Pediatric Nephrology最新文献

{"title":"Optimizing anticoagulation for CKRT in pediatric ECMO: the effectivity of regional citrate anticoagulation.","authors":"Ayşen Durak Aslan, Özge Aydın, Hacer Uçmak, Eda Eyduran, Merve Havan, Tanıl Kendirli","doi":"10.1007/s00467-025-06937-5","DOIUrl":"10.1007/s00467-025-06937-5","url":null,"abstract":"<p><strong>Background: </strong>This retrospective, descriptive study, conducted in a single-center PICU from June 2014 to May 2023, aimed to analyze the efficacy of adjunctive regional citrate anticoagulation for continuous kidney replacement therapy (CKRT) circuits during extracorporeal membrane oxygenation (ECMO).</p><p><strong>Methods: </strong>Patients were divided into two groups based on their CKRT anticoagulation strategy: those receiving regional citrate anticoagulation in addition to systemic heparin (UFH + RCA group) and those receiving only systemic heparin (UFH group). CKRT circuits were also classified as either UFH + RCA or UFH to analyze outcomes specific to each anticoagulation strategy. CKRT circuit lifespan estimation was calculated by dividing the total CKRT duration by the number of circuits used.</p><p><strong>Results: </strong>During the study period, 110 pediatric patients were treated with ECMO at our PICU. During ECMO, 64 (58.2%) of these patients required CKRT. Fluid overload and acute kidney injury were the primary indications for CKRT. While not statistically significant, the median estimate CKRT circuit lifespan was longer in the citrate group [84 (38.4-112.0)] than the heparin group [52 (12.0-408.0)]. Circuit changes due to clotting were significantly higher in the heparin group compared to the citrate group (58.1% vs. 31.7%, p = 0.00). Kaplan-Meier analysis revealed a statistically significant difference in the timing of clotting-related circuit changes, favoring UFH + RCA (p = 0.02).</p><p><strong>Conclusions: </strong>To the best of our knowledge, our study represents the first comparison of UFH + RCA and UFH alone for CKRT in pediatric ECMO patients. Our findings suggest that using UFH + RCA might help the circuit last longer by decreasing changes caused by clotting. Prospective studies on this topic are needed.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"225-231"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023916","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":"Overdose of low molecular weight heparin in an infant with stage 5 chronic kidney disease treated with hemofiltration.","authors":"Beejal Patel, Matko Marlais, Mary Mathias, Samikska Shetty, Liam Watson, Deirdre O' Sullivan","doi":"10.1007/s00467-025-06919-7","DOIUrl":"10.1007/s00467-025-06919-7","url":null,"abstract":"<p><p>Low molecular weight heparin (LMWH) is widely used for the treatment and prevention of many venous thromboembolic disorders. LMWH acts through its ability to potentiate inhibition of factor Xa. LMWH undergoes primary renal excretion and therefore its elimination can be severely impacted by kidney disease. We report on the case of an infant with stage 5 chronic kidney disease (CKD) who received a prolonged accidental overdose of dalteparin. The infant was symptomatic with a falling haemoglobin, perinephric hematoma, and oozing venipuncture sites. Given the inability to predict drug clearance in this infant and her significant risk of bleeding, she underwent a successful trial of continuous veno-venous hemofiltration (CVVH) for the treatment of LMWH overdose. Whilst on CVVH, a steady downward trend in anti-Xa levels over 24 h was observed.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"85-87"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732629","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":"Real-world experience of using vitamin E for symptomatic management of muscle cramps in children living with chronic kidney disease.","authors":"Karma Abukasm, Laura Beresford, Kathryn Haubrich, Mina Matsuda-Abedini, Janis Dionne","doi":"10.1007/s00467-026-07457-6","DOIUrl":"10.1007/s00467-026-07457-6","url":null,"abstract":"","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"4717-4720"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387896","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 rare but misleading cause of hematuria in hemophilia A: renal pelvic hemorrhage mimicking