1. World Kidney Day 2016: Kidney Disease & Children
World Kidney Day 2016: Kidney Disease & Children. Act Early to Prevent It!

2. World Kidney Day 2016: Kidney Disease & Children
World Kidney Day 2016: Kidney Disease & Children. Act Early to Prevent It!
Kidney disease affects millions of people worldwide, including many children who may be at risk at an early age. It is therefore crucial that we encourage and facilitate education, early detection and a healthy life style in children, to fight the increase of preventable kidney diseases and to treat children with inborn and acquired disorders of the kidneys worldwide.

3. Pediatric Kidney Disease – An Update
Edited by the ASPN Clinical Affairs Committee

4. Glomerulonephritis (GN)
Juan Kupferman, MD
Albert Einstein School of Medicine

5. GN: Background
GN is an important cause of morbidity and mortality in patients of all ages
GN is characterized by glomerular injury and inflammation
GN is defined by the presence of some or all of these clinico-biochemical characteristics
Hematuria (always present)
Proteinuria
Edema
Hypertension
Most cases are due to an immunologic response to a variety of etiologic agents
Normal glomerulus
Acute glomerulonephritis

6. GN: Background
GN has multiple etiologies and could be primary (affecting only the kidneys) or secondary to a systemic disease
Most common:
Post-Streptococcal GN (PSGN)
IgA nephropathy (IgAN)
Henoch-Schonlein purpura (HSP)
Systemic lupus erythematosis (SLE)

7. GN: Background
Acute post-Streptococcal GN is the most common glomerulonephritis in childhood
Typically with low complement C3 and evidence of recent Streptococcal infection
Other microorganisms can cause similar findings
IgA nephropathy typically presents with recurrent episodes of gross hematuria
Complement is normal
Normal capillary loop (EM)
Post-Streptococcal GN (EM)

8. GN: Background
Henoch-Schonlein purpura nephritis occurs during or after resolution of the acute disease
Similar renal histologic findings to IgA nephropathy
Systemic lupus erythematosus can cause focal to diffuse proliferative kidney disease
ANA is positive and complements C3 and C4 may be decreased

9. GN: Treatment Specific therapy depends on etiology Treatment goals
Reduce glomerular inflammation
Induce and maintain remission of proteinuria
Improve kidney function, if decreased
Control complications due to fluid retention (i.e. hypertension, edema)
Therapeutic agents include
Antiproteinuric agents (ACE inhibitors or ARBs)
Fish oil (in IgA nephropathy)
Steroids
Immunosuppresive agents
Cyclophosphamide
Mycophenolate mofetil
Rituximab
Plasmapheresis

10. GN: New developments
Hematuria could be a risk factor for chronic kidney disease progression in glomerular diseases
-Moreno et al. Hematuria. Pediatr Nephrol 2015
Urine biomarkers, such as monocyte chemoattractant protein-1/CCL2 and neutrophil gelatinase-associated lipocalin, may be useful tools in the assessment of disease activity in lupus nephritis
-Abulaban et al. Biomarkers. Curr Rheumatol Rep 2015

11. GN: Summary
Characterized by glomerular injury and inflammation, often due to an immunologic response to a variety of etiologic agents
There are a variety of immunomodulator therapies that must be tailored to the specific etiology
Novel biomarkers and medications are being developed to enhance our ability to diagnose, predict prognosis, and treat.
References:
KDIGO guidelines at
Henderson et al. Lupus nephritis 2012
Vecchio et al. IgA nephropathy. Cochrane Database Syst Rev 2015
Moreno et al. Hematuria. Pediatr Nephrol 2015
Abulaban et al. Biomarkers. Curr Rheumatol Rep 2015
Niaudet. Glomerulonephritis. Uptodate 2016
Walters. ANCA vasculitis. Pediatr Nephrol 2016

12. Happy World Kidney Day 2016!
Your pediatric nephrology community continues to work hard to improve clinical care, foster education, and advance the science regarding kidney disease in children! We appreciate your support and all you do for children’s health care!