Tag Archive for: nephrology

group photo from nephrology training in Jamaica

Update: Collaboration across borders to improve access to nephrology care

  • scenes from nephrology training in Jamaica
  • scenes from nephrology training in Jamaica
  • scenes from nephrology training in Jamaica
  • scenes from nephrology training in Jamaica
  • scenes from nephrology training in Jamaica
  • scenes from nephrology training in Jamaica
  • scenes from nephrology training in Jamaica
  • scenes from nephrology training in Jamaica
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Marva Moxey-Mims, M.D., division chief of Nephrology at Children’s National, has a grant from the International Pediatric Nephrology Association (IPNA) to bring care to children with kidney disease in Jamaica.

During her recent trip, Dr. Moxey-Mims was joined by peritoneal dialysis nurse, Jennifer Carver, RN, and three pediatric nephrologists in Jamaica, Drs. Maolynne Miller, Nadia McClean and Sandrica Peart. Together, they trained close to 30 nurses from three hospitals across the island, including the Bustamante Children’s Hospital, the University Hospital of the West Indies — both in Kingston — and the Cornwall Regional Hospital in Montego Bay.

Nurses were given hands-on training in using peritoneal dialysis cycler machines and manual peritoneal dialysis. The training is part of an initiative that focuses on:

  • Improving clinical training of staff (medical, nursing, and allied health) involved in caring for children with kidney disease
  • Developing and upgrading services for children and adolescents with kidney diseases
  • Educating the community on disease awareness and prevention strategies

“Our ability to offer innovative training and resources to nurses underscores our commitment to ensuring children throughout Jamaica receive the essential care they require,” said Dr. Moxey-Mims. “This signifies to both domestic and international audiences that we’re upholding our pledge to health equity.”

U.S. News Badges

Children’s National Hospital ranked #5 in the nation on U.S. News & World Report’s Best Children’s Hospitals Honor Roll

U.S. News BadgesChildren’s National Hospital in Washington, D.C., was ranked #5 in the nation on the U.S. News & World Report 2023-24 Best Children’s Hospitals annual rankings. This marks the seventh straight year Children’s National has made the Honor Roll list. The Honor Roll is a distinction awarded to only 10 children’s hospitals nationwide.

For the thirteenth straight year, Children’s National also ranked in all 10 specialty services, with eight specialties ranked in the top 10 nationally. In addition, the hospital was ranked best in the Mid-Atlantic for neonatology, cancer, neurology and neurosurgery.

“Even from a team that is now a fixture on the list of the very best children’s hospitals in the nation, these results are phenomenal,” said Kurt Newman, M.D., president and chief executive officer of Children’s National. “It takes a ton of dedication and sacrifice to provide the best care anywhere and I could not be prouder of the team. Their commitment to excellence is in their DNA and will continue long after I retire as CEO later this month.”

“Congratulations to the entire Children’s National team on these truly incredible results. They leave me further humbled by the opportunity to lead this exceptional organization and contribute to its continued success,” said Michelle Riley-Brown, MHA, FACHE, who becomes the new president and CEO of Children’s National on July 1. “I am deeply committed to fostering a culture of collaboration, empowering our talented teams and charting a bold path forward to provide best in class pediatric care. Our focus will always remain on the kids.”

“I am incredibly proud of Kurt and the entire team. These rankings help families know that when they come to Children’s National, they’re receiving the best care available in the country,” said Horacio Rozanski, chair of the board of directors of Children’s National. “I’m confident that the organization’s next leader, Michelle Riley-Brown, will continue to ensure Children’s National is always a destination for excellent care.”

The annual rankings are the most comprehensive source of quality-related information on U.S. pediatric hospitals and recognizes the nation’s top 50 pediatric hospitals based on a scoring system developed by U.S. News.

“For 17 years, U.S. News has provided information to help parents of sick children and their doctors find the best children’s hospital to treat their illness or condition,” said Ben Harder, chief of health analysis and managing editor at U.S. News. “Children’s hospitals that are on the Honor Roll transcend in providing exceptional specialized care.”

The bulk of the score for each specialty service is based on quality and outcomes data. The process includes a survey of relevant specialists across the country, who are asked to list hospitals they believe provide the best care for patients with the most complex conditions.