tumor.","authors":"Emine Turkkan, Ozge Yapici, Demet Alaygut","doi":"10.1007/s00467-026-07429-w","DOIUrl":"10.1007/s00467-026-07429-w","url":null,"abstract":"<p><p>Hematuria is a common manifestation in hemophilia A, whereas upper urinary tract bleeding is rare and diagnostically challenging. We report a patient with severe hemophilia A presenting with gross hematuria due to spontaneous renal pelvic hemorrhage (Antopol-Goldman lesion), initially mimicking a urothelial tumor on imaging. The diagnosis was supported by clinical context, imaging characteristics, and response to factor VIII replacement therapy. This case highlights the importance of considering benign hemorrhagic causes in hemophilia patients with atypical imaging findings to avoid unnecessary invasive procedures.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"4405-4408"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345969","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":"APOM-S1P axis as a therapeutic target in steroid sensitive nephrotic syndrome.","authors":"Daniel Heydari, Mallory L Downie","doi":"10.1007/s00467-026-07460-x","DOIUrl":"10.1007/s00467-026-07460-x","url":null,"abstract":"","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"4725-4726"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148387891","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":"Preemptive rituximab for immunosuppressant withdrawal in adolescents and young adults with childhood-onset steroid-dependent nephrotic syndrome.","authors":"Shuichiro Fujinaga, Hiroki Miyano, Taro Hoshino","doi":"10.1007/s00467-026-07464-7","DOIUrl":"10.1007/s00467-026-07464-7","url":null,"abstract":"","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"4729-4730"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148397370","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 clinician perspectives on clinical decision support tools for chronic kidney disease risk after preterm birth.","authors":"Keia Sanderson, Christine E Kistler, Marissa Velarde, Mary E Grewe, T Michael OʼShea, Jennifer E Flythe","doi":"10.1007/s00467-026-07423-2","DOIUrl":"10.1007/s00467-026-07423-2","url":null,"abstract":"<p><strong>Background: </strong>Preterm birth affects approximately 10% of U.S. births, and children born preterm face twice the lifetime risk of chronic kidney disease (CKD). Despite this, kidney health surveillance after preterm birth is uncommon. Although clinical decision support (CDS) tools are widely used in pediatric practice, none address CKD risk stratification after preterm birth. This study assessed pediatric clinician perspectives on facilitators and barriers to CDS tool use, in general and for pediatric CKD risk stratification.</p><p><strong>Methods: </strong>We conducted a qualitative descriptive study using semistructured interviews with neonatologists, general pediatricians, and pediatric nephrologists in the United States (December 2023-April 2024). Interviews were conducted by video or teleconference, digitally recorded, and professionally transcribed. Thematic analysis followed COREQ guidelines, and sampling continued until thematic saturation was confirmed.</p><p><strong>Results: </strong>Twenty-five pediatric clinicians participated (44% neonatologists, 44% general pediatricians, and 12% nephrologists; median age 39 years, 76% female, 52% White, 88% non-Hispanic, and 80% academic practice). Clinicians reported strong preferences for CDS tools that efficiently support workflows, integrate with the electronic health record (EHR), and provide actionable recommendations with caregiver education. Key concerns included unintended consequences such as false reassurance, over-referral to nephrology, and care burden for families with limited subspecialty access. All participants endorsed the need for a pediatric CKD risk stratification tool.</p><p><strong>Conclusions: </strong>Pediatric clinicians prefer EHR-integrated, evidence-based, family-centered CDS tools to guide CKD risk identification after preterm birth. These findings represent an important step toward developing a pediatric kidney disease risk stratification CDS tool.