Kidney consequences of obesity.

Herein, we review the devastating consequences of the worldwide obesity epidemic on kidney health and outcomes. We submit that the obesity epidemic is the most pressing public health crisis facing the nephrology community today. A historical approach has been undertaken, wherein major breakthroughs in the recognition and understanding of obesity-related kidney disease (ORKD) are highlighted.

Urinary sphingolipids in adolescents and young adults with youth-onset diabetes.

Background: This study evaluated urinary sphingolipids as a marker of diabetic kidney disease (DKD) in adolescents and young adults with youth-onset type 1 and type 2 diabetes.

Methods: A comprehensive panel of urinary sphingolipids, including sphingomyelin (SM), glucosylceramide (GC), ceramide (Cer), and lactosylceramide (LC) species, was performed in patients with youth-onset diabetes from the SEARCH for Diabetes in Youth cohort. Sphingolipid levels, normalized to urine creatinine, were compared in 57 adolescents and young adults with type 1 diabetes, 59 with type 2 diabetes, and 44 healthy controls.

Clinical course and management of children with IgA vasculitis with nephritis.

Background: IgA vasculitis is the most common vasculitis in children and is often complicated by acute nephritis (IgAVN). Risk of chronic kidney disease (CKD) among children with IgAVN remains unknown. This study aimed to describe the clinical management and kidney outcomes in a large cohort of children with IgAVN.

Enteral nutrition and the risk of nephrolithiasis in complex pediatric patients.

Purpose: Medically complex, non-ambulatory children can often suffer from nephrolithiasis. The purpose of this study is to determine risk factors which are predictive for recurrent stone formation in this patient population.

Material And Methods: A retrospective cohort study was performed on non-ambulatory patients with cerebral palsy and/or severe developmental delay presenting to a high-volume Pediatric Stone Center from 2015 to 2019.

An initiative to improve effluent culture detection among pediatric patients undergoing peritoneal dialysis through process improvement.

Background: Peritonitis is a significant cause of morbidity and healthcare cost among pediatric patients undergoing peritoneal dialysis. Culture-negative peritonitis has been associated with an increased risk of technique failure. Known risk factors for culture-negative peritonitis are related to the process of collection and sample processing for culture, but additional studies are needed.

Agreement between serum estimates of glomerular filtration rate (GFR) and a reference standard of radioisotopic GFR in children with cancer.

Background: Accurate assessment of renal function is important in the care of children with cancer because renal function has implications for anti-tumor medication dosing and eligibility for clinical trials.

Objective: To characterize agreement between serum estimates of glomerular filtration rate (GFR) and a reference standard of radioisotopic GFR in a large pediatric oncology cohort.

Materials And Methods: We conducted a retrospective cross-sectional study of children who had both radioisotopic GFR (Tc-diethylenetriaminepentaacetic acid, or Tc-DTPA) and serum labs (creatinine, cystatin C) obtained <7 days apart between January 2017 and August 2019.

Omentectomy reduces the need for peritoneal dialysis catheter revision in children: a study from the Pediatric Nephrology Research Consortium.

Background: There are no multi-center studies examining omentectomy and peritoneal dialysis (PD) catheter revision in the pediatric dialysis population.

Methods: We performed a retrospective study at eight centers within the Pediatric Nephrology Research Consortium (PNRC). Data review included all incident tunneled PD catheters placed between 1/1/2011 and 12/31/2016 in pediatric stage 5 chronic kidney disease (CKD 5) patients.

Persistent Hypoglycemia with Polycystic Kidneys: A Rare Combination - A Case Report.

We present the case of an infant referred to our NICU born at 39 weeks' gestation with persistent hypoglycemia with elevated insulin levels (HI) requiring diazoxide to maintain normoglycemia. Additionally, polycystic kidney disease (PKD) was detected by ultrasound. Molecular genetic testing revealed pathogenic variants in the gene, i.

Early microvascular complications in type 1 and type 2 diabetes: recent developments and updates.

The prevalence of youth-onset diabetes is progressing rapidly worldwide, and poor glycemic control, in combination with prolonged diabetes duration and comorbidities including hypertension, has led to the early development of microvascular complications including diabetic kidney disease, retinopathy, and neuropathy. Pediatric populations with type 1 (T1D) and type 2 (T2D) diabetes are classically underdiagnosed with microvascular complications, and this leads to both undertreatment and insufficient attention to the mitigation of risk factors that could help attenuate further progression of complications and decrease the likelihood for long-term morbidity and mortality. This narrative review aims to present a comprehensive summary of the epidemiology, risk factors, symptoms, screening practices, and treatment options, including future opportunities for treatment advancement, for microvascular complications in youth with T1D and T2D.

GFR Estimation After Cystatin C Reference Material Change.

Introduction: Glomerular filtration rate (GFR) is routinely estimated with cystatin C. In June 2010, the International Federation of Clinical Chemistry (IFCC) released a certified cystatin C reference material (ERM-DA471/IFCC), and new cystatin C glomerular filtration rate estimation (eGFR) equations were developed with the IFCC standard. Early in 2018, Siemens discontinued their nonstandardized cystatin C reagent kits and replaced them with IFCC-calibrated kits in the US market.