The eight Children’s National specialty services that U.S. News ranked in the top 10 nationally are:

The other two specialties ranked among the top 50 were cardiology and heart surgery, and urology.

dialysis machines

Profit facility status linked to longer wait times for kidney transplants

dialysis machines

Researchers found that profit dialysis facility status was associated with longer wait-listing times and kidney transplants.

Care of adults at profit versus nonprofit dialysis facilities has been associated with lower access to kidney transplants.

In a study published in JAMA, Celina Brunson, M.D., nephrologist and medical director of dialysis at Children’s National Hospital, and a cohort of researchers, found that profit facility status was associated with longer wait-listing times and kidney transplants. Whether there was a correlation in profit status was unknown before this study.

Researchers reviewed the United States (US) Renal Data System records of 13,333 pediatric patients under the age of 18 who started dialysis from the year 2000 through 2018 in U.S. dialysis facilities. This was followed up through June 30, 2019. Results showed that among U.S. pediatric patients undergoing dialysis, profit dialysis facility status was significantly associated with increased time to wait-listing and kidney transplants.

The full study can be viewed here.

sister center team

Collaboration across borders to improve access to nephrology care

sister center teamChildren’s National Hospital is joining the International Pediatric Nephrology Association (IPNA) to bring care to children with kidney disease in Jamaica. With early screenings, diagnosis and optimal treatments, this collaboration will help decrease the morbidity and mortality associated with renal disease.

“This partnership shows our hospital’s willingness to assist with education and resources in a country will fewer resources,” says Marva Moxey-Mims, M.D., division chief of Nephrology at Children’s National. “This is a signal to those within and outside the United States that we live our stated commitment to health equity.”

This effort will focus on:

  • Improving clinical training of staff (medical, nursing and allied health) involved in caring for children with kidney disease
  • Developing and upgrading services for children and adolescents with kidney diseases
  • Educating the community on disease awareness and prevention strategies

IPNA facilitates the exchange of knowledge and expertise about kidney disease in children in the areas where care is needed most.

“I am excited about our ability to provide specialized clinical training and additional resources to our colleagues in Jamaica,” says Dr. Moxey-Mims. “This will empower them to provide improved care to children with kidney disease on the island through multidisciplinary teams.”

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Children’s National named to U.S. News & World Report’s Best Children’s Hospitals Honor Roll

US News BadgesChildren’s National Hospital in Washington, D.C., was ranked No. 5 nationally in the U.S. News & World Report 2022-23 Best Children’s Hospitals annual rankings. This marks the sixth straight year Children’s National has made the list, which ranks the top 10 children’s hospitals nationwide. In addition, its neonatology program, which provides newborn intensive care, ranked No.1 among all children’s hospitals for the sixth year in a row.

For the twelfth straight year, Children’s National also ranked in all 10 specialty services, with seven specialties ranked in the top 10.

“In any year, it would take an incredible team to earn a number 5 in the nation ranking. This year, our team performed at the very highest levels, all while facing incredible challenges, including the ongoing pandemic, national workforce shortages and enormous stress,” said Kurt Newman, M.D., president and chief executive officer of Children’s National. “I could not be prouder of every member of our organization who maintained a commitment to our mission. Through their resilience, Children’s National continued to provide outstanding care families.”

“Choosing the right hospital for a sick child is a critical decision for many parents,” said Ben Harder, chief of health analysis and managing editor at U.S. News. “The Best Children’s Hospitals rankings spotlight hospitals that excel in specialized care.”

The annual rankings are the most comprehensive source of quality-related information on U.S. pediatric hospitals and recognizes the nation’s top 50 pediatric hospitals based on a scoring system developed by U.S. News.

The bulk of the score for each specialty service is based on quality and outcomes data. The process includes a survey of relevant specialists across the country, who are asked to list hospitals they believe provide the best care for patients with the most complex conditions.

The seven Children’s National specialty services that U.S. News ranked in the top 10 nationally are:

The other three specialties ranked among the top 50 were cardiology and heart surgery, gastroenterology and gastro-intestinal surgery, and urology.

