Pediatric Nephrology最新文献

{"title":"Anti-obesity medications in children and adolescents: blood pressure and chronic kidney disease implications.","authors":"Margaret A Clement, Joyce P Samuel","doi":"10.1007/s00467-026-07293-8","DOIUrl":"10.1007/s00467-026-07293-8","url":null,"abstract":"<p><p>Pediatric obesity is a growing public health crisis with profound cardiometabolic and kidney consequences extending into adulthood. Emerging frameworks now distinguish preclinical obesity from clinical obesity, emphasizing excess adiposity-related organ dysfunction or functional limitations in activities of daily living. Obesity is a central driver of cardiovascular-kidney-metabolic syndrome, underscoring the need for integrated treatment approaches. This narrative review summarizes current evidence for lifestyle interventions and pharmacologic therapies for pediatric obesity, with a focus on implications for hypertension and chronic kidney disease. Intensive health behavior and lifestyle treatment remains first-line therapy, but access and sustainability barriers limit effectiveness. Pharmacotherapy is increasingly used as adjunctive treatment, with five medications currently approved for non-syndromic obesity in children. Among available agents, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and combination phentermine/topiramate demonstrate the greatest efficacy in adolescents, while older agents and off-label therapies offer modest benefit with greater limitations. Emerging data suggest GLP-1 RAs may improve blood pressure and kidney outcomes, although pediatric evidence remains limited. Lack of long-term safety data, durability of weight loss, cost, and access remain substantial barriers in the use of obesity pharmacotherapy for children. Sustained, coordinated care across the lifespan is essential to effectively manage pediatric obesity and its cardiometabolic and kidney sequelae.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"4291-4303"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672431/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute kidney injury and urinary drug crystals in children treated with tosufloxacin: a multicenter retrospective study.","authors":"Yuji Matsumoto, Masato Itano, Takuma Ando, Tomomi Kondoh, Soichiro Ishimaru, Yoshiki Kawamura, Hidetaka Nakai, Masayuki Hirai, Satoru Kisohara, Naonori Kumagai, Yohei Ikezumi","doi":"10.1007/s00467-026-07478-1","DOIUrl":"10.1007/s00467-026-07478-1","url":null,"abstract":"<p><strong>Background: </strong>Tosufloxacin (TFLX), a fluoroquinolone, is widely used in Japanese children with macrolide-resistant Mycoplasma pneumoniae infection. Acute kidney injury (AKI) associated with TFLX has been reported, often with urinary drug crystals; however, its incidence and clinical characteristics remain unclear.</p><p><strong>Methods: </strong>In this multicenter retrospective study, we included 227 children (2-15 years) who underwent blood and/or urine testing. AKI was defined according to KDIGO criteria. Kidney function and clinical characteristics were compared between patients with and without TFLX exposure at the initial visit and during follow-up. Among TFLX-treated patients, factors associated with AKI and urinary drug crystals were analyzed.</p><p><strong>Results: </strong>At the initial visit, AKI was more frequent in patients already receiving TFLX than in those not treated with TFLX (10% vs. 2.0%; p = 0.018). However, when analysis was restricted to patients in whom TFLX was newly initiated at our institutions, AKI incidence was 2.6% and not significantly different from controls. Gastrointestinal symptoms were more common in the AKI group (70% vs. 11%; p < 0.0001). Urinary drug crystals were detected with similar frequencies in the AKI and non-AKI groups (63% vs. 57%), and continuation of TFLX after crystal detection did not lead to AKI progression.</p><p><strong>Conclusions: </strong>Our findings suggest an association between TFLX exposure and creatinine elevation. We also evaluated AKI incidence among patients newly initiated on TFLX. Urinary drug crystals were frequently detected; however, crystal formation alone did not fully explain AKI development. Clinicians should be aware of the potential for AKI during TFLX therapy, particularly in patients with gastrointestinal symptoms.