Dr. Vikas Dharnidharka, Professor of Pediatrics and Pediatric Nephrology Division Director at Washington University School of Medicine in St. Louis, shares his extensive knowledge on PTLD (post-transplant lymphoproliferative disorders) in pediatric kidney transplant recipients. He is the first author of a PTLD textbook (https://link.springer.com/book/10.1007/978-3-030-65403-0) and has published numerous studies and guideline recommendations on the subject. We discuss the pathophysiology, risk factors, clinical presentation, work-up, treatment and prognosis of PTLD in this episode.

References

North American Pediatric Renal Trials and Collaborative Studies Registry (NAPRTCS) and Pediatric Nephrology Research Consortium (PNRC) studies regarding the advantages of lower dose thymoglobulin induction therapy in kidney transplantation

https://pubmed.ncbi.nlm.nih.gov/32903852/

https://pubmed.ncbi.nlm.nih.gov/33912749/

International Pediatric Transplant Association (IPTA) PTLD guidelines

https://pubmed.ncbi.nlm.nih.gov/36369733/

https://pubmed.ncbi.nlm.nih.gov/36369745/

https://pubmed.ncbi.nlm.nih.gov/37294621/

We have two fantastic Canadian guest nephrologists discussing IgA nephropathy on this episode. Dr. Sean Barbour is an adult nephrologist and associate professor at the University of British Columbia. He is a glomerulonephritis and epidemiology expert and serves as the chair of the British Columbia GN Committee and Registry. He developed and validated the IgA clinical prediction tool for both adults and children and has participated in the TESTING and NefIgArd clinical trials. Dr. Alexandra Cambier is a clinician-scientist and an associate professor of pediatric nephrology at Montreal University. She also worked on the pediatric IgA prediction tool and has numerous publications regarding biomarkers and genetic variants in children with IgA nephropathy. 

Publications that we discuss in this episode-

IgA prediction tool validation:

https://pubmed.ncbi.nlm.nih.gov/30980653/ https://pubmed.ncbi.nlm.nih.gov/35490842/

https://pubmed.ncbi.nlm.nih.gov/33220356/

CD89 in childhood IgA nephropathy:

https://pubmed.ncbi.nlm.nih.gov/34756952/

IgA nephropathy therapies in children:

https://pubmed.ncbi.nlm.nih.gov/34756952/

Targeted-release budesonide in adults with IgA nephropathy:

https://pubmed.ncbi.nlm.nih.gov/36270561/

Join us for this special episode regarding how to apply for pediatric nephrology fellowship. We will give residents the inside scoop on succeeding in landing their top match in the application and interview process! Guests on this podcast are pediatric nephrology program directors- Drs. Erum Hartung (CHOP), Julie Goodwin (Yale), Elizabeth Ingulli (UCSD/Rady Children's), Carla Nester (University of Iowa) and current pediatric nephrology fellows- Emily Zangla (University of Minnesota), Carlos Becerril-Romero (Lurie Children's), Emilia Cadiz (Emory), Uche Nwaogazie (CHOP), and Kelly Garrity (UCLA).

Questions? Reach out to Emily at [email protected] 

Join us for the discussion on neonatal dialysis with expert Dr. David Askenazi from the University of Alabama who pioneered the adaptation of the Aquadex machine to infants!

We cover acute kidney injury, the utilization of peritoneal dialysis, CRRT, Aquadex and Carpediem in neonates and the logistics behind the use of these novel new machines. 

To get involved, visit the Neonatal Kidney Collaborative website at: https://babykidney.org/ 

High-yield papers on neonatal AKI and dialysis:

AWAKEN Study: https://pubmed.ncbi.nlm.nih.gov/29732396/

Aquapheresis case series in children: https://pubmed.ncbi.nlm.nih.gov/31462396/ 

CRRT vs. Carpediem outcomes: https://pubmed.ncbi.nlm.nih.gov/34414499/ 

Dr. Brad Rovin, director of the Division of Nephrology and the Vice Chair of Research in Internal Medicine at the Ohio State University, discusses recent advances in lupus nephritis treatment. Dr. Rovin is deputy editor of Kidney International and the co-chair of glomerular disease guidelines for KDIGO. He has published many major landmark nephrology clinical trials in lupus nephritis (listed below), which he highlights in this episode. It's the "golden age" of lupus nephritis treatment! 

