Grand Rounds in Pediatric Nephrology

Recorded On: 06/27/2025

  1. A tale of two pathologies: Rapidly Progressive Glomerulonephritis and Acute Tubulointerstitial Nephritis
  2. Nephropathic Cystinosis: How to Diagnose and Treat
  3. Make the Peritoneal Membrane Work for You
  4. Approach to Infantile Hypercalcemia
  5. Pediatric Renal Genetics: New Advances 
  6. Management of Renal Bone Disease
  7. Resistant Hypertension in Children on Dialysis 
  8. C3 Glomerulonephritis and Dense Deposit Disease – A Tale of Two Twins
  9. Immunosuppression vs post-transplant viral infections: Walking a fine line
  10. A Challenging Case of Nephrotic Syndrome
  11. The Spectrum of Alport Syndrome: Who and how to investigate?
  12. Renal amyloidosis presenting as glucocorticoid resistant nephrotic syndrome
  13. Approach to Treating Lupus Nephritis in Children
  14. All Cysts Are Not Equal
  15. Diagnosis and Management of the Child with Atypical Peritonitis
  16. Renal Tubular Acidosis: Let T(r)ooth Be Told…
  17. Diagnosis and Treatment of Hyperoxaluria Type 1: Old and New
  18. Management of a Child with Posterior Urethral Valves
  19. Evaluation and Management of a Child with a Neurogenic Bladder
  20. Nephro-Uro Crosstalk – A Nephrologist’s Perspective on Bladder Management
  21. Peritoneal Dialysis in low resource settings – pearls and pitfalls
  22. Renovascular hypertension in children
  23. Challenges in diagnosis and treatment of lupus nephritis in a lower-middle income country
  24. Small kidneys at birth: implications into adulthood
  25. Genetic Variations and Short term outcomes in Children with Distal Renal Tubular Acidosis: Insights from the Indian Tubular Disorder Registry
  26. AKI in malaria
  27. HIVAN: Preventable and Treatable, Yet Can Be fatal
  28. The Role of Multidisciplinary Teams in Assessing Pediatric Kidney Transplant Recipients
  29. Challenging case with Nephrotic syndrome
  30. Antenatal findings of kidney disease and counselling

Rukshana Shroff

UK

Neha Bhongale

India

Jyoti Sharma

India

John Mahan

USA

Sukanya Govindan (Moderator)

