BACKGROUND: In extremely preterm newborns (ELGANs, < 28 weeks' gestational age [GA]), early weight trajectories reflect fluid balance, yet thresholds for early risk stratification are lacking. We aimed to evaluate whethe...BACKGROUND: In extremely preterm newborns (ELGANs, < 28 weeks' gestational age [GA]), early weight trajectories reflect fluid balance, yet thresholds for early risk stratification are lacking. We aimed to evaluate whether percentage weight change (ΔW%) from birth weight (BW) and week-1 weight variability were independently associated with death by postnatal day 7 and to identify clinically relevant thresholds. METHODS: We performed a retrospective single-center secondary analysis of the Golden Week Program (University of Alabama at Birmingham NICU, 2014-2021). Newborns < 28 weeks' GA with BW ≥ 400 g and receiving active treatment were included; exclusion criteria were death ≤ 48 h, major congenital anomalies, or incomplete weight data. Multivariable logistic regression was performed, adjusted for GA, 5-min Apgar score, and BW z-score; optimal cutoffs were derived using the Youden Index. RESULTS: Among 805 neonates, 55 (6.8%) died by day 7. Non-survivors had higher day-3 ΔW% than survivors (median - 5.3% vs. - 10.7%; p < 0.007). Day-3 ΔW% was independently associated with mortality (aOR 1.05; 95% CI 1.02-1.08), with an optimal cutoff of - 6.4% (sensitivity 57%, specificity 72%). Among variability metrics, total fluctuation (mean absolute day-to-day change in ΔW%) showed the best discrimination (aOR 1.45; 95% CI 1.29-1.65; AUC 0.84), with an optimal cutoff of 5.3% (sensitivity 76%, specificity 74%). CONCLUSIONS: ELGANs who do not lose 5-7% of BW by postnatal day 3 or exhibit an average day-to-day weight fluctuation > 5% of BW are at increased risk of early mortality. These weight-derived metrics may support early risk stratification but require prospective validation.
BACKGROUND: Pediatric living donor kidney transplantation (KT) with large donor-recipient size mismatch induces a large hemodynamic burden on the child recipient. Although successful KT is known to be beneficial for card...BACKGROUND: Pediatric living donor kidney transplantation (KT) with large donor-recipient size mismatch induces a large hemodynamic burden on the child recipient. Although successful KT is known to be beneficial for cardiac function and remodeling, its effects in small recipients with adult donors have not been evaluated. We aimed to describe left ventricular (LV) function and geometry using conventional and speckle-tracking echocardiography in this population. METHODS: A prospective longitudinal study was performed. Living donor KT recipients with large donor-recipient size mismatch underwent conventional and speckle-tracking echocardiography prior to KT, shortly after KT and at 6 and 12 months post-transplantation. LV global longitudinal strain (GLS), LV ejection fraction, cardiac index, LV mass index (LVMi) and LV dimensions were obtained. RESULTS: Ten patients were included with a median [IQR] age of 5.9 years [4.4-8.5]. The median donor-recipient body surface area ratio was 2.36. Prior to transplantation, LV systolic dysfunction was found in 80% of the patients (GLS -18.9% [-19.7--18.7]). Significant improvement was found after 12 months (change in GLS -1.3% [-1.8--0.9], p = 0.004). A significant reduction in LVMi was found at 6 months and 12 months of -8.9 g/m [-15.6--5.4], p = 0.01 and -14.3 g/m [-15.3--12.9], p = 0.004, respectively. No significant changes in cardiac index were found at 6 and 12 months. CONCLUSIONS: Despite the increased hemodynamic demands after pediatric KT with large donor-recipient size mismatch, improved LV function and reduced left ventricular mass were found within 1 year after transplantation. These results suggest reversed cardiac remodeling.