Handrawn illustration of human Kidneys

Children’s National Nephrology team presents virtually at IPTA’s 11th Congress

Handrawn illustration of human KidneysThe International Pediatric Transplant Association (IPTA) is hosting their 11th Congress meeting March 26-29, 2022, and many Children’s National Hospital providers will be presenting throughout the conference. We hope you will join us!

Diversity, inequity and inclusivity in the practice of pediatric transplantation in the U.S.

Presenter: Marva Moxey-Mims, M.D., division chief, Nephrology

Dr. Moxey-Mims will review the trends in pediatric kidney transplantation over the past decade, focusing on differences by race and ethnicity, whether the gaps have narrowed over that time and steps that can be taken to increase equity.

Prevalence of mycophenolate mofetil discontinuation and subsequent outcomes in pediatric kidney transplant recipients: A PNRC study

Presenter: Asha Moudgil, M.D., medical director, Kidney Transplant

Mycophenolate mofetil (MMF) is a common maintenance immunosuppressant in children receiving kidney transplants but is often discontinued for various reasons. In this multi-center Pediatric Nephrology Research Consortium study, researchers sought to determine the prevalence and reasons for MMF discontinuation and its association with patient and allograft outcomes. They will be discussing their methodology and results from this study.

Additional Children’s National staff involved in the study include:

Changes in diastolic function and cardiac geometry after pediatric kidney transplantation: A longitudinal study

Presenter: Kristen Sgambat, Ph.D., clinical assistant professor

Children with end stage kidney disease are at high risk for cardiovascular morbidities. Indicators of systolic function, such as ejection fraction and fractional shortening, are often preserved and may not reveal cardiac dysfunction until it is severe. Longitudinal changes in diastolic function and cardiac geometry have not been well studied.

Additional Children’s National staff involved in the study include:

COVID19 in pediatric kidney transplant recipients: Incidence, outcomes, and response to vaccine

Presenter: Asha Moudgil, M.D., medical director, Kidney Transplant

At the start of the pandemic, no information was available on the outcomes of pediatric kidney transplant recipients with COVID-19. When the COVID-19 vaccine became available, response of immunosuppressed children to the vaccine was not known. While more information has become available in adult transplant recipients, information on pediatric transplant recipients remains limited.

The team will discuss their methodology of collecting information and their results and conclusions.

Additional Children’s National staff involved in the study include:

Poster presentation: Psychological functioning and adaptive behavior in pediatric patients awaiting renal transplantation.

Presenter: Kaushal Amatya, Ph.D., psychologist

Psychosocial functioning of children with chronic kidney disease (CKD) at pretransplant evaluation is associated with transplant readiness and post-transplant outcomes. Higher prevalence of emotional/behavioral issues is noted in children with CKD compared to healthy counterparts. Although issues with functional impairment is often reported, research on adaptive functioning using a validated measure is lacking. The study aimed to explore psychological and adaptive functioning in pediatric pre-transplant patients to identify areas in need of intervention.

Additional Children’s National staff involved in the study include:

  • Asha Moudgil, M.D., medical director, Kidney Transplant
  • Paige Johnson, Psychology resident

 

Marva Moxey Mims

Tackling bias – the power of one

Marva Moxey MimsIn the most recent edition of the American Society of Pediatric Nephrology’s Kidney Notes, Children’s National Hospital Chief of Nephrology, Marva Moxey-Mims, M.D., wrote a perspective piece asking other providers to join her in an effort to see patients as a whole person and try to put aside personal biases, thereby improving overall patient care.

In this personal commentary, Dr. Moxey-Mims reflects on challenging herself to better serve patients by making sure they feel seen and to understand them. “Just think of the ripple effect if we can do this with even a fraction of our patients,” said Dr. Moxey-Mims. “The goodwill that patients will feel knowing that we are trying to see them is immeasurable.”

You can read the entire article “Tackling Bias – The Power of One” here.

urine sample

Approaches to nephrotic syndrome and proteinuria

urine sample

Nephrologist Melissa Meyers, M.D., recently gave a Lunch and Learn presentation at Children’s National titled, “Urine the Know: General Pediatricians’ Approach to Nephrotic Syndrome and Proteinuria.”

Melissa Meyers, M.D., a nephrologist at Children’s National Hospital, recently gave a Lunch and Learn presentation at Children’s National titled, “Urine the Know: General Pediatricians’ Approach to Nephrotic Syndrome and Proteinuria.”

