Grand Rounds in Pediatric Nephrology
Recorded On: 05/03/2021
-
Register
- Member - Free!
- Subscriber - Free!
Already registered?
Log in now.
- A tale of two pathologies: Rapidly Progressive Glomerulonephritis and Acute Tubulointerstitial Nephritis
- Nephropathic Cystinosis: How to Diagnose and Treat
- Make the Peritoneal Membrane Work for You
- Approach to Infantile Hypercalcemia
- Pediatric Renal Genetics: New Advances
- Management of Renal Bone Disease
- Resistant Hypertension in Children on Dialysis
- C3 Glomerulonephritis and Dense Deposit Disease – A Tale of Two Twins
- Immunosuppression vs post-transplant viral infections: Walking a fine line
- A Challenging Case of Nephrotic Syndrome
- The Spectrum of Alport Syndrome: Who and how to investigate?
- Renal amyloidosis presenting as glucocorticoid resistant nephrotic syndrome
- Approach to Treating Lupus Nephritis in Children
- All Cysts Are Not Equal
- Diagnosis and Management of the Child with Atypical Peritonitis
- Let T(r)ooth Be Told…
- The Value of renal biopsy and its technicalities – get the most from the sample!
- Management of a Child with Posterior Urethral Valves
Rukshana Shroff
UK
Neha Bhongale
India
Jyoti Sharma
India
John Mahan
USA
Sukanya Govindan
India
Oluseyi Oniyangi
Nigeria
Gabriel Obiorah Ezeh
Nigeria
Shaegan Irusen
South Africa
Priya Pais
India
Dept of Pediatric Nephrology,St John's National Academy of Health Sciences, Bangalore, India
Soumya Reddy
India
Paul Goodyer
Canada
Elena Levtchenko
Belgium
Larisa Prikhodina
Russia
Svetlana Papizh
Russia
Felicia Eke
Nigeria
Ifeoma Anochie
Nigeria
Frederick Kaskel
USA
James Pullman
USA
Kimberly Reidy
USA
Nicole Hayde
USA
Pooja G N
India
Marcelo Orias
USA
Indira Agarwal
India
Rouba Garro
USA
Naorem Lakshmee Devi
India
Sukanya Govindan (Moderator)
India
Nadira Sultana
Bangladesh
Ng Kar Hui
Singapore
Syed Saimul Huque
Bangladesh
Fiona Mackie (Moderator)
Australia
Rajiv Sinha
India
Sanjukta Poddar
India
Mordi Mourah
UK
Asheeta Gupta
UK
Alexey N. Tsygin
Russia
Komiljon Khamzaev
Uzbekistan
Fayzakhmatova Feruza
Uzbekistan
Arvind Bagga
India
Priya Pais
India
Iftikhar Ijaz
Pakistan
Zubair Hussain
Pakistan
Mignon McCulloch
South Africa
Felicia U. Ek
Nigeria
Tochi Uchenwa
Nigeria
Kimberly Reidy
USA
Miriam Harel
USA
Key:
Complete
Next
Failed
Available
Locked
Approach to Treating Lupus Nephritis in Children
Open to view video.
Open to view video.
Kidney involvement is common in lupus and the prognosis depends upon the underlying pathology and optimal and early immunosuppressive treatment. The approach should be based on kidney biopsy data, kidney function and immune tests. Different immunosuppressive regimens are indicated in pathology classes III to V based on steroids, cyclophosphamide, MMF and AZA. Monoclonal antibodies as Rituximab and Belimumab are extensively used in the last decades. The results of clinical trials and guidelines will be discussed.
C3 Glomerulonephritis and Dense Deposit Disease – A Tale of Two Twins
Open to view video.
Open to view video.
C3 glomerulopathy is defined by the Consensus Group 2013 as a rare group of kidney disorders due to complement dysregulation. The single diagnostic criteria is dominant C3 deposition in kidney with clinical features of glomerulonephritis (GN). It includes both Dense Deposit Disease (DDD) and C3 GN which have overlapping clinicopathological features. Electron microscopy is necessary to distinguish both. Investigations include tests for complements, antibodies to complement regulating proteins, C3 NeF and genetic analysis. 70% of children and 30 to 50% of adults reach ESKD in 10 years. No treatment is universally effective, though immunosuppression may help.
A tale of two pathologies: Rapidly Progressive Glomerulonephritis and Acute Tubulointerstitial Nephritis
Open to view video.
Open to view video.
Immunosuppression vs post-transplant viral infections: Walking a fine line
Open to view video.
Open to view video.
BK virus (BKV) is a common infection after kidney transplant (KT), with rising prevalence in the era of more potent immunosuppression. Uncontrolled, BKV infection can lead to BK-associated nephropathy, irreversible damage, and graft loss. Concurrent BKV nephropathy and acute rejection is not uncommon, and treatment is challenging. We discuss the case of a child who presented three years after living donor KT with fever, weight loss, GI symptoms, and acute graft dysfunction. Virology screen revealed CMV, BKV, and EBV viremia. Kidney biopsy showed acute cellular rejection. Optimized immunosuppression and antiviral therapy resulted in resolution of viremia and nearly baseline creatinine.
A Challenging Case of Nephrotic Syndrome
Open to view video.
Open to view video.