Papers we discuss:

BLISS (Belimumab) https://www.nejm.org/doi/full/10.1056/NEJMoa2001180 

AURORA (Voclosporin) https://www.thelancet.com/article/S0140-6736(21)00578-X/fulltext 

LUNAR (Rituximab) https://onlinelibrary.wiley.com/doi/epdf/10.1002/art.34359 

NOBILITY (Obinutuzumab) https://ard.bmj.com/content/81/1/100 

TULIP-LN (Anifrolumab) https://ard.bmj.com/content/81/4/496 

Also check out https://kidney.wiki/ pediatric nephrology platform created by Ryan Town, a fellow from Stanford! 

(*OK, maybe not EVERYTHING, but a very thorough and worthwhile review!)

Dr. Michelle O'Shaughnessy, a consultant nephrologist at Galway University Hospitals in Ireland, and Dr. Tiffany Caza, a renal pathologist at Arkana Labs, give us the high-yield points on membranous nephropathy, in both pediatric and adult patients! They are both well published and have excellent clinical experiences to share with listeners. 

Check out Michelle's Cure GN paper on membranous treatment in children: https://pubmed.ncbi.nlm.nih.gov/31844809/ 

Check out Tiffany's newest paper on novel membranous antigens: https://pubmed.ncbi.nlm.nih.gov/36638888/ 

Dr. Lyndsay Harshman, an Associate Professor of Pediatric Nephrology and Director of the Pediatric Kidney Transplantation Program at the University of Iowa, explains how and why kids with chronic kidney disease have different brain structures and cognitive abilities, compared to their healthy peers. She discusses her research discoveries regarding brain imaging in kids with CAKUT and shares her tips so that clinicians can best help their at-risk patients. 

Please provide any feedback you have! We love to hear it! https://s.surveyplanet.com/dmmriui5 

Dr. Brad Rovin, director of the Division of Nephrology and the Vice Chair of Research in Internal Medicine at the Ohio State University, discusses IgA nephrology. Dr. Rovin is deputy editor of Kidney International and the co-chair of glomerular disease guidelines for KDIGO. He has published many major landmark nephrology clinical trials, including the BLISS and AURORA trials in lupus nephritis and the NefIgArd targeted-release budesonide trial in IgA nephropathy, which he highlights in this podcast.

Links to mentioned publications in this episode: 

BLISS https://www.nejm.org/doi/10.1056/NEJMoa2001180?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed

AURORA https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00578-X/fulltext 

TESTING https://jamanetwork.com/journals/jama/fullarticle/2792252   NefIgArd https://www.kidney-international.org/article/S0085-2538(22)00836-5/fulltext  

Meta-analysis SGLT2 inhibitors https://www.thelancet.com/action/showPdf?pii=S0140-6736%2822%2902074-8 

Dr. Marianne Yee, a pediatric hematologist at Emory, and Dr. Rima Zahr, a pediatric nephrologist at the University of Tennessee, share their clinical pearls regarding sickle cell disease and its subsequent kidney involvement. These experts bring up excellent points of discussion including albuminuria screening, hyperfiltration injury, the role of a kidney biopsy, papillary necrosis, nocturnal hypertension, kidney transplant outcomes, renal medullary carcinoma and health disparities that these patients face. This episode is helpful for both pediatric and adult nephrologists, primary care providers and hematologists! 

Check out these high-yield publications:

Genetics of medullary carcinoma: https://pubmed.ncbi.nlm.nih.gov/34261517/

Sickle cell ESRD patient disparities: https://pubmed.ncbi.nlm.nih.gov/36191963/

Pediatric sickle cell kidney biopsy findings: https://pubmed.ncbi.nlm.nih.gov/30945006/

Losartan for sickle cell albuminuria: https://pubmed.ncbi.nlm.nih.gov/28951038/

CKD and albuminuria prevalence in pediatric sickle cell disease: https://pubmed.ncbi.nlm.nih.gov/21940843/

Dr. Michael Bernaba, a Mayo Clinic adult nephrology fellow, Paige Balgie, RD, LD who specializes in pediatric nephrology nutrition at the University of Minnesota and Dr. Chelsey Jensen, PharmD, who has special expertise in pediatric transplant and nephrology patients at the University of Minnesota discuss how to deal with hyperkalemia and hyperphosphatemia. We discuss renal-friendly infant formula,  clinical tricks from our friendly nutritionist and pharmacist and the different approaches adult versus pediatric providers take in regards to binders to deal with these pesky problems. 

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