During the virtual presentation, Dr. Meyers detailed the definitions of proteinuria and nephrotic syndrome and discussed methods used to screen, test and manage the disorders.

She ended with a question-and-answer segment, which included a series of scenarios pediatricians may encounter while diagnosing and treating patients with the conditions.

The full presentation can be viewed here.

Dr. Meyers is a pediatric nephrologist with 10 years’ experience caring for children. She is passionate about kidney health and providing comprehensive medical care to her patients and their families.

colored illustration of kidney x-ray

Partnership with CMS and HRSA addresses national kidney shortage

colored illustration of kidney x-ray

Children’s National Hospital is proud to announce that it is participating in the Centers for Medicare & Medicaid Services (CMS) and Health Resources & Services Administration (HRSA)’s new End-Stage Renal Disease Treatment Choices Learning Collaborative (ETCLC). This effort will focus on addressing kidney disease prevention and treatment, including improved access to kidney transplants in the United States.

The ETCLC will engage transplant centers, Organ Procurement Organizations (OPOs), large donor hospitals, patients and donor family members to identify highly effective practices currently in use and spread the use of these practices throughout the organ procurement, kidney care and kidney transplant community to achieve the following three AIMs:

  • AIM #1: Increase the number of deceased donor kidneys transplanted
  • AIM #2: Decrease the current national discard rate of all procured kidneys
  • AIM #3: Increase the percentage of change for kidneys recovered for transplant in the 60-85 Kidney Donor Profile Index score group

The ETCLC brings the potential for collaboration, communication and innovation across geography into reality. By participating in the ETCLC, Children’s National will benefit by:

  • the creation of efficiencies and reduction of duplicative efforts in kidney patient care
  • exposure to new, innovative ideas regarding the kidney transplant process
  • the enhancement of communication and relationship building within the kidney care community
  • the application of substantive changes to improve the donation and transplantation system
cystic kidney disease

American Heart Association grant funds study of vascular complications in ADPKD

cystic kidney disease

Ashima Gulati, M.D., Ph.D., pediatric nephrologist at Children’s National Hospital recently was awarded a grant from the American Heart Association. Dr. Gulati’s work will aim to identify the genetic determinants of vascular complications in autosomal dominant polycystic kidney disease (ADPKD).

Cerebrovascular complications such as vascular aneurysms and anomalies are an important cause of morbidity in ADPKD that need to be studied. The goal of Dr. Gulati’s research is to contribute to knowledge towards using molecular medicine to inform individual genetic risk of clinically significant vascular complications in ADPKD.

This work addresses a clinically significant vascular complication in ADPKD, the most common inherited form of kidney failure world-wide.

Denver Brown

New grant to conduct single center pilot trial of alkali therapy in children with CKD

Denver Brown

Denver D. Brown, M.D., recipient of the Child Health Research Career Development Award.

Linear growth (i.e., height) impairment is commonly observed in children with chronic kidney disease (CKD). Several studies have suggested metabolic acidosis, a frequent consequence of mild to moderate CKD in children, as a contributing factor to linear growth failure in these patients. Grant awardee Denver D. Brown, M.D., aims to conduct a pilot trial in children with mild metabolic acidosis and CKD, comparing differences in linear growth between an observation period versus a period of supplementation with alkali therapy (i.e., treatment for metabolic acidosis).

“This grant is so important because there has never been a clinical trial of alkali therapy in children with CKD despite its frequent use in this population” says Dr. Brown. “This research has the potential to better inform treatment practices with the aim of improving the care of our young, vulnerable patients.”

The Child Health Research Career Development Award (CHRCDA) of $125,000 will support Dr. Brown in her efforts to carry out this pilot trial.

“Funding for this pilot study could lay the groundwork for a large, randomized controlled clinical trial, which would help fill a major gap in knowledge as to the precise benefits of alkali therapy, especially regarding growth in children with impaired kidney function.”

colored x-ray showing kidneys and spine

New report advances improved way to diagnose kidney disease

colored x-ray showing kidneys and spine

The findings outline a new race-free approach to diagnose kidney disease, recommending the adoption of the new eGFR 2021 CKD EPI creatinine equation.