BACKGROUND: Crescent formation is common in pediatric IgA vasculitis nephritis (IgAVN), but its clinicopathological correlates and the significance of crescent burden and activity remain unclear. METHODS: We retrospectiv...BACKGROUND: Crescent formation is common in pediatric IgA vasculitis nephritis (IgAVN), but its clinicopathological correlates and the significance of crescent burden and activity remain unclear. METHODS: We retrospectively analyzed 1,280 children with biopsy-proven IgAVN and available crescent assessment who were hospitalized at the Department of Pediatric Nephrology, The First Affiliated Hospital of Henan University of Chinese Medicine, between January 2013 and January 2021. Patients were classified by the presence or absence of crescents on kidney biopsy. Univariable and sequential multivariable logistic regression analyses were performed, with additional stratified, post hoc, and sensitivity analyses for crescent burden and active crescents. RESULTS: Crescent formation was identified in 903/1,280 children (70.5%). Compared with those without crescents, children with crescents were older and more likely to have gross hematuria, gross gastrointestinal bleeding, at least one non-cutaneous extrarenal manifestation, and severe renal clinical involvement. They also had higher 24-h urinary protein excretion and D-dimer levels and more frequent active and chronic pathological lesions. In the fully adjusted model, glomerulosclerosis, tubulointerstitial fibrosis, tubulointerstitial inflammation, endocapillary hypercellularity, and glomerular necrotizing lesions remained independently associated with crescent formation. Higher crescent burden was associated with heavier proteinuria, higher D-dimer levels and more frequent active and chronic pathological lesions. In sensitivity analyses, tubulointerstitial inflammation and glomerular necrotizing lesions remained consistently associated across alternative crescent-related outcomes. CONCLUSIONS: In children with IgAVN, crescent formation is associated with a more severe clinicopathological phenotype and should be interpreted in the context of coexisting active and chronic kidney lesions. Kidney biopsy remains essential for defining crescent-related lesions.
Chronic kidney disease of unknown aetiology (CKDu) has emerged as a major public health problem in several regions worldwide. While traditionally considered a disease of adults, the latest evidence suggests that CKDu may...Chronic kidney disease of unknown aetiology (CKDu) has emerged as a major public health problem in several regions worldwide. While traditionally considered a disease of adults, the latest evidence suggests that CKDu may originate early in life. This review summarises current evidence on the epidemiology, aetiology, pathophysiology, and prevention of CKDu from a pediatric perspective. Pediatric studies from endemic regions highlight early markers of kidney injury, including albuminuria, reduced estimated glomerular filtration rate, and evidence of tubular dysfunction. Environmental exposures like unsafe drinking water, agrochemicals, and occupational or climate-related stressors interact with biological vulnerabilities such as low birth weight, malnutrition, and reduced nephron endowment to initiate subclinical kidney injury. Recurrent insults may lead to maladaptive repair, progressive tubulointerstitial fibrosis, and deterioration in kidney function. Early detection and prevention are critical in reducing long-term disease burden. Strategies include improving access to safe drinking water, minimising environmental exposures, and implementing community-based screening programs. However, challenges remain, including limited access to affordable diagnostic tools and insufficient longitudinal pediatric data. Understanding CKDu as a lifelong disease underscores the importance of early-life intervention. A comprehensive, multidisciplinary approach incorporating environmental, clinical, and public health strategies is essential to prevent disease progression and improve long-term outcomes.
BACKGROUND: Shiga toxin-producing Escherichia coli hemolytic uremic syndrome (STEC-HUS) is a leading cause of acute kidney injury in children, but its systemic nature can lead to extrarenal complications. While long-term...BACKGROUND: Shiga toxin-producing Escherichia coli hemolytic uremic syndrome (STEC-HUS) is a leading cause of acute kidney injury in children, but its systemic nature can lead to extrarenal complications. While long-term kidney sequelae are well-documented, data on the long-term consequences of extrarenal involvement are scarce. This study aimed to determine the prevalence of extrarenal complications in STEC-HUS patients, compare acute phase findings between patients with and without extrarenal involvement, and describe the long-term sequelae. METHODS: Retrospective and observational study of 221 children under 18 years old with STEC-HUS admitted between 2005 and 2024. Clinical and laboratory data from the acute phase were analyzed. Extrarenal involvement during the acute phase and the long-term outcome were described. RESULTS: Extrarenal complications were observed in 46 (21%) patients and nearly half of them had compromise of ≥ 2 organs. Central nervous system involvement was the most frequent and the leading cause of death, followed by severe gastrointestinal, cardiac, and ocular compromise. Patients with extrarenal involvement had a significantly higher mortality rate (15.2% vs. 1%, p < 0.0001) and 91% required dialysis. Multivariate logistic regression analysis identified dialysis requirement, leukocytosis > 16,100 cells/mm, arterial hypertension, and dehydration as independent variables associated with extrarenal complications. After a median follow-up of 6.4 years, five patients (11%) developed long-term sequelae: two neurological, two gastrointestinal, and one ocular. CONCLUSIONS: Extrarenal involvement was associated with increased morbidity and mortality and a non-negligible prevalence of long-term sequelae. These findings highlight the importance of screening for extrarenal complications and sequelae during long-term follow up.