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"4449-4459"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148339559","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":"Neuropsychiatric SLE in children with childhood-onset lupus nephritis: a 20-year retrospective cohort study.","authors":"Matthew Lok-Hei Wong, Ka-Man Yip, Alison Lap-Tak Ma, Eugene Yu-Hin Chan","doi":"10.1007/s00467-025-06904-0","DOIUrl":"10.1007/s00467-025-06904-0","url":null,"abstract":"<p><strong>Background: </strong>Neuropsychiatric systemic lupus erythematosus (NPSLE) and lupus nephritis (LN) are two major, life-threatening complications in childhood-onset SLE (cSLE). Data regarding the epidemiology and prognosis of children with concurrent NPSLE and LN remain scarce. This study aimed to investigate the clinical characteristics, associated factors, and outcomes of NPSLE in Chinese children with LN.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted at the Paediatric Nephrology Centre of Hong Kong Children's Hospital, including 95 Chinese children with biopsy-proven cLN. Comparisons were made between children with and without NPSLE.</p><p><strong>Results: </strong>Of 95 Chinese children with cLN, 11 (12%) developed NPSLE, and 31 NPSLE events were reported. Estimated glomerular filtration rate < 30 mL/min/1.73 m² at diagnosis of LN (OR_adj 6.7, 95% CI 1.29-35.1) and higher maximal proteinuria during the observation period (OR_adj 1.07, 95% CI 1-1.13) were predictive of NPSLE upon multivariable analysis. Compared to children with LN who did not develop NPSLE, significantly more children who developed subsequent NPSLE flare following initial kidney involvement had a history of medication non-adherence (100% vs. 25%, p < 0.001), higher degree of proteinuria at the diagnosis of LN (urine protein/creatinine ratio, 5.7 vs. 2.4 mg/mg, p = 0.04) and during the entire observation period (urine protein/creatinine ratio, 13.2 vs. 3.3 mg/mg, p = 0.004). Patients with NPSLE had significantly lower complete remission rates for LN at 6- and 12-month post-induction (27.3% vs. 70.2%, p = 0.014; 45.5% vs. 83.3%, p = 0.01, respectively). Kaplan-Meier analysis showed that patients with NPSLE had worse kidney and patient survivals (log-rank test, p < 0.001, 0.0014, respectively) than those without NPSLE.</p><p><strong>Conclusions: </strong>Worse kidney and patient survivals are observed in cLN patients with NPSLE. Severe LN manifestation and medication non-adherence are associated with the development of NPSLE.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"89-100"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12685967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144964101","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":"Urinary leukotriene E4 for predicting steroid sensitivity in children with nephrotic syndrome: an observational cohort study.","authors":"Nehal Saad, Amal Osman, Mostafa Mansour, Ashraf M Bakr","doi":"10.1007/s00467-025-06952-6","DOIUrl":"10.1007/s00467-025-06952-6","url":null,"abstract":"<p><strong>Background: </strong>Nephrotic syndrome (NS) is a common pediatric kidney disorder characterized by proteinuria, hypoalbuminemia, and edema. Leukotrienes (LTs), as inflammatory mediators, may contribute to NS pathogenesis and influence treatment response. This study aimed to assess urinary leukotriene E4 (LTE4) levels in children with an initial onset of NS and evaluate their potential as biomarkers for steroid responsiveness.</p><p><strong>Methods: </strong>In this observational cohort study, 41 children with a first episode of NS and 41 age- and sex-matched healthy controls were enrolled. Patients were classified into steroid-sensitive NS (SSNS; n = 29) and steroid-resistant NS (SRNS; n = 12) groups following initial steroid therapy. Urinary LTE4 levels were measured prior to treatment, using enzyme-linked immunosorbent assay (ELISA).</p><p><strong>Results: </strong>Urinary LTE4 levels were significantly elevated in children with NS compared to controls (p = 0.001). Although urinary LTE4 to urinary creatinine (U cr) ratios were also higher in patients, the difference did not reach statistical significance (p = 0.09). No significant correlations were observed between urinary LTE4 levels and urinary protein excretion or serum albumin. Furthermore, urinary LTE4 levels did not significantly differ between SSNS and SRNS groups. A receiver operating characteristic (ROC) curve analysis showed poor predictive value of urinary LTE4 for steroid responsiveness, with area-under-the-curve (AUC) values near 0.5.