Patients with kidney disease will benefit from an improved approach, according to a new report.

The findings outline a new race-free approach to diagnose kidney disease, recommending the adoption of the new eGFR 2021 CKD EPI creatinine equation. This calculation estimates kidney function without a race variable. The report also recommends increased use of cystatin C combined with serum creatinine as a confirmatory assessment of eGFR or kidney function.

The effort is being spearheaded by a team of national nephrology experts that includes Marva Moxey-Mims, M.D., chief of the Division of Nephrology at Children’s National Hospital.

“This final report is important in recommending a uniform approach to the calculation of eGFR without the inclusion of race,” Dr. Moxey-Mims says. “This will avoid a piecemeal approach where eGFR is calculated differently at different health care facilities, potentially causing confusion.”

The final report, published in the American Journal of Kidney Diseases and the Journal of the American Society of Nephrology, was drafted with considerable input from hundreds of patients, family members, medical students, clinicians, scientists, health professionals and other stakeholders. This will help achieve consensus for an unbiased and most reasonably accurate estimation of GFR so that laboratories, clinicians, patients and public health officials can make informed decisions to ensure equity and personalized care for patients with kidney diseases.

“Patients, professionals and other stakeholders can have confidence in this estimate that is relying solely on biologic measures. Hopefully, these can evolve even further as the science progresses,” Dr. Moxey-Mims says. “My hope is that health systems and labs will adopt these changes expeditiously.”

US News badges

For fifth year in a row, Children’s National Hospital nationally ranked a top 10 children’s hospital

US News badges

Children’s National Hospital in Washington, D.C., was ranked in the top 10 nationally in the U.S. News & World Report 2021-22 Best Children’s Hospitals annual rankings. This marks the fifth straight year Children’s National has made the Honor Roll list, which ranks the top 10 children’s hospitals nationwide. In addition, its neonatology program, which provides newborn intensive care, ranked No.1 among all children’s hospitals for the fifth year in a row.

For the eleventh straight year, Children’s National also ranked in all 10 specialty services, with seven specialties ranked in the top 10.

“It is always spectacular to be named one of the nation’s best children’s hospitals, but this year more than ever,” says Kurt Newman, M.D., president and CEO of Children’s National. “Every member of our organization helped us achieve this level of excellence, and they did it while sacrificing so much in order to help our country respond to and recover from the COVID-19 pandemic.”

“When choosing a hospital for a sick child, many parents want specialized expertise, convenience and caring medical professionals,” said Ben Harder, chief of health analysis and managing editor at U.S. News. “The Best Children’s Hospitals rankings have always highlighted hospitals that excel in specialized care. As the pandemic continues to affect travel, finding high-quality care close to home has never been more important.”

The annual rankings are the most comprehensive source of quality-related information on U.S. pediatric hospitals. The rankings recognize the nation’s top 50 pediatric hospitals based on a scoring system developed by U.S. News. The top 10 scorers are awarded a distinction called the Honor Roll.

The bulk of the score for each specialty service is based on quality and outcomes data. The process includes a survey of relevant specialists across the country, who are asked to list hospitals they believe provide the best care for patients with the most complex conditions.

Below are links to the seven Children’s National specialty services that U.S. News ranked in the top 10 nationally:

The other three specialties ranked among the top 50 were cardiology and heart surgery, gastroenterology and gastro-intestinal surgery, and urology.

plate of food

Looking back one year later – Keeping it Renal: Global Cuisine for Kids

plate of food

The cookbook introduces a variety of culturally diverse kidney-friendly recipes that kids of all ages love.

It has been one year since the Children’s National Hospital Department of Nephrology released their cookbook “Keeping it Renal: Global Cuisine for Kids” and we are still receiving requests for this collection of recipes. In order to stay healthy, most children with kidney disease have to limit or avoid foods that are high in certain minerals including sodium, potassium and phosphorus. “Children on dialysis have to give up a lot of what they like to eat. This cookbook introduces a variety of culturally diverse kidney-friendly recipes that kids of all ages love. By learning to cook these recipes, our patients can take an active role in their own healthcare and learn some fun new skills,” said Kristen Sgambat, Ph.D., R.D., and Asha Moudgil, M.D., medical director of transplant.