BACKGROUND: Children with chronic kidney disease (CKD) and kidney failure face significant symptom burden, which must be considered in clinical practice. We previously reported the development and validation of a patient...BACKGROUND: Children with chronic kidney disease (CKD) and kidney failure face significant symptom burden, which must be considered in clinical practice. We previously reported the development and validation of a patient-reported outcome measure (PROM) for the assessment of CKD symptoms and its impact in children aged 8-18 years (PRO-Kid). This study aimed to assess the validity of modified PRO-Kid tools for children aged 2-7 years. METHODS: The PRO-Kid questionnaire was modified for younger age groups. For children aged 5-7, the Likert scale was replaced with emojis. For children aged 2-4, the questionnaire was completed by a parent proxy. Parents of children aged 2-4 and children aged 5-7 with stages 3-5 CKD including those on dialysis, were recruited from five pediatric nephrology centers in Canada. Semi-structured cognitive interviews were performed during which participants completed the modified PRO-Kid tool and discussed their experience with the questionnaire. Interview notes were collected for content analysis. RESULTS: We recruited twenty-one participants, 11 in the 2-4-year age group, and 10 in the 5-7 years age group. Analysis shows that the modified PRO-Kid was easy to complete and understand, and it captured the most relevant symptoms. Age groups diverged with respect to the 7-day recall period, with the caregivers of the 2-4-year age group preferring a longer recall period. The replacement of a Likert scale with emojis in the 5-7-year age group was well received and understood. CONCLUSIONS: The modified PRO-Kid tool is acceptable as a PROM for assessment of symptoms related to CKD for 2-7-year-old children.
BACKGROUND: Red blood cell casts (RBCC) on kidney biopsy are linked to favorable renal outcomes in adult IgA nephropathy (IgAN), but their role in pediatric IgAN is unclear. This study examined the prevalence and prognos...BACKGROUND: Red blood cell casts (RBCC) on kidney biopsy are linked to favorable renal outcomes in adult IgA nephropathy (IgAN), but their role in pediatric IgAN is unclear. This study examined the prevalence and prognostic value of RBCC in children. METHODS: This retrospective cohort study analyzed 1283 pediatric patients (≤ 18 years) with biopsy-proven IgAN from Jinling Hospital (2000-2020), with a median follow-up of 122 months. The association between RBCC and a composite kidney endpoint (sustained 30% eGFR decline, kidney failure, or kidney-related death) was assessed. RESULTS: RBCC were present in 13.5% of patients. RBCC positivity was associated with active clinical signs (e.g., gross hematuria) yet a significantly lower risk of the composite endpoint (adjusted HR 0.51, 95% CI 0.32-0.85). This protective effect was strongest in patients with preserved kidney function (eGFR ≥ 60 ml/min/1.73 m; HR 0.14) and no tubular atrophy (T0 lesions). The association was weaker in patients with reduced eGFR and not significant in those receiving immunosuppressive therapy. CONCLUSIONS: In pediatric IgAN, RBCC were associated with an active clinical presentation but a more favorable long-term renal prognosis, particularly in patients with early-stage disease. This suggests RBCC may serve as a useful prognostic marker in this population.
Over the past decade, advances in neonatal nephrology have expanded the ability to provide kidney replacement therapy to increasingly smaller and more medically complex infants. The development and adaptation of devices...Over the past decade, advances in neonatal nephrology have expanded the ability to provide kidney replacement therapy to increasingly smaller and more medically complex infants. The development and adaptation of devices designed specifically for infants have facilitated safer delivery of continuous kidney replacement therapy (CKRT), with reduced extracorporeal circuit volumes, smaller filters, lower blood flow requirements, and improved precision of fluid balance. As a result, CKRT use in critically ill neonates continues to increase. Indications for neonatal CKRT include acute kidney injury and fluid overload, as in older children and adults, but also extend to congenital kidney failure and inborn errors of metabolism. The neonatal population presents unique challenges related to vascular access and the need to provide adequate nutrition to support growth. A thorough understanding of solute clearance mechanisms, dosing strategies, device selection, anticoagulation options, and complication management is essential to optimize outcomes. This case-based educational review summarizes current principles, technologies, and available evidence guiding neonatal CKRT practice, with special considerations for neonates receiving prolonged course of CKRT for kidney failure.
