Department of Pediatrics
Department of Pediatrics
The Department of Pediatrics

Pediatric Nephrology and Hypertension

The Department of Pediatrics at the University of Texas Medical School at Houston is dedicated to improving the health and welfare of all infants, children, and adolescents.


Research Expertise

Our nephrologists remain at the forefront of managing kidney disease through their research in immune mediated kidney diseases, hypertension, chronic kidney disease, and dialysis. The Division has a large support staff which includes experienced research nurses, study coordinators, database specialists, and statisticians. The Department of Pediatrics is dedicated to fostering bench research. The Division benefits from close ties with the Institute of Molecular Medicine for the Prevention of Human Diseases, the Center for Clinical and Translational Sciences, and the Center for Clinical Research and Evidence Based Medicine.

 

Immune Mediated Kidney Diseases

The Division has extensive experience working in mouse models of glomerulonephritis. Interests are centered on 1) the interactions of a group of blood proteins, the complement system, and 2) interactions of renal parenchymal cells with immune complexes. Complement has been shown to play a large role in modulating inflammatory diseases of the kidney such as lupus nephritis (SLE), membranoproliferative glomeruloneprhitis (MPGN), and IgA nephropathy, and many other autoimmune diseases. The research utilizes animal models of these diseases in order to expand our understanding of basic disease mechanisms at a molecular level. All of these diseases involve the deposition or trapping of immune complexes in the kidney, and studies are underway to determine how the kidney cells respond to immune complex deposition. Related research also seeks to identify potential disease biomarkers using cutting edge proteomic tools.  Dr. Braun and Dr. Wenderfer both run basic science research laboratories in the Brown Foundation Institute for Molecular Medicine and are dedicated to training students, post-doctoral scientists, and clinical fellows.

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Hypertension

In 1999, faculty from the Division developed the Houston Pediatric Adolescent Hypertension Program (HPAHP). First, they documented the increasing prevalence of hypertension in children from 1 to 4.5 % in screening over 20,000 children in Houston schools. Secondly, they documented that hypertension causes target organ damage, as manifested by left ventricular hypertrophy and increased carotid intima-media thicknesses. In addition, they have demonstrated the difficulties with causal BP measurement using oscillometric devices and the superiority of using ambulatory blood pressure monitoring to identify hypertensive children with target organ damage. We have been involved in many of the trials of antihypertensive medications now approved for use in children. Currently, this research program is evaluating vascular and cardiac pathology in children with obesity, essential hypertension, type 1 and 2 diabetes mellitus and childhood athletes.

As the field of pediatric nephrology has small numbers of complex patients at any one center, multi-center research is necessary to obtain the research answers we seek. Our center is the coordinating center for ABPM for the new multicenter NIH CKiD study and will also be involved in transplant vascular studies.  Previous collaborations include leadership roles in the Southwest Pediatric Nephrology Study Group, International Pediatric Hypertension Association (IPHA), North American Pediatric Renal Transplant Cooperative Study (NAPRTCS), International Society of Chronobiology and the Peritoneal Dialysis Study Consortium.

Now under the leadership of Dr. Samuels, HPAP has become busier than ever, with ongoing school based screenings, trials of new antihypertensives, and the study of target organ damage in children with hypertension.

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Chronic Kidney Disease - Dialysis

The Division has been involved in research on the care of patients with chronic kidney disease (CKD) and of those unfortunate patients who progress to end stage renal disease (ESRD).   Research has been focused on improving outcomes of patients with CKD and ESRD, both on dialysis and after transplantation. Particular interests include optimizing growth and nutrition, including the use of growth hormone. All aspects of care need to be personalized when a patient with CKD has declining kidney function, and continuity of care is essential when transitioning to dialysis and to transplantation. Patient oriented research includes both local trials and involvement in national and international pediatric research networks. The Division has been very involved in the recruiting of patients and analysis of data for the ongoing CKiD study.

Dr. Swinford has been involved in numerous pediatric clinical research trials involving the use of growth hormone, erythropoiesis-stimulating agents, and vitamin D analogs.

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