Update in Pediatric Nephrology

Abstract

Pediatric nephrology has rapidly evolved over the last several decades, with major advances in the pathophysiology, genetics, diagnosis, and treatment of children with kidney diseases. In the post-vaccination era urinary tract infections have become an important cause of serious bacterial infection in childhood, and children with underlying congenital abnormalities of the kidney and urological tract (CAKUT), including those with vesicoureteral reflux, are known to be a high-risk group. Recent controversies on the appropriate diagnostic workup of children with febrile UTIs and the decision to prescribe long-term antibiotic prophylaxis in the changing landscape of increased antimicrobial resistance have sparked a lively debate in the medical community on appropriate management strategies. Improved understanding of the molecular mechanisms and genetic risk factors underlying glomerulonephritis have resulted in rational therapeutic designs with targeted immunosuppressant medications and rapidly expanding “personalized” treatment options. With refined therapeutics, increasing survival of patients with chronic illnesses, and technological advances in hospital and critical care medicine comes a growing awareness of the increased risk of acute kidney injury in hospitalized children. The economic and social burden of chronic kidney disease remains substantial in children, although much progress has been made in identifying factors associated with CKD progression and better management of various co-morbidities. The epidemiology, diagnosis, and management of childhood hypertension has changed greatly in the last decade, in part fueled by the rising obesity epidemic. Some of the most exciting recent breakthroughs in pediatric nephrology have been in the genetics of kidney development and disease. Emerging tools of next generation sequencing and whole exome sequencing have revolutionized the understanding of genotype-phenotype associations underlying many pediatric kidney disorders and already have started to transform clinical management. Despite these impressive advances much work remains to be done to tailor therapies to individual patients based on refined, individual genetic and molecular diagnoses in the coming era of personalized medicine.