Nephrotic syndrome refractory to standard treatment poses a challenging problem to paediatric nephrologists. Management issues involve many inter-dependent factors, including fluid status, kidney function, nutrition, infection and thrombosis risks. We will present a case of a child with primary nephrotic syndrome refractory to standard treatment. This session will address common management challenges of a nephrotic child, immunosuppressive strategies and general approach to genetic testing.
The Spectrum of Alport Syndrome: Who and how to investigate?
Open to view video.
Open to view video.
Early diagnosis and pharmacologic intervention can delay progression of chronic kidney disease and the onset of kidney failure in patients with Alport syndrome. We aim to highlight the phenotypic spectrum of this condition through a series of cases. We will cover key updates in diagnostics with a focus on genomics, as well as longer term surveillance and management of patients with Alport syndrome.
Renal amyloidosis presenting as glucocorticoid resistant nephrotic syndrome
Open to view video.
Open to view video.
Amyloidosis is a rare multi-system disease. In children, amyloid A (AA) amyloidosis (previously known as reactive or secondary amyloidosis) may occur due to chronic inflammation. Pediatric AA amyloidosis mainly involves the kidneys and presents with proteinuria, hematuria, hypertension and nephrotic syndrome. Therapy for AA amyloidosis is targeted towards control of the underlying inflammatory disease and suppression of serum amyloid protein production.
In this webinar, we will present a case of renal amyloidosis, successfully treated with IL-6 antibody.
All Cysts Are Not Equal
Open to view video.
Open to view video.
“Simple cysts” are extremely rare in children and any cyst in the kidney of a child should be appropriately evaluated. Major clinical entities include multicystic dysplastic kidney, juvenile nephronopthisis, glomerulocystic kidney and Polycystic kidney diseases.
Clinical case: A 12-year-old, male, JE, was referred from peripheral hospital with recurrent fever and abdominal pain of 4 and 1 month(s) respectively. Accompanying abdominal ultrasound report showed diffuse renal cysts which was confirmed on repeat scan. Some cysts contained debris suggestive of haemorrhage or infection. Autosomal Dominant Polycystic Kidney Disease (ADPKD) was suspected and both parents had KUB ultrasound scan done. Mother had bilateral multiple cysts. Genetic work up is not feasible in our center. Child had 100mls of serous aspirate drained from multiple locules Child’s BP remained normal (between 50th -90th). Fever persisted for 3 weeks and finally settled on Piperacin-Tozobactam. ADPKD, though rare in children, should be suspected if diffuse cysts without dysplasia can be demonstrated in either parent even in areas without facilities for genetic testing so that maximal anticipatory care could be instituted. Recalcitrant infected cyst(s) should be aggressively treated.
Learning Objectives:
How to approach kidney cyst in a child
When to suspect and diagnose Autosomal Dominant Polycystic Kidney Disease in children
Discuss anticipatory care, monitoring and complications of ADPKD in children
Diagnosis and Management of the Child with Atypical Peritonitis
Open to view video.
Open to view video.
Peritoneal dialysis (PD)-related peritonitis is one of the most frequent and severe complications of PD. In this webinar, we present a case of fungal peritonitis and discuss the literature on fungal peritonitis and peritonitis caused by atypical organisms and their impact on patient outcomes. A high index of suspicion is required to recognise peritonitis caused by atypical organisms and implement appropriate treatment in a timely manner.
A delay in diagnosis and treatment can lead to peritoneal damage, necessitating the need for PD catheter removal and may even be life-threatening.
Learning objectives:
Understand when to suspect atypical peritonitis
Assessment of appropriate diagnostic strategy
To acquire knowledge towards high-risk patients management
Prevention and treatment including PD catheter removal where necessary
Let T(r)ooth Be Told…
Open to view video.
Open to view video.
We present 2 children with poor growth, polyuria, dental abnormalities, hypokalemia, and hyperchloremic metabolic acidosis. Detailed evaluation suggested the diagnosis of rate-dependent distal renal tubular acidosis with bilateral medullary nephrocalcinosis. There was transient proximal tubular dysfunction with hypophosphatemia and aminoaciduria. Genetic screening helped clarify the clinical diagnosis, and enable genetic counselling.
Diagnosis and Treatment of Hyperoxaluria Type 1: Old and New
Open to view video.
Open to view video.
A child presented with a history of multiple kidney stones and end-stage kidney disease. Diagnostic evaluation demonstrated hyperoxaluria type 1. We will review the different clinical scenarios when one should suspect hyperoxaluria type 1 and how to make the diagnosis. Finally, we will discuss therapeutic options, including pyridoxine, liver transplantation and lumasiran, a recent advance in the treatment of hyperoxaluria type 1.
Learning objectives:
Describe 3 different clinical presentations of hyperoxaluria type 1.
Plan the diagnostic strategy for a patient with suspected hyperoxaluria type 1.
Explain how lumasiran decreases liver oxalate production in hyperoxaluria type 1.
Management of a Child with Posterior Urethral Valves
Open to view video.
Open to view video.
The case of a 21-year-old boy diagnosed with posterior urethral valves (PUV) at one month and had valve ablation at two months of age will be presented during the webinar. He has been showing lately with deterioration of kidney function and bladder outlet obstruction. We will review the immediate and long-term management of posterior urethral valves. Our urologist will discuss urology management and our pediatric nephrologist will provide input about nephrology management and collaboration with the pediatric urology team.
Learning objectives:
Recognize the importance of joint pediatric urology and nephrology management of posterior urethral valves.
Understand the unique complications of PUV.
Describe the management of CKD secondary to PUV