Pediatric Nephrology最新文献

{"title":"Therapeutic strategies for hypertension: exploring the role of microbiota-derived short-chain fatty acids in kidney physiology and development.","authors":"Giovane G Tortelote","doi":"10.1007/s00467-025-06883-2","DOIUrl":"https://doi.org/10.1007/s00467-025-06883-2","url":null,"abstract":"<p><p>Gut microbiota have emerged as a key regulator of systemic health, influencing various physiological processes, including kidney development, function, and blood pressure regulation. This review highlights the role of microbiota-derived short-chain fatty acids (SCFAs), primarily acetate, propionate, and butyrate, in the gut-kidney axis, focusing on their signaling mechanisms, vascular effects, and developmental implications. Evidence suggests that SCFAs modulate kidney development and function and exert anti-inflammatory, antioxidant, and vasoregulatory effects through specific G protein-coupled receptors (GPR41, GPR43, GPR109A, OLFR78, and OLFR558). Human studies and research using genetically modified animals have demonstrated that gut dysbiosis disrupts SCFA metabolism, potentially contributing to hypertension, endothelial dysfunction, and chronic kidney disease (CKD). Germ-free microbiota-transplantation studies revealed that the presence of gut microbiota directly influences vascular tone and systemic blood pressure via SCFA-mediated mechanisms. Furthermore, acetate, a SCFA, is shown to impact fetal kidney development and nephron progenitor cell dynamics. Sex-specific effects of gut microbiota on vascular remodeling and immune responses further highlight the complexity of microbiome-host interactions. In pediatric patients, altered SCFA profiles are associated with CKD progression and relapse in nephrotic syndrome. Clinical data suggest that plasma SCFA levels may serve as biomarkers for hypertension risk and cardiovascular outcomes in children with kidney disease. Therapeutically, interventions targeting SCFA pathways, such as probiotics, prebiotics, dietary fiber diet, and receptor agonists, may help restore gut-kidney axis balance and improve kidney and cardiovascular outcomes. This review illustrates the critical role of SCFAs as mediators linking the gut microbiota to kidney and vascular health. Continued investigation into SCFA signaling may uncover novel strategies for preventing and managing hypertension, CKD, and developmental nephropathies.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144601150","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":"Dialytic sodium removal in children with acute kidney injury treated with peritoneal dialysis.","authors":"Peter Nourse, Mignon McCulloch, Ashton Coetzee, Tim Bunchman, Stefano Picca, Dieter Van der Westhuizen, Andre Brooks, Hilton Heydenrych, Brenda Morrow","doi":"10.1007/s00467-025-06861-8","DOIUrl":"https://doi.org/10.1007/s00467-025-06861-8","url":null,"abstract":"<p><strong>Background: </strong>Dialytic sodium removal (DSR) is an important parameter of peritoneal dialysis (PD) adequacy. The aim of this study was to report the DSR of children with acute kidney injury (AKI) on a standard acute PD prescription and to compare it to that of children on continuous flow peritoneal dialysis (CFPD).</p><p><strong>Methods: </strong>A secondary analysis of prospectively collected data was performed from a published randomized controlled crossover trial comparing children on conventional PD and CFPD. The conventional PD prescription used: fill volume 20 mL/kg, glucose 2.5%, dwell time 45-60 min. In this study, we described and compared DSR in 15 children with AKI receiving PD and CFPD. Relative ultrafiltration through small pore (UFSP) was also described and compared.</p><p><strong>Results: </strong>The median (range) weight and age of patients were 5.8 (2.3-14.0) kg and 6 (0.2-14) months. Approximately 8 h of dialysis was received per patient per modality. Results were then extrapolated and expressed per day. The mean ± SD DSR on conventional PD and CFPD were 2.7 ± 6 and 8.4 ± 10 mmol /kg/day, respectively (P = 0.02). The mean ± SD sodium dialysate to plasma (D/P) ratio on conventional PD and CFPD were 0.94 ± 0.03 and 0.94 ± 0.04 mmol/mmol (P = 1.0). Mean ± SD UFSP to total UF ratios on conventional PD and CFPD were 0.82 ± 0.39 and 0.66 ± 0.51 mL/mL (P = 0.14).</p><p><strong>Conclusions: </strong>This study adds to the limited data on DSR in children on PD for AKI. CFPD removes more salt compared to conventional PD because of increased ultrafiltration (UF). A high percentage of UF was through small pores in both modalities.