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"4647-4655"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148536519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"APOL1 and chronic kidney disease in pediatrics: a study from the Biorepository and Integrative Genomics Initiative.","authors":"Rima S Zahr, Lokesh Chinthala, Akram Mohammed, Csaba P Kovesdy, Robert L Davis","doi":"10.1007/s00467-026-07385-5","DOIUrl":"10.1007/s00467-026-07385-5","url":null,"abstract":"<p><strong>Background: </strong>APOL1 variants confer increased risk for kidney disease in individuals of African ancestry, particularly in homozygous or compound heterozygous states. A missense variant, p.N264K, has been shown to attenuate this risk when co-inherited with the G2 allele. While these associations are established in adults, data in pediatric populations remain limited. Using the University of Tennessee Health Science Biorepository and Integrative Genomics initiative, we assessed chronic kidney disease (CKD) risk by APOL1 high-risk genotype and the potential protective effect of p.N264K in a diverse pediatric cohort.</p><p><strong>Methods: </strong>This is a case-control study of African American children enrolled in the BIG initiative at Le Bonheur Children's Hospital (2014-2022). Composite CKD was defined by eGFR < 90 mL/min/1.73 m² or albuminuria (UACR > 30 mg/g) on two occasions ≥ 90 days apart. The p.N264K variant status was assessed in patients with APOL1 high-risk (HR). Logistic regression models adjusted for age, sex, and five principal components of ancestry assessed associations with CKD and albuminuria.</p><p><strong>Results: </strong>CKD cases had 8% higher odds of APOL1 HR status (Odds Ratio (OR): 1.08, 95% Confidence Interval (CI): 0.88-1.33). Stronger associations were observed in cases with albuminuria and APOL1 HR status (OR: 1.41, 95% CI: 1.02-1.92, p = 0.03). The p.N264K variant was detected in 4.3% of cases and 4.5% of controls, and appeared to attenuate CKD risk among HR individuals, though sample size limited statistical power.</p><p><strong>Conclusions: </strong>APOL1 HR genotypes were associated with albuminuria in African American children. The p.N264K variant may modify this risk, warranting further study.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"4057-4063"},"PeriodicalIF":2.5,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13612674/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148227396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Young adults born moderately to extremely preterm have higher eGFR and cystatin C compared to young adults born at term.","authors":"Tyler T Shimfessel, Gregory P Barton, Keri A Drake, Kara N Goss","doi":"10.1007/s00467-026-07299-2","DOIUrl":"10.1007/s00467-026-07299-2","url":null,"abstract":"<p><strong>Background: </strong>Adolescents and adults born preterm are at increased risk for kidney dysfunction, possibly secondary to incomplete nephrogenesis. However, few long-term follow-up studies are available from U.S.-born preterm cohorts.</p><p><strong>Methods: </strong>Using the Parkland Hospital Neonatal Intensive Care Unit Registry (Dallas, TX), patients aged 12-40 years born ≤ 32 weeks gestation or < 1500 g were recruited, along with healthy term-born similarly aged participants. Study procedures included anthropometrics, vitals, and basic laboratory testing. Glomerular filtration rate (eGFR) was calculated using the CKD-Epi Creatinine Equation (2021). Least squares regressions were used to determine the main effect of neonatal and adult factors on markers of kidney function.</p><p><strong>Results: </strong>Participants included 103 preterm (GA 29.5 ± 2.5 wks, current age 26.1 ± 6.0 yrs) and 43 term (GA 39.2 ± 1.1 wks; current age 29.1 ± 7.3 yrs) individuals. Patients born prematurely had similar creatinine (0.73 ± 0.21 vs. 0.82 ± 0.21 mg/dL; p = 0.112), higher eGFR (120.5 ± 17.76 vs. 112.4 ± 16.28 mL/min/1.73 m²; p = 0.003), and higher cystatin C (12.15 ± 3.17 vs. 11.46 ± 2.66 µg/mL; p = 0.035) in adolescence/adulthood compared to term, respectively. Multivariate linear regression demonstrated that gestational age was significantly related to eGFR and cystatin C, where lower GA was associated with higher eGFR but also higher cystatin C.</p><p><strong>Conclusion: </strong>Despite similar creatinine, individuals born prematurely had higher eGFR and higher cystatin C. The elevated eGFR suggests a potential hyperfiltrative state, while the elevated cystatin C suggests increased risk for progression to chronic kidney disease.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"3903-3912"},"PeriodicalIF":2.5,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13555590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acute kidney injury in children with acute febrile tropical illness.","authors":"Vidushi Mahajan, Tanya Vasudeva, Seema Singla, Vishal Guglani","doi":"10.1007/s00467-026-07395-3","DOIUrl":"10.1007/s00467-026-07395-3","url":null,"abstract":"<p><strong>Background: </strong>We aimed to determine the incidence, predictors, and outcomes of acute kidney injury (AKI) in children hospitalized with acute febrile tropical illnesses (AFTI).