modern-era/ 

Dr. Maria Diaz-Gonzalez de Ferris, MD, MPH, PhD, joins us for a conversation about her approach to transitions of care in Nephrology. She is a pediatric nephrologist at UNC Chapel Hill, the Director of the UNC Transition Program otherwise known as STARx. Through her research work focusing on healthcare transitions for children with medical complexity, she has developed a system of healthcare checkpoints and resources that assess autonomy and self-management. In this episode, we briefly discuss the importance of transitions of care, general guidelines and resources, approaches in specialized populations such as transplant/CKD/ESRD, and resources that are available to those interested in optimizing their local transitions of care infrastructure.

Resources:

National and International Guidelines

STARx Program Description: https://www.med.unc.edu/transition/about-us-1/

STARx Transition Tools (Healthcare passport, All you need is love transition syllabus, Transition Index readiness assessment, STARx questionnaire): https://www.med.unc.edu/transition/transition-tools/

Drs. Stu Goldstein, Professor & Director of the Center of Acute Care Nephrology at Cincinnati Children's, and Jordan Symons, Professor, Fellowship Program Director and Apheresis Director at Seattle Children's Hospital provide their expertise regarding pediatric acute kidney injury. We discuss the emergence of the sub-specialty of critical care nephrology, harms of fluid overload, utility of biomarkers, benefits of early AKI awareness and CRRT therapy and an individualized approach to the pediatric patient with an AKI.

References

AWARE Study NEJM 2016- https://pubmed.ncbi.nlm.nih.gov/27959707/

Renal Angina Index (RAI) validation 2014 Kidney Int  -https://pubmed.ncbi.nlm.nih.gov/24048379/

Renal Angina Index & Fluid Overload Prediction BMC Neph 2021- https://pubmed.ncbi.nlm.nih.gov/34635072/

TAKING FOCUS-2 RAI + uNGAL improves outcomes Kidney Int. 2023- https://pubmed.ncbi.nlm.nih.gov/38106571/

Fluid Overload Review Ped Neph 2024- https://pubmed.ncbi.nlm.nih.gov/37861865/

Urinary NGAL Validation Kidney Int. 2024-https://pubmed.ncbi.nlm.nih.gov/39156146/ 

Urinary NGAL is FDA cleared in children! https://bioporto.us/pronephro-aki/ 

For this episode on ARPKD interviewed Dr. Lisa Guay-Woodford a clinician scientist at Children’s Hospital of Philadelphia who is a world-renowned expert on cystic kidney diseases. She was part of one of the teams that discovered the ARPKD gene and provides fascinating insight into the history and management of the condition.

References

ARPKD genetic variations: https://www.sciencedirect.com/science/article/abs/pii/S1096719209002947

Bilateral nephrectomy outcomes: https://www.nature.com/articles/s41598-020-71956-1 

We talk to the experts in the Neonatal Kidney Collaborative (NKC) about the recently published guidelines regarding kidney follow-up for NICU graduates, a product of the NIH-supported workshop in 2024 spearheaded by Dr. Michelle Starr of Indiana University/Riley Children's Hospital. Guests include Dr. Marissa DeFreitas, pediatric nephrologist at the University of Miami, Dr. Matt Harer, neonatologist at the University of Wisconsin, Dr. Kat Gist, pediatric cardiac intensivist at Cincinnati Children's, Dr. Heidi Steflik, neonatologist at the Medical University of South Carolina, and Dr. Tom Forbes, pediatric nephrologist at Royal Children's Hospital in Melbourne, Australia. 

Links

Kidney Monitoring for NICU Grads Follow-Up Guidelines: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2823652

AWAKEN study: https://pmc.ncbi.nlm.nih.gov/articles/PMC5933049/ 

Join the NKC! https://www.babykidney.org/ 

Dr. Matthew Sampson, a pediatric nephrologist and associate professor of pediatrics at Harvard Medical School, walks us through genetic testing for pediatric patients with kidney disease. He discusses indications for genetic testing and how to interpret results. He also talks about his lab and work as a genomics researcher. 

Episode References

Join us for an episode on anemia of chronic kidney disease with two pediatric nephrology experts on the topic, Dr. Meredith Atkinson, Associate Professor of Pediatrics at Johns Hopkins, and Dr. Mark Hanudel, Associate Professor of Medicine at UCLA. We will explore the underlying mechanisms behind anemia of CKD, novel treatments for anemia, thoughts on preventing hemoglobin cycling in the setting of Epoetin Alfa, and various iron supplementation tips. 

Join us for a journal-style episode covering 2023 CJASN article, "Timing of Kidney Replacement Therapy among Children and Young Adults." Drs. Nick Larkins and Simon Carter discuss the findings from the Australia and New Zealand Dialysis and Transplant Registry and compare and contrast it to United States, Canada and European data. 

Article link: https://pubmed.ncbi.nlm.nih.gov/37279903/ 

Dr. Clemens Bergwitz, an associate professor of endocrinology at Yale University, walks us through how to work-up and treat patients with calcium and phosphorus disorders. He helped to discover the disease HHRH (hereditary hypophosphatemic rickets with hypercalciuria) and has wonderful knowledge to share with listeners regarding the bone-mineral axis! 

References

2024 KIR Update on HHRH https://pubmed.ncbi.nlm.nih.gov/38364990/ 

2009 Ped Nephrology Genetic causes of hypercalciuric nephrolithiasis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2770137/ 

TMP calculation and reference ranges https://www.nbt.nhs.uk/sites/default/files/Protocol%20for%20measurement%20of%20TmP.pdf