Diagnostic Considerations in H1N1 Influenza-induced Thrombotic Microangiopathy.

Influenza virus can trigger atypical hemolytic uremic syndrome and present with complement-driven thrombotic microangiopathy (TMA). When administered promptly, complement-blocking therapies can spare organ injury and be lifesaving. However, diagnosing TMA in the setting of a severe viral infection can be challenging, as a significant overlap of symptoms and disease complications exists.

Does a Multidisciplinary Pediatric Stone Center Improve Outcomes?

Introduction: Urolithiasis is becoming more prevalent in children in the United States. A multidisciplinary pediatric stone center was initiated in 2014 to address this growing public health issue. The purpose of this manuscript is to assess the development of the stone center and its clinical outcomes.

Bariatric surgery and kidney disease outcomes in severely obese youth.

Bariatric surgery, an emerging treatment for severely obese youth with and without T2D, provides marked improvement in insulin resistance, beta-cell function, and central adiposity. Further, preliminary data suggest that bariatric surgery also results in significant improvement in markers of obesity-related nephropathy and DKD, beyond that which can be achieved with current medical interventions. Yet, the mechanisms whereby bariatric surgery attenuates kidney disease remain unclear.

Five-year kidney outcomes of bariatric surgery differ in severely obese adolescents and adults with and without type 2 diabetes.

Bariatric surgery improves markers of kidney health in severe obesity, yet it is unclear if kidney disease outcomes differ according to age at surgery. Therefore, we examined health effects of Roux-en-Y gastric bypass between 161 adolescents and 396 adults participating in two related but distinct studies. Primary outcomes were elevated urine albumin-to-creatinine ratio (UACR) of 30 mg/g or more and hyperfiltration (an estimated glomerular filtration rate of 135 ml/min/1.

Effect of Surgical Versus Medical Therapy on Diabetic Kidney Disease Over 5 Years in Severely Obese Adolescents With Type 2 Diabetes.

Objective: To compare diabetic kidney disease (DKD) rates over 5 years of follow-up in two cohorts of severely obese adolescents with type 2 diabetes (T2D) undergoing medical or surgical treatment for T2D.

Research Design And Methods: A secondary analysis was performed of data collected from obese participants of similar age and racial distribution enrolled in the Teen-Longitudinal Assessment of Bariatric Surgery (Teen-LABS) and the Treatment Options of Type 2 Diabetes in Adolescents and Youth (TODAY) studies. Teen-LABS participants underwent metabolic bariatric surgery (MBS).

Childhood Obesity and the Metabolic Syndrome.

Obesity is a leading cause of chronic kidney disease. Children with severe obesity have an increased prevalence of early kidney abnormalities and are at high risk to develop kidney failure in adulthood. The pathophysiology of obesity-related kidney disease is incompletely understood, although the postulated mechanisms of kidney injury include hyperfiltration, adipokine dysregulation, and lipotoxic injury.

Composite Health Outcomes in Pediatric and Young Adult Kidney Transplant Recipients.

Objective: To assess composite health outcomes in pediatric and young adult kidney transplant recipients following kidney transplantation.

Study Design: We conducted a cross-sectional study of all recipients at our center who had a 1-, 3-, 5-, and/or 10-year transplant anniversary visit between October 2008 and February 2015. The kidney transplant recipients were assessed at each time point according to an outcome measure consisting of 15 pass/fail criteria in 5 domains: allograft health, rejection and immunology, infection, cardiovascular health, and growth.

Estimating heterogeneous treatment effects for latent subgroups in observational studies.

Individuals may vary in their responses to treatment, and identification of subgroups differentially affected by a treatment is an important issue in medical research. The risk of misleading subgroup analyses has become well known, and some exploratory analyses can be helpful in clarifying how covariates potentially interact with the treatment. Motivated by a real data study of pediatric kidney transplant, we consider a semiparametric Bayesian latent model and examine its utility for an exploratory subgroup effect analysis using secondary data.

Effect of bariatric surgery on urinary sphingolipids in adolescents with severe obesity.

Background: Untreated severe obesity of adolescents is associated with abnormal kidney function and development of chronic kidney disease. Lipotoxicity due to lipid accumulation in glomeruli might be an important mechanism in the progression of kidney disease in obesity.

Objective: To assess subclinical glomerular injury by measuring urinary sphingolipids in adolescents with severe obesity before and after weight loss surgery.

Obesity and chronic kidney disease.

Purpose Of Review: To review recent advances in the epidemiology, pathophysiology, clinical features, and treatment of obesity-related kidney disease.

Recent Findings: Studies have confirmed that obesity is associated with increased risk of developing chronic kidney disease (CKD). This risk extends to those who are metabolically healthy, indicating that obesity per se contributes to CKD independent of the metabolic syndrome.

Insulin Sensitivity and Diabetic Kidney Disease in Children and Adolescents With Type 2 Diabetes: An Observational Analysis of Data From the TODAY Clinical Trial.

Background: Diabetic kidney disease is a major cause of premature mortality in type 2 diabetes mellitus (T2DM). Worsening insulin sensitivity independent of glycemic control may contribute to the development of diabetic kidney disease. We investigated the longitudinal association of insulin sensitivity with hyperfiltration and increased albumin excretion in adolescents with T2DM.