</p><p><strong>Methods: </strong>This prospective observational study was conducted at a tertiary-care centre in north India over 1.5 years. Consecutive children (2 months-18 years) admitted with AFTI were enrolled. AKI was defined using KDIGO criteria based on serum creatinine and urine output. The primary outcome was the incidence of AKI in children with AFTI. Secondary outcomes included predictors for AKI, need for organ support, and mortality. Least absolute shrinkage and selection operator (LASSO) regression followed by multivariable logistic regression with bootstrap internal validation was used to identify independent predictors of AKI.</p><p><strong>Results: </strong>Amongst 585 enrolled children with AFTI, AKI occurred in 68 (11.6%), of whom 30 (44.2%) had severe AKI (KDIGO stage 2/3). With respect to etiology, AKI was significantly more frequent in dengue with warning signs, malaria, leptospirosis and brucellosis. Children with AKI had significantly higher requirements for intensive care interventions, including intubation, inotropes, kidney replacement therapy, and longer duration of hospitalization. Mortality was markedly higher in the AKI group (19.1% vs. 0.19%, p < 0.001). On multivariable logistic regression, age (months), inotropic support and use of ≥ 2 nephrotoxic medications in 24 h period were independently associated with development of AKI.</p><p><strong>Conclusions: </strong>AKI affects one in ten children hospitalized with AFTI and is strongly associated with disease severity, organ support, and mortality. Age, inotropic support and use of ≥ 2 nephrotoxic medications were independent predictors of AKI in children with AFTI.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"4065-4072"},"PeriodicalIF":2.5,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148252569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Monogenic variants drive low recurrence risk in pediatric steroid-resistant nephrotic syndrome after kidney transplantation: a high-consanguinity cohort.","authors":"Fatimah ALQattan, Ahmed Azzam, Hanan Alkanani, Waad Alharthi, Hebattallah Bahbah, Ammar Hammed, Mohammed Almaghrabi, Alanoud Alshami","doi":"10.1007/s00467-026-07430-3","DOIUrl":"10.1007/s00467-026-07430-3","url":null,"abstract":"<p><strong>Background: </strong>Steroid-resistant nephrotic syndrome (SRNS) is a leading cause of stage 5 chronic kidney disease (CKD 5) in children and carries a substantial risk of post-transplant disease recurrence. Data from the Arabian Peninsula are sparse.</p><p><strong>Methods: </strong>This retrospective cohort study included all paediatric patients (aged < 18 years) who underwent a first kidney transplant at King Fahad Specialist Hospital-Dammam between January 2008 and December 2023 with a confirmed diagnosis of SRNS, focal segmental glomerulosclerosis (FSGS), congenital nephrotic syndrome, or a pathogenic monogenic variant known to cause SRNS. Patients were classified as having genetic or non-genetic SRNS according to next-generation sequencing results. Primary outcomes were post-transplant recurrence rate and graft survival. Secondary outcomes included estimated glomerular filtration rate (eGFR) values and treatment response.</p><p><strong>Results: </strong>Among 208 paediatric kidney transplant recipients, 60 (28.8%) had CKD 5 attributable to SRNS/FSGS. Genetic testing (performed in 59/60 patients, 98.3%) identified pathogenic variants in 44 patients (74.6%); NPHS2 was most prevalent (28.8%). Post-transplant recurrence occurred in 6 patients (10%): 5 of 15 in the non-genetic group (33%) and 1 of 44 in the genetic group (2.3%) (p < 0.001). All six patients with recurrence received plasmapheresis; five also received rituximab. Complete remission was achieved in 5 patients (83%) and partial remission in 1 (17%). The 5-year graft survival rate was 98% overall-100% in the genetic group versus 93% in the non-genetic group (log-rank p = 0.21). The eGFR at 5 years was significantly higher in the genetic group (73.5 ± 17.6 vs. 60.6 ± 22.9 mL/min/1.73 m², p = 0.049).</p><p><strong>Conclusions: </strong>SRNS/FSGS accounts for approximately 29% of paediatric CKD 5 in this cohort and is characterised by a high prevalence of monogenic variants reflecting regional consanguinity. Genetic testing reliably stratifies recurrence risk: non-genetic SRNS carries a substantially higher recurrence rate, yet combined plasmapheresis and rituximab achieves remission in most affected patients. Graft outcomes are comparable to those seen in other CKD 5 aetiologies.