It is often challenging for children and their families to balance these dietary restrictions with proper nutrition and enjoyable mealtimes. “This cookbook offers novel and exciting recipes that patients and families may not be aware of. Seeing these options can help patients see that a renal diet does not have to be bland or repetitive and thus improve patients’ outlook on treatment and motivate them to adhere to the dietary restrictions,” said Kaushalendra Amatya, Ph.D., pediatric psychologist for Nephrology and Cardiology at Children’s National.

As an innovative way to facilitate adherence to these limitations, our nephrology department collaborated with our patient families to create the cookbook “Keeping it Renal: Global Cuisine for Kids,” a compilation of their favorite kidney-friendly recipes.

Children’s National is one of the top pediatric hospitals in NIH funding, and our nephrology program ranks number 7 in the country, according to U.S. News & World Report. The Kidney Transplantation Program is the only one of its kind in the Washington, D.C., area focused on the needs of children and teens with kidney disease. Committed to providing the best quality care to all of our pediatric dialysis and transplant patients, we are always looking for new ways to support our patient families.

If you would like to receive a copy of the Keeping it Renal: Global Cuisine for Kids cookbook, please send your request to: emorrow@childrensnational.org.

 

Denver Brown, M.D., and Celina Brunson, M.D.

Children’s National expands its nationally ranked nephrology division

Children’s National Hospital has added five physicians to its nationally ranked Nephrology Division. Denver Brown, M.D., Celina Brunson, M.D., Ashima Gulati, M.D., Melissa Meyers, M.D., Catherine Park, M.D., all have joined the department over a span of the past two years.

“These physicians are incredible additions to our nephrology division,” said Marva Moxey-Mims, M.D., chief of the Division of Nephrology at Children’s National. “We are excited about the expertise these young physicians already contribute to our division and can’t wait to share more as we continue to expand our efforts as one of the top nephrology programs in the country. We are elated to have them on our team.”

Each of the new faculty members has specific areas of clinical and research interests. Dr. Brown’s focus is chronic kidney disease (CKD) and the impact of acidosis on growth and disease progression. Dr. Brunson’s interest is dialysis, health disparities and social determinants of health for children with CKD. She is a JELF Advocacy scholar through the American Society of Nephrology. Dr. Gulati is an expert in inherited kidney diseases with a particular focus on polycystic kidney disease for which she has external grant support. Dr. Meyers’ interest is kidney transplantation and Dr. Park, our newest addition, is interested in systemic inflammatory diseases, especially lupus nephritis.

The nephrology team will continue to provide comprehensive inpatient and outpatient care to children throughout the full spectrum of kidney diseases.

Denver Brown, M.D., Celina Brunson, M.D., Ashima Gulati, M.D., Melissa Meyers, M.D., Catherine Park, M.D.

Denver Brown, M.D., Celina Brunson, M.D., Ashima Gulati, M.D., Melissa Meyers, M.D. and Catherine Park, M.D., recently joined the nephrology division.

High magnification micrograph of focal segmental glomerulosclerosis

Reducing urinary protein for patients with FSGS slows kidney decline

High magnification micrograph of focal segmental glomerulosclerosis

High magnification micrograph of focal segmental glomerulosclerosis (FSGS).

Reducing the amount of protein in the urine of patients with focal segmental glomerulosclerosis (FSGS), a rare disease in which scar tissue forms on the parts of the kidneys that filter waste from the blood, can significantly slow declines in kidney function and extend time before patients’ kidneys fail, a new analysis by a Children’s National Hospital researcher and her colleagues shows. These findings, published online Aug. 10, 2020, in the American Journal of Kidney Disease, could provide hope for patients who are able to lower their urinary protein with available treatments but aren’t able to achieve complete remission, the researchers say.

FSGS affects about seven per every million people in the general population. However, in the United States, it’s responsible for between 5 and 20% of all cases of end stage kidney disease (ESKD), a condition in which the kidney function declines enough that patients can’t survive without dialysis or a kidney transplant. There are no proven treatments specifically targeting FSGS, but steroids and other immunosuppressants have shown promise in clinical trials.

