The future of pediatric nephrology

Abstract

The delineation of renal disease in children dates to the 1880s with descriptions of Henoch's purpura, bladder exstrophy, renal rickets and nephritis. The discipline of pediatric nephrology mainly emerged during the 20th century in response to problems in fluid and electrolyte balance, characterization of the nephrotic syndrome, use of renal biopsy, antibiotic therapy of urinary tract infections, dialysis and transplantation in children, growth problems associated with chronic renal failure, detection and therapy of hypertension, and the creation of both national and international pediatric nephrology societies and a journal now in its 18th year. The development of molecular and cell biology, genetic and genomic techniques and bioinformatics methods underlie many future directions. We should anticipate further elucidation of single gene disorders, of complex trait analysis of disorders, such as diabetic nephropathy and hypertension, the interplay of developmental genes and gene products and interactions within the podocyte. Specific therapies directed against inflammation, vascular damage, cyst development, the ravages of proteinuria and graft rejection (or induction leading to tolerance) will be developed. Stem cell therapies may replace lost renal mass, even of specific nephron sites. Novel therapies will also modulate the cell cycle, tyrosine kinase signaling and apoptosis. In addition, drugs will be specifically tested in children for many renal conditions. Larger and more specialized registries will be developed; epidemiologic studies and exploration of large data sets will lead to clinical guidelines that are evidenced-based. There is a need for more careful measurement of glomerular filtration rate (GFR), proteinuria and cytokines, and a fuller appreciation of the nutritional and hormonal role of the kidney. Finally, the antecedents of adult renal disease and the need to intervene in a proactive fashion will be realized. Despite these impressive advances in care, the greatest challenges will be in providing children with renal disease access to well-trained pediatric nephrologists, especially in Asia (1 billion children), Africa, Central and South America, and in immigrant and refugee populations. Included in this challenge is the capacity to have affordable access to use of contemporary techniques, and effective medications and prevention strategies. The International Pediatric Nephrology Association (IPNA), its journal, and pediatric advocates will need to use their energies to take on these challenges.

Report of an NIH task force on research priorities in chronic kidney disease in children

“…More information is needed about how socioeconomic factors influence the progression and treatment of CRI in children [35], and the database is currently not equipped to answer this question. Much is known about growth and developmental retardation in children with CRI, but not about why current treatments seem incomplete.…”

Análisis descriptivo de la consulta externa de nefrología pediátrica en el Hospital Universitario Hernando Moncaleano Perdoma de Neiva

“…Entendiendo todas las limitaciones del estudio, creemos que la muestra es representativa de la morbilidad de la patología renal en la población pediátrica del Huila y el conocerla nos permitirá estructurar programas de prevención, seguimiento y tratamiento de dichas patologías para lograr una mejor calidad de vida de nuestros niños, así como el diagnóstico precoz y detección temprana de la enfermedad renal crónica y de esta manera evitar su progresión (10) . Esperamos continuar con dicho registro y de esta manera poder enriquecer la información que nos permita poder tener una visión más cercana a nuestra realidad.…”

Implementation of pediatric nephrology in a Sub-Saharan African setting: the case of Cotonou, Benin

“…Consequently, a high standard has been achieved in the care of children with kidney disease (KD) [1]. In contrast, pediatric nephrology as a medical sub-speciality has yet to be developed in Africa, especially in Sub-Saharan Africa where pediatric nephrologists are very few, thereby hampering the appropriate diagnosis and medical care of children with KD [2].…”