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"4127-4139"},"PeriodicalIF":2.5,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148331972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cystatin C and glomerular hyperfiltration in preterm-born adults.","authors":"Mahnoor Safdar, Raveeha Ayub, Maryam Asghar","doi":"10.1007/s00467-026-07403-6","DOIUrl":"10.1007/s00467-026-07403-6","url":null,"abstract":"","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"4227-4228"},"PeriodicalIF":2.5,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148265337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to: Chuang, \"Caution is needed when interpreting eGFR of adults born preterm\" and Safdar, \"Cystatin C and glomerular hyperfiltration in preterm-born adults\".","authors":"Tyler T Shimfessel, Kara N Goss, Keri A Drake","doi":"10.1007/s00467-026-07484-3","DOIUrl":"10.1007/s00467-026-07484-3","url":null,"abstract":"","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"4231-4232"},"PeriodicalIF":2.5,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148813769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-dose versus multi-dose steroid therapy in pediatric nephrotic syndrome: a systematic review and meta-analysis.","authors":"Candela Romano, Lisyareli Salazar Arriaga, Linda Estefania Cordero Velez, Alexandra Melendez Delgado, Tatiana Alexandra Moreno Díaz, Haya Al Shakkakee, Abhigna Reddy Kudumula, Steysi Connie Falcon Aragon, Ernesto Calderon Martinez","doi":"10.1007/s00467-026-07175-z","DOIUrl":"10.1007/s00467-026-07175-z","url":null,"abstract":"<p><strong>Background: </strong>Corticosteroids remain the cornerstone of therapy for steroid-sensitive nephrotic syndrome (SSNS), yet the optimal dosing strategy, single daily versus divided doses, remains uncertain.</p><p><strong>Methods: </strong>We conducted a systematic review of studies comparing once-daily and divided-dose prednisolone in children with SSNS. Three randomized controlled trials and one non-randomized study were included, enrolling a total of 288 patients. Primary outcomes were time to remission and relapse frequency; secondary outcomes included hypothalamic-pituitary-adrenal (HPA) axis suppression and adverse events.</p><p><strong>Results: </strong>Overall, remission rates were comparable between single and divided dosing. In relapse settings, one trial showed faster remission with split dosing (by 1-2 days), though without differences in relapse frequency or safety. In first-episode disease, single daily dosing was associated with less HPA axis suppression and a longer time to first relapse. Adverse event profiles were similar across regimens.</p><p><strong>Conclusions: </strong>Single-dose and split-dose prednisolone regimens demonstrate comparable remission efficacy in children with SSNS. Divided dosing may shorten remission by 1-2 days during relapse episodes, but this small benefit must be weighed against the greater HPA-axis suppression observed with multi-dose schedules. Given the heterogeneity and small sample sizes of available trials, the current evidence remains insufficient to establish superiority. Larger multicenter RCTs with standardized protocols and longer follow-up are needed to provide more definitive guidance.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"3841-3851"},"PeriodicalIF":2.5,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13612631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147317644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intractable dialysis-associated headache: a management dilemma in pediatric hemodialysis.","authors":"Aviad Schnapp, Amir Shimonov, Ari Simckes, Adi Nitzan-Luques, Tal Gilboa, Oded Volovelsky","doi":"10.1007/s00467-026-07281-y","DOIUrl":"10.1007/s00467-026-07281-y","url":null,"abstract":"<p><p>Dialysis-associated headache (DAH) is a common and recognized complication of chronic hemodialysis. We report a diagnostically challenging case of severe intradialytic headache in an adolescent with chronic kidney disease stage 5 and a history of ventriculoperitoneal shunt. A comprehensive evaluation excluded dialysis disequilibrium syndrome, biochemical and hemodynamic contributors, primary headache disorders, infection, vascular pathology, ophthalmologic causes, and shunt malfunction. Subsequent progression of focal neurological findings revealed a diffuse intramedullary spinal cord glioma. This case highlights the limitations of solely attributing refractory DAH to dialysis-related etiologies and underscores the importance of repeated neurological reassessment and multidisciplinary management in pediatric dialysis patients.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"3779-3784"},"PeriodicalIF":2.5,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147513903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}