Rickard M, Chua ME, Robinson CH
… +10 more, Selvathesan N, Bencardino CM, Kim JK, Khondker A, Bruniera M, Richter J, McKay A, Dos Santos J, Teoh CW, Lorenzo AJ
BACKGROUND: Posterior urethral valves (PUV) is a leading cause of childhood kidney failure requiring kidney transplantation (KT). Although graft survival in transplant patients with PUV has been reported to be similar to...BACKGROUND: Posterior urethral valves (PUV) is a leading cause of childhood kidney failure requiring kidney transplantation (KT). Although graft survival in transplant patients with PUV has been reported to be similar to non-urologic etiologies of kidney failure, differences in long-term graft function and clinically meaningful kidney outcomes remain incompletely characterized. We compared post-KT progression to chronic kidney disease (CKD) in children transplanted for PUV versus non-urological conditions, exploring factors associated with faster decline. METHODS: A retrospective cohort study of pediatric KT recipients transplanted between 2000 and 2024 was conducted. Thirty-one patients with PUV were matched 1:1 by age at KT to males with non-urologic causes. Kidney function was assessed using estimated glomerular filtration rate (eGFR) at fixed time intervals. Time-to-event (TTE) analyses were performed for the development of CKD stage ≥ 3. Multivariable Cox proportional hazards regression evaluated factors associated with progression to CKD stage ≥ 3. RESULTS: Baseline demographic and KT characteristics, including rejection rates, were similar across groups. Patients with PUV had lower eGFR than controls at 1-10 years after KT. Post-transplant urinary tract infections (UTI) were significantly more common in patients with PUV (68% vs. 3%, p < 0.01). TTE analysis demonstrated earlier progression to CKD stage ≥ 3 among patients with PUV. In multivariable Cox regression, rejection was independently associated with progression to CKD stage ≥ 3 after adjusting for infections. Four graft losses occurred in the PUV cohort and none in the control cohort. Exclusion of graft losses did not alter TTE results. CONCLUSIONS: Despite similar KT characteristics and rejection rates, children transplanted for PUV experience more infections and earlier deterioration of graft function and progression to CKD compared with children transplanted for non-urologic causes. These findings suggest the need for long-term, close monitoring and the proactive use of strategies to optimize bladder function in PUV KT recipients.
BACKGROUND: Acute kidney injury (AKI) is a common and serious complication in critically ill children. Data from Southeast Asia remain limited, particularly from high-acuity pediatric centers. This study evaluated the in...BACKGROUND: Acute kidney injury (AKI) is a common and serious complication in critically ill children. Data from Southeast Asia remain limited, particularly from high-acuity pediatric centers. This study evaluated the incidence, associated factors, and outcomes of AKI in a quaternary pediatric intensive care unit (PICU). METHODS: We conducted a prospective cohort study of children aged > 28 days to ≤ 18 years admitted to PICU between 1 July 2023 and 30 June 2024. AKI was defined and staged using Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Demographic and clinical data were collected, and multivariable logistic regression identified factors associated with AKI. Outcomes were assessed at 30 days and 3 months for kidney recovery. RESULTS: Among 422 children analyzed, 83 (19.7%) developed AKI, predominantly pre-renal (77.1%). Stage 3 AKI occurred in 34.9% at onset and 47.0% at peak within the first week. Older age (adjusted odds ratio [aOR] 1.10 per year, 95%CI 1.04-1.16), sepsis (aOR 2.41, 95%CI 1.32-4.38), and use of multiple inotropes (aOR 5.83, 95%CI 2.73-12.46) were associated with AKI. Kidney replacement therapy (KRT) was required in 21.7%. Overall 30-day mortality was 8.8%, compared with 21.7% among children with AKI. At 3 months, AKI resolved in most survivors, although six (7.2%) progressed to chronic kidney disease, including one requiring ongoing dialysis. CONCLUSIONS: AKI affected one in five critically ill children in this PICU cohort, frequently progressed to severe stages. Associated factors included age, sepsis, and inotropic support. Strategies to prevent AKI and enhance timely access to treatments are warranted to improve outcomes.