</p><p><strong>Conclusions: </strong>While urinary LTE4 levels are elevated in children with NS, they failed to reliably differentiate between SSNS and SRNS. These findings suggest a limited role for urinary LTE4 as a predictive biomarker of steroid responsiveness in pediatric NS. However, future large-scale studies incorporating both plasma and urinary leukotriene profiles are warranted to validate its role in disease pathogenesis and treatment response.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"101-108"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12686090/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145200602","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":"Biomarkers of kidney involvement in paediatric IgA vasculitis: a systematic review and meta-analysis.","authors":"Mădălina Andreea Beldie, Márk Viktor Hernádfői, Karen Krisztina Fazekas, Dóra Luca Bodócs, Péter Hegyi, Csaba Lódi, Iuliana Magdalena Stârcea","doi":"10.1007/s00467-026-07382-8","DOIUrl":"10.1007/s00467-026-07382-8","url":null,"abstract":"<p><strong>Background: </strong>IgA vasculitis nephritis (IgAVN) develops in 20-80% of patients with IgA vasculitis (IgAV), yet diagnosis is often delayed. Readily available biomarkers can help identify patients at risk earlier.</p><p><strong>Objective: </strong>To conduct a systematic review and meta-analysis of all available serum and urinary biomarkers to evaluate their prognostic potential in predicting IgAVN in paediatric patients.</p><p><strong>Data sources: </strong>A comprehensive search was performed in PubMed, EMBASE and Cochrane Library on November 9, 2024, covering publications from inception. The search strategy included three domains: paediatric population, IgAV diagnosis and studied biomarkers. No language or additional restrictions were applied.</p><p><strong>Study eligibility criteria and participants: </strong>We included original retrospective, prospective and cross-sectional studies that involved paediatric IgAV patients and reported biomarker levels in patients with and without nephritis. Two reviewers independently screened studies, and a third reviewer resolved conflicts.</p><p><strong>Study appraisal and synthesis methods: </strong>Data extraction was performed by two independent reviewers. A random-effects model was used for analysis. The review followed PRISMA guidelines, and study quality was assessed using the QUIPS tool. Outcomes were reported as mean or standardised mean differences with 95% confidence intervals (CI). Where possible, odds ratios (OR) and diagnostic performance measures were also evaluated.</p><p><strong>Results: </strong>Of 10,611 records screened, 129 studies including 23,726 patients were included. The neutrophil-to-lymphocyte ratio (NLR) was significantly higher in patients with nephritis (0.48; 95% CI 0.04-0.93), with notable effects in the Turkish population (0.86; 95% CI 0.19-1.52) but not in the Chinese population (- 0.02; 95% CI - 0.75-0.72). The platelet-to-lymphocyte ratio (PLR) showed a similar pattern, being higher in the Turkish subgroup (21.9; 95% CI 9.64-34.16) and lower in the Chinese subgroup (- 6.75; 95% CI - 11.27-2.22). A positive faecal occult blood test (FOBT) was associated with increased odds of kidney involvement (OR 2.04; 95% CI 1.05-3.96).</p><p><strong>Limitations: </strong>This study has limitations, including the predominance of retrospective data, limited reporting of diagnostic accuracy metrics (e.g. sensitivity, specificity), and substantial inter-study heterogeneity in nephritis definitions, measurement methods and study populations, which restrict firm conclusions about biomarker performance.</p><p><strong>Conclusions and implications of key findings: </strong>While statistically significant biomarker associations exist, clinically actionable predictors of IgAVN remain lacking. NLR, PLR and FOBT warrant prospective validation in multicentre cohorts with standardised protocols.</p><p><strong>Systematic review registration number: </strong>CRD42024593928.</p>","PeriodicalId":19735,"journal":{"name":"Pediatric Nephrology","volume":" ","pages":"4379-4392"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672260/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163918","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}