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

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

Iftikhar Ijaz

Pakistan

Zubair Hussain

Pakistan

Mignon McCulloch

South Africa

Felicia U. Ek

Nigeria

Tochi Uchenwa

Nigeria

Miriam Harel

USA

Lorna Lourdes Simangan

Philippines

Marnelle Gay Yandra Aramburo

Philippines

Gayathri Raman

Australia

Aniruddh Deshpande

Australia

Eugene Yu Hin Chan

Hong Kong

Natasa Stajic

Serbia

Jelena Stojanovic

UK

Marina Peric

Serbia

Hui Kim Yap

Singapore

Judith Exantus

Haiti

Toussaint Jeanne d’Arc

Haiti

Aditya Pawar

USA

Valerie Luyckx

Switzerland

Nancy Rodig

USA

Onex Ton-Aimé

Haiti

Jaime Restrepo

Colombia

Martin Bitzan

United Arab Emirates

Athira Puthukara

India

Athira Puthukara

India

Arpana Iyengar

India

Peace Imani

USA

Anthony Batte

Uganda

Judith Caroline Aujo

Uganda

Malcolm Lewis

UK

Michael Ross

USA

Kimberly Reidy

USA

Ana Petrovic

Serbia

Kar Hui Ng

Singapore

Fanny Tsz-wai

Hong Kong

Alison Ma

Hong Kong

Gulshan Nigar Chaudhury

Bangladesh

Rumana Amin

Bangladesh

Neha Agarwal

India

Faidra Veligratli

UK

Prakhar Goyal

India

Minh Dien Duong

USA

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Approach to Treating Lupus Nephritis in Children
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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.
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C3 Glomerulonephritis and Dense Deposit Disease – A Tale of Two Twins
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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.
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Resistant Hypertension in Children on Dialysis
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Open to view video.
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Management of Renal Bone Disease
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Open to view video.
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Pediatric Renal Genetics: New Advances
Open to view video.
Open to view video.
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Nephropathic Cystinosis: How to Diagnose and Treat
Open to view video.
Open to view video.
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Approach to Infantile Hypercalcemia
Open to view video.
Open to view video.
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A tale of two pathologies: Rapidly Progressive Glomerulonephritis and Acute Tubulointerstitial Nephritis
Open to view video.
Open to view video.
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Make the Peritoneal Membrane Work for You
Open to view video.
Open to view video.
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Immunosuppression vs post-transplant viral infections: Walking a fine line
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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.
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A Challenging Case of Nephrotic Syndrome
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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.
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The Spectrum of Alport Syndrome: Who and how to investigate?
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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.
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Renal amyloidosis presenting as glucocorticoid resistant nephrotic syndrome
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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.
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All Cysts Are Not Equal
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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
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Diagnosis and Management of the Child with Atypical Peritonitis
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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
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Renal Tubular Acidosis: Let T(r)ooth Be Told…
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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.
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Diagnosis and Treatment of Hyperoxaluria Type 1: Old and New
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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.
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Management of a Child with Posterior Urethral Valves
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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
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Evaluation and Management of a Child with a Neurogenic Bladder