BACKGROUND: Mid-arm circumference (AC) is typically measured in person to determine cuff size for ambulatory blood pressure monitoring (ABPM). Our objective was to develop a model to predict cuff size using electronic he...BACKGROUND: Mid-arm circumference (AC) is typically measured in person to determine cuff size for ambulatory blood pressure monitoring (ABPM). Our objective was to develop a model to predict cuff size using electronic health record (EHR) data to enable virtual ABPM programs. METHODS: We developed a prediction model for youth 3-21 years in the National Health and Nutrition Examination Survey. Using linear regression, we considered piecewise and polynomial effects of age, sex, height, and weight as predictors of AC. We selected the model with the lowest bootstrapped root-mean-square error (RMSE) and predicted residual error sum of squares with leave-one-out cross-validation. We validated the model in pediatric hypertension clinics at an academic medical center. RESULTS: Based on 34,517 youth in the derivation cohort (median 12 years (25th, 75th percentiles: 7, 16), 49.0% female, 16.6% obesity), the final model included age, age, sex, height, weight, weight, weight, and all possible interactions between age and height and between age and weight (adjusted R, 0.97; RMSE, 1.20). In the external validation cohort of 107 youth (median 14 years (25th, 75th percentiles: 10, 17), 35.5% female, 61.7% obesity), observed and predicted AC were highly concordant (⍴, 0.94) with mean bias of -0.5 cm (95% limits of agreement, -5.2; 4.1). Overall agreement for the correct cuff size was 87.5% in the derivation cohort (weighted κ, 0.92) and 83.2% in the validation cohort (weighted κ, 0.90). CONCLUSIONS: We found substantial agreement between observed and predicted AC using basic EHR data. This model may facilitate ABPM when in-person visits are not feasible.
BACKGROUND: Children with chronic kidney disease may continue to experience respiratory muscle weakness and reduced functional capacity after kidney transplantation. While inspiratory muscle training (IMT) improves respi...BACKGROUND: Children with chronic kidney disease may continue to experience respiratory muscle weakness and reduced functional capacity after kidney transplantation. While inspiratory muscle training (IMT) improves respiratory muscle strength, evidence on the combined use of IMT and expiratory muscle training (EMT) is limited. This study investigated whether an 8-week combined IMT + EMT program integrated with chest physiotherapy improves pulmonary function, respiratory and peripheral muscle strength, and functional capacity in pediatric kidney transplant recipients compared with chest physiotherapy alone. METHODS: In this single-blinded randomized controlled trial, 30 pediatric kidney transplant recipients (8-18 years) were randomized to an experimental group (EG; n = 15) receiving combined IMT + EMT plus chest physiotherapy or a control group (CG; n = 15) receiving chest physiotherapy with sham training. Pulmonary function, respiratory and peripheral muscle strength, and functional capacity were assessed at baseline and after 8 weeks. RESULTS: Significant time × group interactions were observed for pulmonary function parameters, with greater improvements in the experimental group (FVC: + 11.53 vs. + 1.06; FEV₁: + 8.40 vs. - 1.06; PEF: + 10.20 vs. - 3.13; all p < 0.01). Maximal inspiratory and expiratory pressures increased more in the experimental group (MIP: + 8.66 vs. + 4.13 cmH₂O; MEP: + 12.73 vs. + 2.06 cmH₂O; p < 0.05). Functional capacity (6-min walk test) improved in both groups but was significantly greater in the experimental group (+ 49.46 m vs. + 13.33 m; p = 0.006). No significant between-group differences were observed in exercise-related dyspnea or fatigue. CONCLUSIONS: Combined IMT + EMT integrated with chest physiotherapy significantly improved pulmonary function, respiratory muscle strength, and functional capacity in pediatric kidney transplant recipients, suggesting it is a valuable adjunct in post-transplant rehabilitation.