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591939","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":"In vitro measurements of ultrafiltration precision in hemofiltration and hemodialysis devices used in infants, Part 2: Comparison of PrisMax and CARPEDIEM with previous data on NIDUS, Prismaflex and Aquarius.","authors":"Jean Crosier, Denise Colosimo, Rachel Hansen, Heather J Lambert, Malcolm G Coulthard, Zaccaria Ricci","doi":"10.1007/s00467-025-06788-0","DOIUrl":"https://doi.org/10.1007/s00467-025-06788-0","url":null,"abstract":"<p><strong>Background: </strong>We sought to determine in vitro whether the PrisMax and CARPEDIEM hemofiltration and hemodialysis devices can reliably deliver ultrafiltration (UF) control that is sufficiently precise to treat infants.</p><p><strong>Methods: </strong>We have previously measured the precision of UF control of the Prismaflex, Aquarius and NIDUS devices by in vitro testing with a bag of saline set up as a dummy patient, and comparing the differences between the UF set and displayed by the devices, and the actual fluid removal or addition measured by precise weighing. Here we have tested the PrisMax (updated version of Prismaflex) and the CARPEDIEM using the same method.</p><p><strong>Results: </strong>The variances of the setting vs. actual errors, and display vs. actual errors after 15 min of 'treatment' with the PrisMax and CARPEDIEM were similar, but were significantly larger than in the NIDUS, and much smaller than in the Prismaflex. However, after a 4-h 'treatment session', the cumulative errors were still within ± 9 mL for these devices, compared with a maximum error of 2.6 mL in the NIDUS, and a deviation of -37.5 mL in the Prismaflex.</p><p><strong>Conclusions: </strong>The PrisMax and the CARPEDIEM have adequate precision to be used in infants. The only device with UF error below 3 ml in 4 h is the volumetrically-controlled NIDUS. We recommend that regulatory bodies should introduce UF precision-testing for devices intended for use in infants.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584490","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":"SGLT2 inhibitors for kidney protection in children: expanding horizons beyond endocrinology.","authors":"Costanza Pucci, Davide Silvio Marazza, Evgenia Preka, Antonio Mastrangelo, Giovanni Montini, Olivia Boyer","doi":"10.1007/s00467-025-06838-7","DOIUrl":"https://doi.org/10.1007/s00467-025-06838-7","url":null,"abstract":"<p><p>For over two decades, kidney protection in children has relied on angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs), which present significant limitations. Sodium-glucose cotransporter 2 inhibitors (SGLT2i), initially developed as antidiabetic agents, have demonstrated significant benefits in preserving kidney function in adults with chronic kidney disease (CKD), regardless of diabetes status. The pathophysiology of paediatric CKD differs from adult CKD, with congenital anomalies of the kidney and urinary tract (CAKUT) as the predominant cause. Extrapolating adult data to paediatric patients is challenging, though preliminary studies suggest SGLT2i may mitigate hyperfiltration-related damage, reduce proteinuria, and slow CKD progression, on top of RAS-blockers. Recent paediatric case series and small clinical trials have shown promising results, though larger controlled studies are needed to confirm efficacy and safety. The ongoing DOUBLE PRO-TECT Alport trial represents a significant step toward evaluating SGLT2i kidney protection in children. While current data suggest potential benefits, careful assessment of adverse effects such as euglycaemic ketoacidosis (EuDKA) and calcium phosphorus imbalances is crucial. This review aims to explore the mechanism of action, clinical evidence, and future perspectives of SGLT2i in paediatric CKD, highlighting their potential as a novel therapeutic strategy beyond diabetes management.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584491","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":"Technicalities, current evidence, and clinical indications of hemoadsorption in critically ill children.","authors":"Giovanni Ceschia, Germana Longo, Josè Igeno, Enrico Vidal","doi":"10.1007/s00467-025-06882-3","DOIUrl":"https://doi.org/10.1007/s00467-025-06882-3","url":null,"abstract":"<p><p>Hemoadsorption devices represent a significant advancement in extracorporeal organ support therapies, enabling the targeted removal of molecules that are not cleared by conventional kidney replacement therapies. Several hemoadsorption devices are currently available, each with distinct characteristics, mechanisms of action, and molecular adsorption profiles that enable their targeted use in a broad range of clinical scenarios in critically ill patients. Their application has recently been explored in pediatric patients with conditions such as septic shock, acute liver failure, hyperinflammatory syndromes, rhabdomyolysis, and intoxications. Preliminary findings suggest both clinical and biochemical improvements, including reduction in severity scores and circulating inflammatory mediators. However, the current body of evidence remains limited, primarily consisting of case reports and small case series, and often lacks robust clinical trial data. In the pediatric population, several challenges persist, including concerns about device sizing, the unintended removal of essential substances, such as medications, nutrients, albumin, and fibrinogen, and the procedural invasiveness, particularly for younger children. Future research should focus on patient stratification to identify those most likely to benefit from hemoadsorption, and on conducting large, multicenter studies to validate its effectiveness and utility in the pediatric setting.