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Open to view video. A neurogenic bladder may result from several causes, such as spina bifida, sacral agenesis, anorectal and cloacal malformations, spinal cord injury, transverse myelitis and sometimes as a part of a progressive systemic neurologic disorder. Every pediatric nephrologist should be equipped with knowledge about the close monitoring and management of children with neurogenic bladder (and bowel) to be able to prevent, recurrent urinary tract infections (UTIs), irreversible deterioration of kidney function and urinary and bowel incontinence. This requires a multidisciplinary team approach. In this webinar a nephro-urology duo discuss the investigations and management of a child with sacral agenesis, including discussions on the adaptations that may be considered in low-resource settings. Learning objectives: Recognize the child with a neurogenic bladder Advise relevant investigations Discuss the management options Further reading: Brownrigg N, Lorenzo AJ, Rickard M, Dos Santos J. The urological evaluation and management of neurogenic bladder in children and adolescents-what every pediatric nephrologist needs to know. Pediatr Nephrol. 2023 Jul 31. doi: 10.1007/s00467-023-06064-z Fairchild RJ, Aksenov LI, Hobbs KT et al (2022) Medical management of neurogenic bladder in patients with spina bifida: a scoping review. J Pediatr Urol 19:55–63
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Nephro-Uro Crosstalk – A Nephrologist’s Perspective on Bladder Management
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Open to view video. This webinar addresses bowel and bladder dysfunction, common in children with conditions like vesical-ureteric reflux (VUR), leading to recurrent urinary tract infections that can damage the kidneys and accelerate the decline to kidney failure. The session focuses on a case of complicated infections, discussing practical aspects of urotherapy, bowel management, and our current approach to bladder management in children with VUR. Learning objectives: Understand the Role of Bowel and Bladder Dysfunction as a Risk Factor for Recurrent Urinary Tract Infections Grasp General Principles for Managing Recurrent Urinary Tract Infections in Children to prevent Kidney Failure Develop Practical Skills in Performing Urotherapy Gain Proficiency in Bowel Management for the Pediatric Nephrologist Further reading: Nieuwhof-Leppink AJ, Hussong J, Chase J, Larsson J, Renson C, Hoebeke P, Yang S, von Gontard A. Definitions, indications and practice of urotherapy in children and adolescents: – A standardization document of the International Children’s Continence Society (ICCS). J Pediatr Urol. 2021 Apr;17(2):172-181. doi: 10.1016/j.jpurol.2020.11.006. Epub 2020 Nov 5. PMID: 33478902. Yang, S., Chua, M.E., Bauer, S. et al. Diagnosis and management of bladder bowel dysfunction in children with urinary tract infections: a position statement from the International Children’s Continence Society. Pediatr Nephrol 33, 2207–2219 (2018). https://doi.org/10.1007/s00467-017-3799-9 Klijn AJ, Asselman M, Vijverberg MA, Dik P, de Jong TP. The diameter of the rectum on ultrasonography as a diagnostic tool for constipation in children with dysfunctional voiding. J Urol. 2004 Nov;172(5 Pt 1):1986-8. doi: 10.1097/01.ju.0000142686.09532.46. PMID: 15540772.
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Peritoneal Dialysis in low resource settings – pearls and pitfalls
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Open to view video. Explore the intricacies of Peritoneal Dialysis in resource-limited settings through an insightful session titled “Peritoneal Dialysis in low resource settings – pearls and pitfalls.” Delve into the nuances of Acute Peritoneal Dialysis (PD) with a comprehensive overview, specifically focusing on pediatric Acute Kidney Injury (AKI). The session includes a compelling case study on Haemolytic Uraemic Syndrome presented by Handsome Deksiso, followed by expert insights into the pearls of Acute PD shared by Mignon McCulloch. Additionally, the discussion extends to the practical aspects of using acute PD catheters, including insights into locally made fluid. Explore troubleshooting techniques and gain valuable knowledge on Continuous Flow PD (CFPD) led by Peter Nourse. The session addresses common catheter issues, providing a platform to discuss essential concepts related to CFPD. Join us as we navigate through the challenges and best practices associated with Peritoneal Dialysis in settings with limited resources. Learning objectives: Understand the indications and techniques for implementing Acute Peritoneal Dialysis (PD) in the context of Acute Kidney Injury (AKI). Gain insights into the different types and applications of Acute PD catheters. Explore improvisation strategies for situations where there is a lack of available fluid and catheters for Acute PD. Acquire troubleshooting skills specific to Peritoneal Dialysis in the context of AKI, addressing common challenges and complications. Explore the principles and applications of Continuous Flow Peritoneal Dialysis, understanding its role and significance in clinical practice. Further reading: Nourse P, Cullis B, Finkelstein F, Numanoglu A, Warady B, Antwi S, McCulloch M. ISPD guidelines for peritoneal dialysis in acute kidney injury: 2020 Update (paediatrics). Perit Dial Int. 2021 Mar;41(2):139-157. doi: 10.1177/0896860820982120. Epub 2021 Feb 1. PMID: 33523772.