One characteristic sign of FSGS is proteinuria, in which too much protein is present in patients’ urine. Most clinical trials of FSGS treatments have focused on complete remission of proteinuria as a sign that the intervention is working. However, says Marva Moxey-Mims, M.D., researcher and chief of the Children’s National Division of Nephrology, only a fraction of patients meet that end goal. Instead, many patients achieve some reduction in proteinuria, but it’s been unclear whether those reductions lead to significant benefits for kidney health.

To investigate this question, Dr. Moxey-Mims and her colleagues used data from the National Institutes of Health-funded FSGS clinical trial that took place between November 2004 and May 2008. Participants in this study — 138 patients who developed proteinuria due to FSGS between the ages of 2 and 40 and didn’t respond to steroids — received one of two different immunosuppressant regimens. They received frequent checkups including urinary protein tests during the duration of the study and were followed for a maximum of 54 months.

Results showed that about 49% of the study participants’ proteinuria improved by 26 weeks of treatment on either regimen. More importantly, says Dr. Moxey-Mims, these patients retained significantly better kidney function over time, determined by a test called estimated glomerular filtration rate (eGFR), compared to those whose urinary protein remained high. The greater the reduction in proteinuria, the better their kidney function remained, and the longer their kidneys remained active before they developed ESKD.

“Even a modest reduction in proteinuria, as small as 20 or 30%, had an impact on these patients’ kidney health,” Dr. Moxey-Mims says.

Dr. Moxey-Mims notes that the finding could impact the design of clinical trials for FSGS treatments. Currently, these trials typically must include large numbers of patients to show a benefit if complete remission of proteinuria — which only occurred in about 20% of patients in the National Institute of Diabetes and Digestive and Kidney Diseases trial — is used as the end point.

If researchers use a range of proteinuria reduction as end points, she says, it could be easier to see if a drug or other intervention is working.

Similarly, she says, patients with FSGS and their doctors should view any proteinuria reduction as a positive.

“They shouldn’t be discouraged if they can’t reach full remission,” Dr. Moxey-Mims says. “Doctors and patients alike can feel reassured that if they’re reducing protein in the urine to some degree, then patients are getting some benefit.”

 

cystic kidney disease

NIH $4 million grant funds new core center for childhood cystic kidney disease

cystic kidney disease

The University of Alabama at Birmingham (UAB), in collaboration with Children’s National Hospital has received a five-year, $4 million grant from the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health (NIH) to create a core center for childhood cystic kidney disease (CCKDCC). The UAB-CCKDCC will conduct and facilitate research into the causes of and possible treatments for cystic kidney diseases, particularly those that present in childhood.

The UAB/Children’s National grant is a U54 center grant, an NIH funding mechanism to develop a multidisciplinary attack on a specific disease entity or biomedical problem area. With this grant, UAB joins with investigators at the University of Kansas and the University of Maryland-Baltimore as part of the NIH Polycystic Kidney Disease Research Resource Consortium. The NIH describes the consortium as a framework for effective collaboration to develop and share research resources, core services and expertise to support innovation in research related to polycystic kidney disease.

“Infants with childhood cystic kidney disease may develop kidney failure within a few years after birth and some need dialysis and kidney transplantation before they reach adulthood,” said Lisa Guay-Woodford, M.D., director of the Clinical and Translational Science Institute at Children’s National and co-director of the UAB-CCKDCC. “In many cases, the earlier the onset of symptoms, the more severe the outcome.”

“The intent is to accelerate the science and advance research into new therapies for cystic kidney disease through enhanced sharing of resources and the establishment of a robust research community,” said Bradley K. Yoder, Ph.D., professor and chair of the UAB Department of Cell, Developmental and Integrative Biology and co-director of the UAB-CCKDCC. “Childhood polycystic disease can be a devastating condition for children and their families.”