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144584492","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":"Pediatric and adult point of view on the gut-kidney axis in CKD.","authors":"Johannes Holle, Felix Behrens, Laetitia Koppe","doi":"10.1007/s00467-025-06780-8","DOIUrl":"https://doi.org/10.1007/s00467-025-06780-8","url":null,"abstract":"<p><p>Chronic non-communicable diseases pose a significant global health challenge, with the human gut microbiota emerging as a key player in several (patho) physiological functions, including immunity, metabolic homeostasis, and inflammation. While dysbiosis, or imbalance in taxonomy and function of gut microbiota, has been implicated in chronic kidney disease (CKD), whether it is a cause or consequence of the disease remains controversial. Understanding the gut microbiota's role in CKD pathogenesis is essential for developing novel therapeutic interventions. CKD in children presents unique opportunities for studying disease-specific mechanisms due to the absence of comorbidities typically seen in adults, such as diabetes, obesity, and hypertension, although few studies exist. On the other hand, unlike the relatively stable gut microbiota of healthy adults, the infant's microbiome undergoes significant development and maturation during the early years of life. Integrating knowledge from both pediatric and adult populations may provide a comprehensive understanding of gut microbiota dysbiosis in CKD. This review aims to provide an overview of the gut microbiota's development in healthy individuals and CKD patients and discusses how these findings can inform personalized treatment approaches to CKD.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575966","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":"Nephrotoxicity of immunotherapy and targeted therapies used to treat paediatric cancer.","authors":"Megan B Sim, Shahrad Rod Rassekh","doi":"10.1007/s00467-025-06852-9","DOIUrl":"https://doi.org/10.1007/s00467-025-06852-9","url":null,"abstract":"<p><p>Children with cancer have had significant improvements in cure rates over the last few decades through advancements in surgery, chemotherapy, and radiation therapy. However, survivors have been left with long-term adverse effects of therapy, including significant nephrotoxicity. With advancement in genomic sequencing and novel therapeutics, there has been a recent shift towards the incorporation of targeted therapies and immunotherapy to improve cure rates and reduce long-term sequelae in survivors. However, these new therapies are not without their own toxicities, and with more widespread use of these agents, paediatric oncologists and nephrologists need to be aware of the short- and long-term impact of these treatments on children with cancer. This review highlights some of the emerging knowledge regarding the impact of these novel therapeutics on the kidneys.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575965","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":"Early detection of kidney impairment in school-aged children born very preterm: a parallel use of traditional and modern biomarkers.","authors":"Vaia Dokousli, Nikolaos Gkiourtzis, Anastasia Stoimeni, Despoina Samourkasidou, Kali Makedou, Christos Tsakalidis, George Koliakos, Despoina Tramma","doi":"10.1007/s00467-025-06876-1","DOIUrl":"https://doi.org/10.1007/s00467-025-06876-1","url":null,"abstract":"<p><strong>Background: </strong>Prematurity has been linked to kidney dysfunction from infancy through adulthood. Children born very preterm are at particular risk due to interrupted nephrogenesis. However, early detection remains challenging, and a uniform monitoring strategy is lacking.</p><p><strong>Methods: </strong>This cross-sectional study involved school-aged (6-16 years) children born at ≤ 32 weeks of gestation, with no history of small for gestational age (SGA). They were further stratified by birth weight (BW): low, very low, and extremely low (LBW, VLBW, ELBW) categories. Age- and sex-matched full-term children served as controls. Anthropometry, blood pressure (BP), and kidney function were assessed, using traditional (urea; creatinine, Cr; β2-microglobulin, B2M; albuminuria) and modern biomarkers (cystatin C, CysC; symmetric dimethylarginine, SDMA). Estimated glomerular filtration rate (eGFR) based on Cr and Cr-CysC was also calculated. Statistical analysis was performed using R (version 4.3.2), with significance set at p < 0.05.