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Renovascular hypertension in children
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Open to view video.  |   Closed captions available Primary arterial hypertension is an emerging problem in the pediatric population and is often seen in obese children. Among the patients with secondary hypertension, renovascular causes are the third most common cause and are the cause of high blood pressure in 5 – 25% of hypertensive children. Renovascular hypertension is most associated with fibromuscular dysplasia, starts early in life, and can be asymptomatic for years making it challenging for diagnosis. We will present a patient with renovascular hypertension who initially started treatment in Serbia and continued at Great Ormond Street Hospital for Children where the patient was subsequently, successfully treated. Learning objectives: Demonstrate effective techniques for presenting and conducting investigations on patients diagnosed with renovascular hypertension. Evaluate and compare the medical, endovascular, and surgical treatment options available for managing pediatric patients afflicted with renovascular hypertension. Analyze the clinical outcomes and devise strategies for long-term follow-up care in pediatric patients undergoing treatment for renovascular hypertension. Further reading: Patel P. and Stojanovic J. Diagnosis and treatment of renovascular disease. Roentgenol. 2019 Oct;54(4):367-383. Kurt-Sukur E, Brennan E, Davis M, Forma C, Hamilton G, Kessaris N, Marks S, McLaren C, Minhas K, Patel P, Roebuck D, Stojanovic J, Stuart S, Tullus K. Presentation, treatment, and outcome of renovascular hypertension below 2 years of age. Eur J Pediatr. 2022 Sep;181(9):3367-3375.PMID:35792951 Redhead ECG, Paessler A, Arslan Z, Patel P, Minhas K, Forman C, Hollis P, Lava S, Ionescu F, Manuel D, Ray S, Kessaris N, Giardini A, Ratnamma V, Dobby N, Tullus K, Simmonds J, Stojanovic J. Pediatr Nephrol. Cardiovascular outcomes improve in children with renovascular hypertension following endovascular and surgical interventions 2024 Feb;39(2):521-530. PMID:37658875 Arslan Z, Patel P, Minhas K, Tullus K, Stojanovic J. Importance of the arc of Riolan in children with severe middle aortic syndrome. Dis Child. 2021 April 14 Mudalige N, Ranasinghe C, Stojanovic J. The Clinical and Radiological Cerebrovascular Abnormalities Associated with Renovascular Hypertension in Children: A systematic review. Nephrol. 2021 Jul 8 Tullus K, Brennan E, Hamilton G, Lord R, McLaren CA, Marks SD, Roebuck DJ. Renovascular hypertension in children. Lancet. 2008 Apr 26;371(9622):1453-63. doi: 10.1016/S0140-6736(08)60626-1. PMID: 18440428. Salice P, Mircoli L, Butera G, Burdick L, Borzani I, Mastrangelo A, Ardissino G, Beretta C, Ferraresso M, Ughi L, Montini G, Carugo S, Morganti A. Percutaneous cutting balloon angioplasty for the treatment of renovascular hypertension in children and adolescents. J Hypertens. 2022 Oct 1;40(10):1902-1908. doi: 10.1097/HJH.0000000000003162. Epub 2022 Aug 18. PMID: 35983863. de Oliveira Campos JL, Bitencourt L, Pedrosa AL, Silva DF, Lin FJJ, de Oliveira Dias LT, Simões E Silva AC. Renovascular hypertension in pediatric patients: update on diagnosis and management. Pediatr Nephrol. 2021 Dec;36(12):3853-3868. doi: 10.1007/s00467-021-05063-2. Epub 2021 Apr 13. PMID: 33851262.
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Challenges in diagnosis and treatment of lupus nephritis in a lower-middle income country
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Open to view video.  |   Closed captions available Systemic lupus erythematosus is a lifelong multi-systemic autoimmune condition. Kidney involvement occurs in over 50% of children and treatment decisions are guided by histological classification. However,kidney biopsies and their histological interpretation is not available in some LMIC such as Haiti where it may be impossible to get histopathology on a kidney biopsy and where regular immunological testing may not be easily available. The aim of this webinar is to discuss the management of a child with lupus nephritis, relying more on clinical examination than advanced imaging tests. We present an adolescent girl with florid systemic lupus erythematosus and discuss the management of complex lupus nephritis. Learning objectives: Diagnose Lupus Nephritis in Low- and Middle-Income Countries (LMICs): Identify and apply diagnostic criteria and techniques suitable for resource-limited settings. Adapt Treatment Protocols for Lupus Nephritis Based on Medication Availability: Develop and adjust treatment regimens considering the availability and accessibility of medications in LMICs. Evaluate Outcomes and Implement Follow-Up Strategies for Patients with Lupus Nephritis: Assess patient outcomes and establish effective follow-up protocols to monitor disease progression and treatment response.
