University of Texas Houston Pediatric Nephrology and Hypertension Faculty

Rita Swinford MD

Associate Professor of Pediatrics

Director End Stage Kidney Disease Program

Director Pediatric Kidney Transplant Program

Medical Director, Children's Memorial Hermann Dialysis Unit

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Scott Wenderfer MD, PhD

Instructor of Pediatrics

Research Fellow, Center for Immunology & Autoimmune Diseases, Brown Foundation Institute for Molecular Medicine

Monesha Gupta MD

Assistant Professor of Pediatrics, Division of Pediatric Cardiology

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Dr. Portman’s expertise is in clinical research of pediatric hypertension. He along with Drs. Jonathan Sorof, Karen McNiece and Monesha Gupta have been instrumental in providing important data in this area. In 1999, the Houston Pediatric Adolescent Hypertension Program (HPAP) was developed. First, they have documented the increasing prevalence of hypertension in children from 1 to 4.5 % in screening over 20,000 children in Houston schools. Secondly, they have documented that hypertension causes end organ damage. This is manifested by left ventricular hypertrophy and increased carotid intima-media thicknesses. They have also demonstrated the difficulties with oscillometric BP measurement. They have demonstrated that ambulatory blood pressure monitoring is the most effective BP measurement technique with the closest association with end organ damage. Currently, this research program is evaluating vascular and cardiac pathology in children with obesity, essential hypertension, type 1 and 2 diabetes mellitus and athletes.

Dr. Portman is involved in the development of research in pediatric hypertension for the International Pediatric Hypertension Association (IPHA) as Chair of the Executive Committee. 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 actively involved in this form of research. His and Dr. Swinford’s collaborations include a leadership role in the Southwest Pediatric Nephrology Study Group, IPHA, North American Pediatric Renal Transplant Cooperative Study, International Society of Chronobiology and the Peritoneal Dialysis Study Consortium. Our center will be the coordinating center for ABPM for the new multicenter NIH CKiD study and will also be involved in Transplant Vascular studies.

Nationally Dr Portman has been very active. He edited the only text on Pediatric Hypertension. He is the past-chairman of IPHA. He is the only pediatric representative for the Hypertension Committee of the American Society of Nephrology. He was a member of the NHLBI working group that recently published pediatric BP guidelines. He wrote the BP measurement and ABPM sections of the Kidney Disease Outcome Quality Initiative (K/DOQI) of the National Kidney Foundation Guidelines on Hypertension. He has been appointed to the Cardio-Renal Section of the FDA.

Research Projects	Principal Investigator(s)	Source(s) of Financial Support
Chronic Kidney Disease in Children (CKiDs study) Center for Ambulatory Blood Pressure Monitoring	Ronald J Portman, MD	NIDDK/NHLBI/NICHD
Toprol-XL..Hypertensive Pediatric Subj. Double Blind Parallel Study	Ronald J. Portman, MD	Astrazeneca
Assessment of Cardiovascular Structure and Function in Hypertensive and Normotensive Children	Ronald J Porman, MD	AstraZeneca and Novartis
“Assessment of Vascular Function in Hypertensive Children.” Ruth L. Kirschstein National Research Service Award for Karen McNiece, fellow	Mentor: Ronald Portman, MD	NIH F32 HL079813-01
Analysis of Longitudinal Cardiopulmonary Data.	Bernard Rosner, PhD, Ronald Portman, MD	NIH R01 HL040619-13A1
A Dose-Ranging & Safety Study of Candesartan Cilexetil in Hypertensive Pediatric Subjects 6 to <17 Yrs	Ronald J. Portman, MD	Astrazeneca
A Dose-Ranging & Safety Study of Candesartan Cilexetil in Hypertensive Pediatric Subjects 1 to 5 Yrs	Ronald J. Portman, MD	Astrazeneca
Sub study of Protocol K726-014002...Ramipril on Am. Blood	Ronald J. Portman, MD	King Pharmaceuticals R&D Inc chairman, advisory board
A Double-Blind, Randomized, Multicenter Study Followed by 12 Months Open-label Treatment to Evaluate the Dose-response and Safety of Valsartan in Pediatric Hypertensive Patients	Ronald J. Portman, MD	Novartis member, advisory board
School Hypertension Screening Program	Ronald J Portman, MD	King Pharmaceuticals, Astrazeneca Pharmaceuticals
A Randomized, Double-Blind, Placebo Withdrawal, Parallel Group, Dose-Response Study to Evaluate the Efficacy and Safety of Epleronone in the Treatment of Hypertension in Children	Ronald J. Portman, MD	Pfizer on advisory board
Study to determine Prevelence of Microalbuminuria in Pediatric Patients with Diabetes	Ronald J. Portman, MD	Boehringer-Ingelheim, IPHA

Director of Research, Associate Program Director, Assistant Professor of Pediatrics

Recruited to the IMM in August of 2001, Dr. Braun is a graduate of Princeton University and the University of Pennsylvania School of Medicine. He completed his Pediatric Residency at Children's Memorial Hospital in Chicago (Northwestern University), and his Pediatric Nephrology Fellowship at Children's Hospital Medical Center in Cincinnati. Dr. Braun pursued additional basic science training at the National Institute of Allergic and Infectious Diseases (NIAID) in the Laboratory of Clinical Investigation under the direction of Dr. Brian Kelsall.

Dr. Braun received the Kidney Foundation of Greater Cincinnati Research Award in 1995, and a Fellows Award for Research Excellence in 1999 from the NIH. Dr. Braun is a Fellow of the American Academy of Pediatrics and is board certified in General Pediatrics and Pediatric Nephrology. He is a fellow of the American Society of Pediatric Nephrology and a member of the International Pediatric Nephrology Association.