</p><p><strong>Results: </strong>Eighty-one children were included: 43 preterm (77% from multiple pregnancies) and 38 controls. Compared to controls, preterm participants had higher serum cystatin C (p < 0.001) and lower Cr-CysC-eGFR (p < 0.001). They also had higher serum urea (p = 0.002), but all individual values were within the normal range. No differences were observed in BP, serum Cr, Cr-eGFR, or albuminuria. ELBW children had lower body mass index (BMI) (p = 0.048) and higher B2M (p = 0.046) than LBW peers.</p><p><strong>Conclusions: </strong>School-aged children born very preterm may already exhibit subtle signs of kidney dysfunction, with ELBW children showing greater metabolic and renal strain. Cystatin C and Cr-CysC-eGFR appear promising biomarkers for early detection of kidney alterations in this high-risk population.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575964","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":"Unmasking fluid overload in children on peritoneal dialysis: a multimodal diagnostic approach.","authors":"Bahriye Atmis, Ikbal Turker, Derya Cevizli, Cagla Cagli Piskin, Faruk Ekinci, Dincer Yildizdas, Aysun K Bayazit","doi":"10.1007/s00467-025-06825-y","DOIUrl":"https://doi.org/10.1007/s00467-025-06825-y","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to assess fluid status in pediatric patients on peritoneal dialysis by combining ultrasonography and bioimpedance spectroscopy (BIS). It specifically focused on examining the changes in volume status following a 2-h dwell time ultrafiltration exchange and evaluating the reliability of these techniques.</p><p><strong>Methods: </strong>Thirteen pediatric patients on peritoneal dialysis were enrolled in this study, and their hydration status was assessed clinically. In addition, 56 lung ultrasound measurements, inferior vena cava (IVC) collapsibility index assessments, and BIS evaluations were performed both before and after a 2-h dwell exchange using 2.27%/2.5% dextrose dialysate.</p><p><strong>Results: </strong>The mean age of the patients was 8.6 ± 4.1 years, and eight of them (61.5%) were male. The IVC collapsibility index significantly increased (26.3 ± 10.0% vs. 44.4 ± 9.4%; p < 0.001), and the total number of B-lines significantly decreased (median 22 vs. 11.5; p < 0.001) after a 2-h dwell exchange using 2.27%/2.5% dextrose dialysate. A positive correlation was observed between the total number of B-lines and fluid overload measured using BIS both pre-dialysis (r = 0.504, p = 0.006) and post-dialysis (r = 0.528, p = 0.004). A significant reduction in the total number of B-lines was observed across all hydration groups after dialysis (p < 0.001). The area under the receiver-operating characteristic curve (AUC) for the total number of B-lines in predicting severe overhydration was 0.685 (p = 0.097) when assessed using BIS and 0.740 (p = 0.181) when assessed by weight.</p><p><strong>Conclusion: </strong>Our results highlight marked changes in fluid status parameters from pre- to post-dialysis, underscoring the clinical value of combining lung ultrasonography and BIS for monitoring fluid overload in pediatric patients undergoing peritoneal dialysis.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144554127","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":"Effect of therapeutic plasma exchange on amoxicillin, clindamycin, midazolam, and morphine pharmacokinetics in a critically ill child.","authors":"André Yaghyazaryan, Valentina Gracchi, Sybrand W J Zielhuis, Elisabeth H Schölvinck, Daan J Touw, Martin C J Kneyber, Paola Mian","doi":"10.1007/s00467-025-06873-4","DOIUrl":"https://doi.org/10.1007/s00467-025-06873-4","url":null,"abstract":"<p><p>We report a 15-year-old boy with severe septic shock and multiple organ failure, requiring intensive care and extracorporeal therapies, including veno-arterial extracorporeal membrane oxygenation, continuous veno-venous hemodiafiltration, and therapeutic plasma exchange. Given their critical role in the clinical management, pharmacokinetics of amoxicillin, clindamycin, midazolam, and morphine were closely monitored. Drug concentrations were measured before, during, and after therapeutic plasma exchange sessions. Despite theoretical predictions, clinically significant reductions in plasma drug concentrations of amoxicillin, clindamycin, and midazolam were observed following therapeutic plasma exchange. This case report emphasizes the necessity of therapeutic drug monitoring to adjust dosing appropriately and optimize patient outcomes.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144554126","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}