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Small kidneys at birth: implications into adulthood
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Open to view video.  |   Closed captions available It has been well recognized that individuals born with low birth weight, small for gestation age and/or delivered prematurely are at increased risk for the development of hypertension and chronic kidney disease (CKD). The basis of this risk is believed to be related to disruption of developmental programming leading to reduced nephron number. Supportive measures and treatments that promote renal health and retard progression of CKD are broadly available. However, many individuals who are at-risk based upon their birth history do not receive adequate screening to permit early detection and intervention. We will present the case of a teenager who was delivered both prematurely and at a very low birth weight and subsequently developed CKD and hypertension. We will then review the relationship of abnormal birth history and subsequent kidney disease and hypertension. We will discuss the importance of identifying at-risk individuals and ensuring disease screening during childhood and adulthood. We will also discuss the opportunity to reduce the risk of preterm birth and abnormal intrauterine growth by optimizing maternal health, thereby reducing the burden of CKD globally Learning objectives: Being born too early (preterm) or too small (small for gestational age) are risk factors for longer term hypertension, kidney disease, cardiovascular disease and pregnancy complications Preterm birth and being small for gestational age are associated with smaller kidneys with fewer nephrons. Being born with smaller kidneys constitutes a first kidney “hit” which enhances vulnerability further kidney “hits” Long-term follow up of at-risk infants is advised to permit early diagnosis, and intervention to prevent or delay kidney disease Addressing the Social Determinants of Health across the life course is important to reduce the cycle of risk Further reading: Bianchi, M. E., & Restrepo, J. M. (2022). Low birthweight as a risk factor for non-communicable diseases in adults. Frontiers in medicine, 8, 793990. Iyengar, A., Nesargi, S., George, A., Sinha, N., Selvam, S., & Luyckx, V. A. (2016). Are low birth weight neonates at risk for suboptimal renal growth and function during infancy?. BMC nephrology, 17, 1-9. Luyckx, V. A., Shukha, K., & Brenner, B. M. (2011). Low nephron number and its clinical consequences. Rambam Maimonides medical journal, 2(4). Weight, The Low Birth, and Nephron Number Working Group. “The impact of kidney development on the life course: a consensus document for action.” Nephron. Clinical Practice 136.1 (2017): 3. Anna Gjerde et al. Intrauterine growth restriction and risk of diverse forms of kidney disease during the first 50 years of life. CJASN 2020.
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Genetic Variations and Short term outcomes in Children with Distal Renal Tubular Acidosis: Insights from the Indian Tubular Disorder Registry
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Open to view video.  |   Closed captions available Renal tubular acidosis (RTA) is a tubulopathy causing normal anion gap hyperchloremic metabolic acidosis, categorized into four types: distal (type 1), proximal (type 2), mixed (type 3), and hyperkalemic (type 4). Distal RTA (dRTA) results from impaired hydrogen ion excretion and was previously thought to be benign but can lead to significant long-term morbidities. This webinar will present a case study of pediatric dRTA, discuss genetic variations, and review outcomes from the Indian Tubulopathy Registry, highlighting the importance of early diagnosis and short term outcomes Learning objectives: Approach to a child with suspected renal tubular acidosis Clinical phenotype and genetic profile of children with distal renal tubular acidosis Genetic variation and short term out come of distal RTA: Indian tubular disorder registry Further reading: Palazzo V, Provenzano A, Becherucci F, et al. The genetic and clinical spectrum of a large cohort of patients with distal renal tubular acidosis. Kidney Int. 2017;91(5):1243-1255. doi:10.1016/j.kint.2016.12.01 Lopez-Garcia SC, Emma F, Walsh SB, et al. Treatment and long-term outcome in primary distal renal tubular acidosis. Nephrol Dial Transplant. 2019;34(6):981-991. doi:10.1093/ndt/gfy409