Dr. Braun's research interests are focused on the interactions of a group of blood proteins, the complement system, and their role in modulating inflammatory diseases of the kidney such as lupus nephritis (SLE) and other autoimmune renal diseases. Dr. Braun is working both with animal models of these diseases and at a molecular level in order to expand our understanding of basic disease mechanisms. He has shown that in the MRL^lpr mouse model of lupus nephritis, that C5a receptor deficiency results in a significant reduction in renal injury as well as reductions in T-cell recruitment and activation. These data provide, for the first time, experimental support for the use of C5a inhibitors in the treatment of Systemic Lupus Erythematosus. Studies examining the effect of C3a receptor deficiency and combined C3a and C5a receptor deficiency are on-going. Dr. Braun is also characterizing the effects of C5a and C3a receptor deficiencies in a purely complement dependent model of renal injury-murine Factor H deficiency. Preliminary findings suggest that, similar to the MRL^lpr data, loss of function of the C3a or C5a receptor results in significant attenuation of kidney damage. Taken together, these findings indicate that inhibition of C3a and C5a are likely to be therapeutic targets for the treatment of a wide range of immune mediated renal diseases. Finally, in collaboration with Dr. Rowen Chang (IMM, Protein Core Facility) and Dr. William Dubinsky (Director, UTHSC-H Proteomics Core Facility), Dr. Braun is using advanced proteomic analysis to develop urinary biomarkers in the Factor H deficient mouse model. These studies are designed not only to provide insight into mechanisms by which chronic complement activation mediated renal injury, but also to provide translational approaches to the diagnosis and treatment of kidney disease in humans.

Publications

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Residency: Pediatrics, Arkansas Children's Hospital/University of Arkansas for Medical Sciences

Fellowship: Pediatric Nephrology, University of Texas Health Science Center, Houston

Undergraduate School: B.A. (Biology and Bio-Psychology), Wesleyan University, Middletown, CT, 1991.

Graduate Degree: Master of Public Health, University of Texas School of Public Health, Houston, TX, 2002.

Residency: Internal Medicine/Pediatrics, University of Rochester, Rochester, NY 1999.

Fellowship: Adult and Pediatric Nephrology, University of Texas Health Science Center, Houston, TX, 2003.

Certification: General Pediatrics 2000-2007, Pediatric Nephrology 2003, Internal Medicine 1999-2009, Nephrology, 2003.

Clinical and research interests include acute and chronic kidney disorders, electrolyte abnormalities, acid-base disorders, hypertension, and other renal complications of cancer. Dr. Samuels is an adult and pediatric nephrologist who joined M.D. Anderson in 2003.

Dr Swinford has area of expertise is in management of End Stage Renal Disease. She is the Director of the Memorial Hermann Children’s Dialysis Unit. She is responsible for supervising the subspecialty residents’ education in the area of End Stage Renal Disease including hemodialysis, peritoneal dialysis, slow low efficiency dialysis (SLED) and continuous venovenous hemodialfiltration (CVVHD). She also plays an integral role in the development of our renal transplant protocols. Dr Swinford along with Dr. Portman spend the most time on service and thus in teaching the subspecialty residents clinical pediatric nephrology. She has multiple clinical research grants for studies in ESRD including research with calcitriol and growth hormone. She is also a superb lecturer. She has been instrumental in teaching the subspecialty residents effective presentation preparation. She played an integral role in the recent teaching award voted for the Division.

Dr. Swinford’s clinical studies explore the ramifications of longer standing chronic kidney disease in children on growth and nutrition, with particular emphasis on traditional cardiovascular risk factors and modifications of those risk factor thereof. Additionally, nontraditional risk factors with respect to altered vascular compliance are being evaluated. She is also one of the major consultants for research studies performed in the use of human growth hormone in chronic kidney disease.

Dr. Wenderfer is a graduate of the University of Notre Dame and the University of Cincinnati MD/PhD program. He completed his Pediatric Residency and his Pediatric Nephrology Fellowship at the University of Texas in Houston. Dr. Wenderfer's clinical interests include glomerulonephritis, tubular and interstitial nephritis, and renal manifestations of rheumatic diseases such as lupus erythematosus. He cares for patients with all forms of pediatric kidney disease or hypertension.

Dr. Wenderfer received the Wulsin Fellowship for pre-doctoral research at the University of Cincinnati in 1996 and an NRSA training award in 2005 for fellowship research in the Center for Immunology and Autoimmunity at the Institute of Molecular Medicine here at UT-Houston. He wrote his dissertation on "genomic analysis of antigen processing and the IL-4 cytokine family in the immune system" under the mentorship of Dr. John Monaco. He is currently collaborating with Dr. Michael Braun and Dr. Rick Wetsel to study mechanisms of inflammatory kidney disease.

Dr. Wenderfer is a member of the American Academy of Pediatrics, the American Society of Pediatric Nephrology, and the American Association of Immunologists.

Dr. Gupta has been involved in our clinical and research activities on pediatric hypertension. She follows all patients with hypertension due to cardiac causes and she is instrumental in screening all of our chronic hypertensive patients for end organ damage. She is an expert in pharmacologic and non-pharmacologic treatments of essential hypertension, obesity, and the metabolic syndrome.

Interests: Pediatric Hypertension, Kawasaki Disease, Fetal Childhood and Adult Congenital Heart Defects, Childhood Aortopathy, Fetal Arrhythmias

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