Pediatric Nephrology and Hypertension
Research Expertise
Our nephrologists remain at the forefront of techniques for treatment through research in immune mediated kidney diseases, hypertension, acute renal failure, chronic kidney disease, and end stage renal disease. 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.
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; this is manifested by left ventricular hypertrophy and increased carotid intima-media thicknesses. They have demonstrated the difficulties with oscillometric BP measurement. Fox example, they have demonstrated that ambulatory blood pressure monitoring is the most effective BP measurement technique with the closest association with target 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 childhood athletes.
The division is very involved in the International Pediatric Hypertension Association (IPHA). 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 collaborative research. Previous collaborations include leadership roles 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.
Dr. Portman, now retired, has been responsible for carrying out trials of most antihypertensive medications now approved for use in children. 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.
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.
The Division has been interested in factors effecting the development and outcome of acute kidney failure (AKF). The major focus is on clinical and genetic factors associated with AKF in critically ill patients with cancer. Cancer has become a leading cause of morbidity and mortality, with increasing hospitalization. AKF affects over 50,000 hospitalized Americans each year, and the mortality of patients with AKF in intensive care units has been reported as high as 86%. Current predictive models are inadequate to provide individualized prognostication. The research aims to refine predisposing clinical exposures and evaluate genetic markers that predict the onset and prognosis of AKF in critically ill cancer patients. Multiple genetic polymorphisms associated with AKF will be tested. This will allow for better prediction of AKF in ICU patients and better prognostication of their outcome.
Chronic Kidney Disease - Dialysis
The
Division has been involved in research on the care of those
unfortunate patients with chronic kidney disease (CKD) whose disease progresses
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 optimiziing 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.
Designed by Scott Wenderfer - last updated February 2008 - email with comments or questions