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AKI in malaria
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Open to view video.  |   Closed captions available Malaria is a common cause of acute kidney injury (AKI) in children in low and middle income countries. AKI occurs in 24–59% of children hospitalized with severe malaria. Risk factors for malaria associated AKI include black water fever, hypovolemia, use of nephrotoxic medications and herbal medicines. AKI is a significant predictor of both in-hospital and post discharge mortality among children with severe malaria. Among survivors, malaria associated AKI is a predictor of chronic kidney disease and neuro-cognitive dysfunction. We present a case of 10 year old child who was hospitalized with severe malaria associated AKI. The child required dialysis during hospitalization and recovered following treatment. We will discuss the epidemiology, risk factors, short and long-term outcomes of malaria associated AKI in children. Learning objectives: Outline the epidemiology of severe malaria acute kidney injury Understand the pathophysiology of severe malaria associated acute kidney injury Discuss the risk factors for severe malaria associated acute kidney injury Discuss the short and long-term outcomes of severe malaria associated acute kidney injury Further reading: Batte, A., Berrens, Z., Murphy, K., Mufumba, I., Sarangam, M. L., Hawkes, M. T., & Conroy, A. L. (2021). Malaria-associated acute kidney injury in African children: prevalence, pathophysiology, impact, and management challenges. International Journal of Nephrology and Renovascular Disease, 235-253. Namazzi, R., Batte, A., Opoka, R. O., Bangirana, P., Schwaderer, A. L., Berrens, Z., & Conroy, A. L. (2022). Acute kidney injury, persistent kidney disease, and post-discharge morbidity and mortality in severe malaria in children: a prospective cohort study. EClinicalMedicine, 44. Conroy, A. L., Opoka, R. O., Bangirana, P., Idro, R., Ssenkusu, J. M., Datta, D., … & John, C. C. (2019). Acute kidney injury is associated with impaired cognition and chronic kidney disease in a prospective cohort of children with severe malaria. BMC medicine, 17, 1-12.
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HIVAN: Preventable and Treatable, Yet Can Be fatal
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Open to view video.  |   Closed captions available HIV associated nephropathy (HIVAN) was first recognized in 1984 and became a frequent cause of ERF in patients, particularly within the Black ethnic community. With the use of ART and subsequently HART from the 1990’s onward ERF from HIVAN has become much less common in the US and Europe. In children, who most often have vertically acquired disease, it is no longer seen, despite the evidence of nephrotoxicity from HART itself. This is not the case in Africa, despite the free availability of HART and the free provision of services for diagnosis and assessment. We present a case of ERF in a teenage male patient which led to the patient’s death. This case is typical of many seen each year. Most acquire HIV through vertical transmission. Many of the children are orphans at the time of presentation. Shame and stigma lead to late diagnosis. Failure to explain the disease to young people leads to non compliance to therapy. Relative poverty means RRT is not affordable. A new approach to HIV in society in Africa is needed. Learning objectives: Explain the pathogenesis and explore current and emerging treatments for HIV nephropathy. Describe the renal pathology associated with HIV nephropathy, including its key features and progression. Analyze the societal factors that influence the diagnosis, management, and treatment of HIV nephropathy, and compare how these factors vary across different continents. Further reading: A review of renal disease in children with HIV infection. Jindal AK, Tiewsoh K, Pilania RK. Infect Dis (Lond). 2018 Jan;50(1):1-12. doi: 10.1080/23744235.2017.1371852. Epub 2017 Sep 8. PMID: 28885079 Childhood HIV-associated nephropathy: 36 years later. Ray PE, Li J, Das JR, Tang P.Pediatr Nephrol. 2021 Aug;36(8):2189-2201. doi: 10.1007/s00467-020-04756-4. Epub 2020 Oct 12.PMID: 33044676  HIV-associated nephropathy in children: challenges in a resource-limited setting. Nkoy AB, Ekulu PM, Labarque V, Van den Heuvel LP, Levtchenko EN.Pediatr Nephrol. 2023 Aug;38(8):2509-2521. doi: 10.1007/s00467-022-0581 Epub 2022 Dec 6.PMID: 36472655
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The Role of Multidisciplinary Teams in Assessing Pediatric Kidney Transplant Recipients
