Pediatric Nephrology最新文献

{"title":"AI-powered insights in pediatric nephrology: current applications and future opportunities.","authors":"Arwa Nada, Yamen Ahmed, Jieji Hu, Darcy Weidemann, Gregory H Gorman, Eva Glenn Lecea, Ibrahim A Sandokji, Stephen Cha, Stella Shin, Salar Bani-Hani, Sai Sudha Mannemuddhu, Rebecca L Ruebner, Aadil Kakajiwala, Rupesh Raina, Roshan George, Rim Elchaki, Michael L Moritz","doi":"10.1007/s00467-025-06911-1","DOIUrl":"https://doi.org/10.1007/s00467-025-06911-1","url":null,"abstract":"<p><p>Artificial intelligence (AI) is rapidly emerging as a transformative force in pediatric nephrology, enabling improvements in diagnostic accuracy, therapeutic precision, and operational workflows. By integrating diverse datasets-including patient histories, genomics, imaging, and longitudinal clinical records-AI-driven tools can detect subtle kidney anomalies, predict acute kidney injury, and forecast disease progression. Deep learning models, for instance, have demonstrated the potential to enhance ultrasound interpretations, refine kidney biopsy assessments, and streamline pathology evaluations. Coupled with robust decision support systems, these innovations also optimize medication dosing and dialysis regimens, ultimately improving patient outcomes. AI-powered chatbots hold promise for improving patient engagement and adherence, while AI-assisted documentation solutions offer relief from administrative burdens, mitigating physician burnout. However, ethical and practical challenges remain. Healthcare professionals must receive adequate training to harness AI's capabilities, ensuring that such technologies bolster rather than erode the vital doctor-patient relationship. Safeguarding data privacy, minimizing algorithmic bias, and establishing standardized regulatory frameworks are critical for safe deployment. Beyond clinical care, AI can accelerate pediatric nephrology research by identifying biomarkers, enabling more precise patient recruitment, and uncovering novel therapeutic targets. As these tools evolve, interdisciplinary collaborations and ongoing oversight will be key to integrating AI responsibly. Harnessing AI's vast potential could revolutionize pediatric nephrology, championing a future of individualized, proactive, and empathetic care for children with kidney diseases. Through strategic collaboration and transparent development, these advanced technologies promise to minimize disparities, foster innovation, and sustain compassionate patient-centered care, shaping a new horizon in pediatric nephrology research and practice.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145075963","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":"Membranous-like glomerulopathy with masked IgG-k deposits in a pediatric patient with juvenile idiopathic arthritis.","authors":"Priyanka Chati, Jill Krissberg, Kammi Henriksen, Brian Nolan, Meredith Harris","doi":"10.1007/s00467-025-06954-4","DOIUrl":"https://doi.org/10.1007/s00467-025-06954-4","url":null,"abstract":"<p><p>Membranous-like glomerulopathy with masked IgG-kappa deposits (MGMID) is a rare entity described primarily among young females with previously diagnosed autoimmune diseases. We present a 12-year-old female with systemic juvenile idiopathic arthritis (sJIA) with persistent non-nephrotic range proteinuria despite normal kidney function. She underwent two kidney biopsies with the second ultimately confirming her diagnosis. The initial biopsy was suggestive of mild C3 glomerulonephritis (C3GN). She was started on an angiotensin-converting enzyme inhibitor (ACE-I) without improvement. Proteinuria progressed to the nephrotic range, prompting initiation of high-dose steroids followed by a steroid taper. Mycophenolate was added during steroid weaning due to ongoing proteinuria. Despite full-dose mycophenolate and ACE-I therapy, a repeat biopsy was performed due to lack of response and revealed MGMID. She remains on full-dose mycophenolate and lisinopril with significant improvement in her proteinuria.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145070183","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":"Special considerations for assessing Major Adverse Kidney Events (MAKE) in children < 2 years of age.","authors":"Danielle E Soranno, Stuart L Goldstein, Andrew Shaw, Dana Y Fuhrman","doi":"10.1007/s00467-025-06955-3","DOIUrl":"https://doi.org/10.1007/s00467-025-06955-3","url":null,"abstract":"","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145065325","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":"Navigating complex clinical decisions: kidney transplantation following abdominal aorto-aortic bypass in infantile Takayasu arteritis.","authors":"Moran Plonsky Toder, Rami Tibi, Ran Steinberg, Tony Karram, Aharon Hoffman, Dawn Coleman, Irina Libinson-Zebegret, Renata Yakubov, Israel Eisenstein, Daniella Magen, Shirley Pollack","doi":"10.1007/s00467-025-06932-w","DOIUrl":"https://doi.org/10.1007/s00467-025-06932-w","url":null,"abstract":"<p><strong>Background: </strong>Takayasu arteritis (TAK) is a granulomatous large-vessel vasculitis typically affecting young adult females. Pediatric cases are rare, and infantile onset is exceptional. Management relies on immunosuppression, with surgery reserved for severe complications.