The UAB-CCKDCC will focus primarily on childhood polycystic kidney disease, a condition that affects about one in 20,000 infants in the United States. The center’s primary goals are:

  • Provide the Polycystic Kidney Disease Research Resource Consortium members with access to phenotypic, genetic and clinical information and biomaterials from CCKD patients
  • Analyze pathways involved in cyst pathogenesis through the generation of verified genetic model systems and biosensor/reporter systems
  • Assess the impact of patient variants on cystic disease proteins through generation and validation of innovative models
  • Provide ready access to biological materials from genetic CCKD models
  • Develop efficient pipelines for in vitro and in vivo preclinical testing of therapeutic compounds

Dr. Guay-Woodford is an internationally recognized pediatric nephrologist with a research program focused on identifying clinical and genetic factors involved in the pathogenesis of inherited renal disorders, most notably autosomal recessive polycystic kidney disease (ARPKD). Her laboratory has identified the disease-causing genes in several experimental models of recessive polycystic kidney disease and her group participated in the identification of the human ARPKD gene as part of an international consortium. In addition, her laboratory was the first to identify a candidate modifier gene for recessive polycystic kidney disease. For her contributions to the field, she was awarded the Lillian Jean Kaplan International Prize for Advancement in the Understanding of Polycystic Kidney Disease, given by the Polycystic Kidney Disease Foundation and the International Society of Nephrology.

Nephrology at Children's National

2020 at a glance: Nephrology at Children’s National

The Children’s National Division of Nephrology is consistently recognized by U.S. News & World Report as one of the top programs in the nation.

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Children’s National ranked a top 10 children’s hospital and No. 1 in newborn care nationally by U.S. News

US News Badges

Children’s National Hospital in Washington, D.C., was ranked No. 7 nationally in the U.S. News & World Report 2020-21 Best Children’s Hospitals annual rankings. This marks the fourth straight year Children’s National has made the list, which ranks the top 10 children’s hospitals nationwide.

In addition, its neonatology program, which provides newborn intensive care, ranked No.1 among all children’s hospitals for the fourth year in a row.

For the tenth straight year, Children’s National also ranked in all 10 specialty services, with seven specialties ranked in the top 10.

“Our number one goal is to provide the best care possible to children. Being recognized by U.S. News as one of the best hospitals reflects the strength that comes from putting children and their families first, and we are truly honored,” says Kurt Newman, M.D., president and CEO of Children’s National Hospital.

“This year, the news is especially meaningful, because our teams — like those at hospitals across the country — faced enormous challenges and worked heroically through a global pandemic to deliver excellent care.”

“Even in the midst of a pandemic, children have healthcare needs ranging from routine vaccinations to life-saving surgery and chemotherapy,” said Ben Harder, managing editor and chief of Health Analysis at U.S. News. “The Best Children’s Hospitals rankings are designed to help parents find quality medical care for a sick child and inform families’ conversations with pediatricians.”

The annual rankings are the most comprehensive source of quality-related information on U.S. pediatric hospitals. The rankings recognize the nation’s top 50 pediatric hospitals based on a scoring system developed by U.S. News. The top 10 scorers are awarded a distinction called the Honor Roll.

The bulk of the score for each specialty service is based on quality and outcomes data. The process includes a survey of relevant specialists across the country, who are asked to list hospitals they believe provide the best care for patients with the most complex conditions.

Below are links to the seven Children’s National specialty services that U.S. News ranked in the top 10 nationally:

The other three specialties ranked among the top 50 were cardiology and heart surgery, gastroenterology and gastro-intestinal surgery, and urology.

cooking in the kitchen

Keeping it Renal: Global Cuisine for Kids

cooking in the kitchen

Children with kidney disease have very special diet and nutrition needs. In order to stay healthy, most children with kidney disease have to limit or avoid foods that are high in certain minerals including sodium, potassium and phosphorus. It is often challenging for children and their families to balance following these diet restrictions with getting proper nutrition and enjoying meal times.

As an innovative way to facilitate adherence to these limitations, our nephrology department collaborated with our patient families to create a cookbook “Keeping it Renal: Global Cuisine for Kids,” a compilation of their favorite kidney-friendly recipes.

Children’s National is one of the top pediatric hospitals in NIH funding, and our nephrology program ranks number 6 in the country, according to U.S. News & World Report. The Kidney Transplantation Program is the only one of its kind in the Washington, D.C. area focused on the needs of children and teens with kidney disease. Committed to providing the best quality care to all of our pediatric transplant patients, we are always looking for new ways to support our patient families.

If you would like to receive a copy of the Keeping it Renal: Global Cuisine for Kids cookbook, please send your request via email to: emorrow@childrensnational.org.