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Open to view video.  |   Closed captions available The profile of pediatric kidney transplant recipients is evolving in the 21st century. Children with conditions leading to end-stage kidney disease are surviving beyond infancy and becoming transplant candidates earlier in childhood. Additionally, more children with multi-organ involvement are now being considered for transplantation. Proper preparation for kidney transplantation is essential for achieving optimal clinical outcomes. This webinar will explore the assessment of pediatric kidney transplant candidates with complex conditions and the role of the multidisciplinary team (MDT) in the transplant process. Learning objectives: - Essential pre transplant assessment of children going for kidney transplant - Assessment of children with complexities - Organising and delivering kidney transplant as MDT
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Challenging case with Nephrotic syndrome
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Open to view video.  |   Closed captions available Nephrotic syndrome is the most common glomerular disorder in children, yet its management can be especially complex when compounded by kidney impairment and limited resources. This webinar offers practical insights into navigating immunosuppressant therapy, biopsy timing, and infection prevention strategies, all through the lens of a real-world case study. Join us to enhance your clinical decision-making and improve outcomes for young patients facing these challenges. Learning objectives: - Recognize the difference between acute and chronic kidney impairment in children with nephrotic syndrome. - Evaluate immunosuppressant use in the context of kidney dysfunction and active infections. - Apply practical strategies for managing pediatric nephrotic syndrome in low-resource settings. Further reading: Trautmann A, Vivarelli M, Samuel S, et al. IPNA clinical practice recommendations for the diagnosis and management of children with steroid-resistant nephrotic syndrome. Pediatr Nephrol. 2020;35(8):1529-1561. doi:10.1007/s00467-020-04519-1 Chan EY, Boyer O. Childhood idiopathic nephrotic syndrome: recent advancements shaping future guidelines. Pediatr Nephrol. Published online December 26, 2024. doi:10.1007/s00467-024-06634-9 Glenn DA, Zee J, Mansfield S, et al. Immunosuppression Exposure and Risk of Infection-Related Acute Care Events in Patients With Glomerular Disease: An Observational Cohort Study. Kidney Med. 2022;4(11):100553. Published 2022 Oct 1. doi:10.1016/j.xkme.2022.100553 O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis. 2011;52(9):e162-e193. doi:10.1093/cid/cir257 Meyrier A, Niaudet P. Acute kidney injury complicating nephrotic syndrome of minimal change disease. Kidney Int. 2018;94(5):861-869. doi:10.1016/j.kint.2018.04.024
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Antenatal findings of kidney disease and counselling
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Open to view video.  |   Closed captions available Congenital anomalies of the kidney and urinary tract (CAKUT) are among the most frequently detected abnormalities during routine antenatal screening. This group of disorders encompasses a wide clinical spectrum, ranging from transient hydronephrosis to life-threatening bilateral renal dysplasia. Accurate antenatal assessment requires the integration of ultrasound imaging, amniotic fluid evaluation, family history, and in selected cases, genetic testing. Prognosis depends on multiple variables including renal size and morphology, presence of oligohydramnios, and the evolution of findings over time. Given the clinical and emotional complexity of these cases, antenatal counselling must be individualized and delivered through a coordinated multidisciplinary team. This webinar will explore diagnostic strategies, prognostic considerations, and practical approaches to family-centred counselling in the antenatal setting. Learning objectives: - Understand the prevalence, classification, and clinical spectrum of CAKUT as identified in antenatal screening. - Describe the key antenatal diagnostic tools—including ultrasound and genetic testing—and their role in risk stratification and prognostication. - Discuss best practices for multidisciplinary antenatal counselling, including how to communicate uncertainty and tailor information to the needs of each family. Further reading: Walker, E.Y.X., Winyard, P., & Marlais, M. (2023). Congenital anomalies of the kidney and urinary tract: antenatal diagnosis, management and counselling of families. Pediatric Nephrology, 39(4), 1065–1075.  Yulia, A., & Winyard, P. (2018). Management of antenatally detected kidney malformations. Early Human Development, 126, 38–46.
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