Update in Pediatric Nephrology

Chapter

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 more rational therapeutics with immunosuppressant medications and rapidly expanding treatment options. With refined therapeutics, increasing survival of chronic illnesses, and technological advances in hospital and critical care medicine also come the 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-morbid conditions. 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 the genotype-phenotype associations underlying many pediatric kidney disorders and already have started to transform routine clinical management. Despite these impressive advances much work remains to be done, with the hope for progress to tailor therapies to individual patients based on their underlying molecular genetics in the coming era of personalized medicine.

Keywords

Pediatric nephrology urinary tract infection Vesicoureteral reflux IgA nephropathy Post-streptococcal glomerulonephritis Henoch-Schonlein Purpura acute kidney injury hypertension chronic kidney disease nephrolithiasis 

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Section of Pediatric Nephrology, Department of PediatricsUniversity of Missouri – Kansas City School of Medicine, Children’s Mercy Hospital and ClinicsKansas CityUSA
  2. 2.Division of Nephrology, Department of Pediatrics, McGill University Health CenterMontreal Children’s HospitalQCCanada

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