</p><p><strong>Case report: </strong>We describe a now 5.5-year-old boy diagnosed with TAK at six months of age, presenting with hypertensive encephalopathy and kidney dysfunction. Despite treatment with corticosteroids and anti-TNFα, his kidney function deteriorated, leading to kidney failure and dialysis. At nearly three years of age, he underwent abdominal aorto-aortic bypass and bilateral nephrectomy due to progressive vascular narrowing and refractory hypertension. At age four, he successfully received a deceased-donor kidney transplant. Eighteen months post-transplant, he maintains excellent graft function and shows no signs of TAK recurrence.</p><p><strong>Clinical significance: </strong>This case underscores the complexity of diagnosing and managing infantile TAK with multiorgan involvement. To our knowledge, he is among the youngest reported TAK patients to undergo successful kidney transplantation following major vascular surgery. His course demonstrates the potential for long-term remission and safe transplantation under standard immunosuppression, without continued anti-TNFα therapy. The literature is sparse regarding kidney failure and transplantation in TAK, particularly in infants.</p><p><strong>Key management points: </strong>This case highlights key management dilemmas in infantile TAK, including clinical diagnosis, timing of surgery and transplantation, choice of immunosuppression, and long-term monitoring. It emphasizes the importance of a multidisciplinary approach and the need for collaborative research to address knowledge gaps in this rare but complex condition.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033861","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":"A novel marker of electrical instability in children with hypertension: cardiac electrophysiological balance index.","authors":"Seyma Kayali, Emine Gulsah Ozdemir, Yucel Hanilce","doi":"10.1007/s00467-025-06934-8","DOIUrl":"https://doi.org/10.1007/s00467-025-06934-8","url":null,"abstract":"<p><strong>Background: </strong>Pediatric hypertension is a growing health concern, with prolonged exposure to high blood pressure potentially causing electrical instability and increasing arrhythmia risk. The index of cardiac electrophysiological balance (iCEB), calculated as QT interval divided by QRS duration, is a potential non-invasive marker for arrhythmogenesis. This study aimed to evaluate iCEB and corrected iCEB (iCEBc) in hypertensive children and investigate their relationship with arrhythmic risk.</p><p><strong>Methods: </strong>This cross-sectional study included 81 children with primary hypertension and 36 age- and sex-matched healthy controls. Office blood pressure, 24-h ambulatory blood pressure monitoring (ABPM), standard echocardiography, and 12-lead electrocardiograms (ECGs) were obtained. QT, QTc, Tp-e, Tp-e/QT, Tp-e/QTc, iCEB, and iCEBc were calculated. Echocardiographic measurements and laboratory parameters were also evaluated.</p><p><strong>Results: </strong>The mean age of the hypertensive group was 13.8 ± 3 years, with 60.5% males. Most (64.2%) demonstrated a non-dipping BP pattern. Echocardiography showed preserved ejection fraction (72.7 ± 5.4%) and shortening fraction (42 ± 5.1%), with left ventricular hypertrophy (LVH) observed in 8.6% of cases. ECG analysis revealed significantly prolonged QTc interval (416.8 ± 30.2 ms vs. 401.8 ± 23.4 ms; p = 0.008), iCEB (3.92 vs. 3.44; p = 0.02), and iCEBc (4.58 vs. 4.09; p = 0.001) values in hypertensive patients compared to controls. No significant differences were observed in Tp-e, Tp-e/QT, or Tp-e/QTc.</p><p><strong>Conclusion: </strong>Children with hypertension exhibit subclinical alterations in cardiac electrophysiology, including significantly elevated iCEB and iCEBc values, which may indicate electrical instability and a higher arrhythmia risk. These indices may serve as practical, non-invasive tools for early detection of subclinical electrophysiological changes in pediatric hypertension.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033877","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":"Association between body mass index, urine metabolic disturbances, and nephrolithiasis in pediatric patients.","authors":"Jingyi Yang, Jie Ni, Yu Zhou, Xiaorong Liu","doi":"10.1007/s00467-025-06865-4","DOIUrl":"https://doi.org/10.1007/s00467-025-06865-4","url":null,"abstract":"<p><strong>Background: </strong>The link between obesity, urine metabolic disturbances, and the development of kidney stones in children and adolescents remains controversial.</p><p><strong>Objectives: </strong>The objective of this work is to identify the association between BMI, urine metabolic disturbance, and pediatric nephrolithiasis.</p><p><strong>Data sources: </strong>PubMed, Embase, Web of Science, Cochrane Library, and Scopus databases were searched from inception to June 30, 2023.</p><p><strong>Study eligibility criteria: </strong>Case-control, cohort, and cross-sectional studies with nephrolithiasis in patients aged 21 years or younger, with the topic of BMI and urine metabolic disruption were included.</p><p><strong>Participants and inventions: </strong>Children and adolescents with nephrolithiasis are the participants.