Background Growth failure is common among children with chronic kidney disease (CKD). We examined the relationship of growth parameters with glomerular filtration rate (GFR), CKD diagnosis, sex, and laboratory results in children with CKD. Methods Baseline data from 799 children (median age 11.0 years, median GFR 49.9 mL/min/1.73m2) participating in the Chronic Kidney Disease in Children Study were examined. Growth was quantified by age-sex-specific height, weight, body mass index (BMI-age), and height-age-sex-specific BMI (BMI-height-age) standard deviation scores (SDS). Results Median height and weight SDS were -0.55 (Inter-quartile Range (IQR): -1.35 to 0.19) and 0.03 (IQR: -0.82 to 0.97), respectively. Girls with non-glomerular CKD were the shortest (median height SDS -0.83 [IQR: -1.62, -0.02]). Compared to those with serum bicarbonate (CO2) ≥22 mEq/L, children with CO2<18 mEq/L had height SDS that was on average 0.67 lower (95% Confidence Interval (CI): -1.03 to -0.31). Only 23% of children with height SDS≤ -1.88 were prescribed growth hormone therapy. Forty-six and 32 percent of children with glomerular and non-glomerular CKD were overweight or obese (BMI-height-age ≥ 85th percentile). Conclusions Growth outcomes in a contemporary cohort of children with CKD remain suboptimal. Interventions targeting metabolic acidosis and overcoming barriers to rhGH usage may improve growth in this population.

EBV-SMT are a rare entity following organ transplantation. Given the rarity of the tumor, there is no standard approach to diagnosis and treatment. A literature search identified 28 reported cases of EBV-SMT in addition to our own experience with one case. The aim of this review is to summarize the existing data regarding pathogenesis, diagnosis, and treatment.

A retrospective chart review of 40 patients with sickle cell anemia (SCA) between the ages of 5-19 years who were seen within a 1-year period was performed to determine clinical and laboratory correlates for microalbuminuria and proteinuria. Age, sex, height, body mass index (BMI), serum creatinine [and estimated glomerular filtration rate (eGFR) by Schwartz and MDRD formulas], type of SCA, hemoglobin (Hb) level [total Hb and hemoglobin F percentage (HbF%)], lactate dehydrogenase (LDH) level, reticulocyte count, blood pressure, history of splenectomy, history of hydroxyurea use, and history of transfusions were correlated with microalbuminuria and proteinuria by univariate and multivariate regression analysis. The prevalence of microalbuminuria and proteinuria among these patients was 15 and 5%, respectively. Univariate analyses revealed a significant correlation between LDH level and microalbuminuria (Pearson r=0.47, p=0.04) and between LDH level and proteinuria (Pearson r=0.48, p=0.035). Multivariate analysis revealed a significant correlation between microalbuminuria and LDH level (p = 0.04) when controlled for age, sex, eGFR, Hb level, HbF%, type of SCA, BMI, history of transfusions, and reticulocyte count. In this pediatric SCA population, LDH was found to correlate with the presence of microalbuminuria and proteinuria. Further studies are needed to confirm LDH as an early marker for the risk of kidney involvement among SCA patients.

SummaryBackground and objectives Poor linear growth is a well described complication of chronic kidney disease (CKD). This study evaluated whether abnormal birth history defined by low birth weight (LBW; Ͻ2500 g), prematurity (gestational age Ͻ36 weeks), small for gestational age (SGA; birth weight Ͻ10th percentile for gestational age), or intensive care unit (ICU) at birth were risk factors for poor growth outcomes in children with CKD.Design, setting, participants, & measurements Growth outcomes were quantified by age-sex-specific height and weight z-scores during 1393 visits from 426 participants of the Chronic Kidney Disease in Children Study, an observational cohort of children with CKD. Median baseline GFR was 42.9 ml/min per 1.73 m 2 , 21% had a glomerular diagnosis, and 52% had CKD for Ն90% of their lifetime.Results A high prevalence of LBW (17%), SGA (14%), prematurity (12%), and ICU after delivery (40%) was observed. Multivariate analyses demonstrated a negative effect of LBW (Ϫ0.43 Ϯ 0.14; P Ͻ 0.01 for height and Ϫ0.37 Ϯ 0.16; P ϭ 0.02 for weight) and of SGA (Ϫ0.29 Ϯ 0.16; P ϭ 0.07 for height and Ϫ0.41 Ϯ 0.19; P ϭ 0.03 for weight) on current height and weight. In children with glomerular versus nonglomerular diagnoses, the effect of SGA (Ϫ1.08 versus Ϫ0.18; P ϭ 0.029) on attained weight was more pronounced in children with a glomerular diagnosis.Conclusions LBW and SGA are novel risk factors for short stature and lower weight percentiles in children with mild to moderate CKD independent of kidney function.

Microarrays might be an important tool to uncover the mechanisms of multifactorial diseases, such as CAN.