</p><p><strong>Study appraisal and synthesis methods: </strong>We assessed the quality of the included studies using the AHRQ and NOS assessment, but the heterogeneity of the studies did not allow for data synthesis and meta-analyses.</p><p><strong>Result: </strong>Hypercalciuria, hypocitraturia, and hyperoxaluria are the most prevalent in pediatric nephrolithiasis. Obese pediatric patients would have different urinary mineral profiles depending on the region, dietary habits, and heritability. Also, we found that children of different ages may have varying risk factors for stones. Increasing fluid intake is a simple and affordable strategy for preventing kidney stones, as recommended for children. Improving poor nutritional habits would aid in the decrease of metabolic variables involved in stone formation.</p><p><strong>Conclusions and implications of key findings: </strong>Obesity alone may not contribute to stone formation in pediatrics, but a combination of metabolic factors, different urinary mineral profiles, and abnormal metabolic status may predispose to stones in children, owing to children tending to undergo rapid changes in growth in a relatively short period, and partly due to different risk factors for stones in different regions. In addition to BMI, other indicators such as %BF (percent body fat) and BRI (body roundness index) may be used to comprehensively assess nutritional status and metabolism in children. Evaluating individual metabolic profiles and promoting increased fluid intake are simple, cost-effective strategies for preventing kidney stones in this population.</p><p><strong>Systematic review registration number: </strong>CRD4202456817.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040435","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":"Response to commentary on \"Ultra-rare severe kidney dysplasia mimicking salt-wasting tubulopathy associated with TFCP2L1 gene variants\".","authors":"Manuel Vaqueiro Graña, Sara Gómez-Conde, Leire Madariaga","doi":"10.1007/s00467-025-06948-2","DOIUrl":"https://doi.org/10.1007/s00467-025-06948-2","url":null,"abstract":"","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145040786","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":"A new era of complement inhibition: are we ready for the infectious risks?","authors":"Nicolas Bergeron, Geneviève Benoit, Alexandra Cambier, Camille Laroche, Véronique Phan, Jean Philippe Roy, Anne-Laure Lapeyraque","doi":"10.1007/s00467-025-06958-0","DOIUrl":"https://doi.org/10.1007/s00467-025-06958-0","url":null,"abstract":"","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145033906","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":"Regarding \"Pilot pragmatic clinical trial of iron therapy in children with anemia of chronic kidney disease (FeTCh-CKD)\".","authors":"Maha Faraz, Muhammad Ahsan Tariq, Mishaal Sheikh","doi":"10.1007/s00467-025-06950-8","DOIUrl":"https://doi.org/10.1007/s00467-025-06950-8","url":null,"abstract":"","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145030233","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":"Copeptin in the diagnosis and management of renal tubular disorders.","authors":"Leire Madariaga, Angela Ferrulli, Marta García-Alonso","doi":"10.1007/s00467-025-06941-9","DOIUrl":"https://doi.org/10.1007/s00467-025-06941-9","url":null,"abstract":"<p><p>Copeptin, a stable glycopeptide derived from the precursor of arginine vasopressin (AVP), has emerged as a valuable surrogate biomarker for AVP due to its stability and ease of measurement. This narrative review explores the physiological role of copeptin, its utility as a diagnostic and prognostic biomarker in different kidney diseases, and its clinical relevance in renal tubular disorders. The clinical application of copeptin as a diagnostic biomarker is best established in the differential diagnosis of polyuria-polydipsia syndrome (PPS), distinguishing nephrogenic diabetes insipidus (NDI) from central diabetes insipidus (CDI) and primary polydipsia (PP). Baseline and stimulated copeptin levels demonstrate high diagnostic accuracy, although methodological and population-specific limitations exist, especially in pediatrics. Copeptin has also proved to be a marker of disease severity in a wide range of acute pathologies. In chronic kidney disease (CKD), it correlates negatively with kidney function, and it has been shown to be a marker of kidney function decline in kidney transplant patients and in autosomal dominant polycystic kidney disease (ADPKD). Regarding renal tubular disorders, CKD has increasingly been recognized in these patients, potentially driven by persistent volume depletion and activation of the renin-angiotensin-aldosterone system. Copeptin may offer an objective assessment of volume status and disease severity, particularly in infants and young children. However, further studies are needed to define standardized reference values, clarify its mechanistic role, and validate its prognostic utility in tubulopathies. Copeptin holds potential as both a diagnostic and prognostic biomarker in renal tubular disease, with implications for clinical practice and patient management.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":""},"PeriodicalIF":2.6,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023884","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}