BACKGROUND: Hypertension remains one of the most prevalent modifiable risk associations for adverse outcomes in children receiving dialysis. Despite this, limited longitudinal data exist regarding ambulatory blood pressu...BACKGROUND: Hypertension remains one of the most prevalent modifiable risk associations for adverse outcomes in children receiving dialysis. Despite this, limited longitudinal data exist regarding ambulatory blood pressure monitoring (ABPM) and cardiac outcomes in children and young people (CYP) initiating dialysis. METHODS: This is a retrospective, longitudinal study of CYP age 5-18 with paired echocardiogram and ABPM evaluations over 12 months ("baseline" to "follow-up") following dialysis initiation. Left ventricular hypertrophy (LVH) was defined by age-specific indexed left ventricular mass (LVMI) and LV mass-for-height z-score ≥ 95th percentile. Hypertension was defined if day, night, or 24-h ABPM ≥ 95th percentile and CYP was categorised as having persistent hypertension, resolved hypertension, persistent normotension, or emergent hypertension. RESULTS: There were 32 CYP, with a mean age of 12.7 ± 3.1 years. LVH was present in 37.5% at baseline and 25% at follow-up. LVH rates improved on haemodialysis (baseline 52.9%, follow-up 17.6%, P = 0.031), but not on peritoneal dialysis. Higher rates of hypertension were found in LVH versus no LVH at follow-up. Masked hypertension rates was present in 14 (43.8%) at both baseline and follow-up. Mean LVMI was higher in persistently hypertensive versus persistently normotensive CYP at follow-up. ΔLVMI was independently associated with LVH at baseline (yes/no) (β = -0.482, P = 0.001), and Δlog N-terminal pro-brain b-type natriuretic peptide (NT Pro-BNP) (β = 0.412, P = 0.005). CONCLUSIONS: CYP with persistent hypertension had worst rates of LVH and indexed LV mass. A correlation between changes in NT Pro-BNP and LVMI highlights a probable role of fluid overload. Further research into using NT Pro-BNP as a biomarker to improve hypertension management is warranted.
González-Río E, Muñiz-Morilla M, García-Fuentes A
… +6 more, González-Navarro P, Vellosillo-González P, Fernández SN, de la Mata S, López-Herce J, Santiago MJ
BACKGROUND: Continuous kidney replacement therapy (CKRT) in children under 12 months of age is challenging. This study aimed to compare complications and mortality between patients younger and older than 12 months receiv...BACKGROUND: Continuous kidney replacement therapy (CKRT) in children under 12 months of age is challenging. This study aimed to compare complications and mortality between patients younger and older than 12 months receiving CKRT and to identify independent mortality risk factors. METHODS: Retrospective observational study of pediatric patients treated with CKRT using adult devices in a tertiary hospital (2010-2023). Demographic, clinical, laboratory data, and complications were analyzed. Independent predictors of mortality were identified using multivariate logistic regression. RESULTS: A total of 186 patients were analyzed; 69% had heart disease. Common complications were catheter replacement (29%), hypotension during connection (28%), bleeding (27%), and hypocalcemia (27%). Overall mortality was 31%. Compared with older children (n = 105), infants under 12 months (n = 81) had greater illness severity, more frequently required ECMO support (57% vs. 25%, p < 0.001) and higher rates of catheter replacement (37% vs. 23%, p = 0.02), hypomagnesemia (23% vs. 10%, p = 0.008), and hypothermia (32% vs. 15%, p = 0.005), but less hypocalcemia (19% vs. 33%, p = 0.017). Mortality was higher among infants (41% vs. 23%, p = 0.007). In multivariate analysis, bleeding (OR 3.16, 95% CI 1.49-6.75, p = 0.003), initial lactate > 3 mmol/L (OR 2.99, 95% CI 1.32-6.87, p = 0.009), and normal initial creatinine (OR 3.20, 95% CI 1.35-7.78, p = 0.009) were independently associated with mortality. CONCLUSIONS: Children under 12 months compared to older children had greater illness severity, more ECMO support, and higher rates of catheter replacement, hypomagnesemia, hypothermia, and mortality, but less hypocalcemia. Independent mortality predictors were bleeding, initial lactate > 3 mmol/L, and normal initial creatinine levels.
BACKGROUND: This study compared urinary stone composition and clinical characteristics between Tibetan and non-Tibetan children in Western China. METHODS: This retrospective cross-sectional study included 237 children (a...BACKGROUND: This study compared urinary stone composition and clinical characteristics between Tibetan and non-Tibetan children in Western China. METHODS: This retrospective cross-sectional study included 237 children (aged 0-14 years) with urolithiasis hospitalized at West China Hospital (2008-2023). Stone composition was analyzed via Fourier-transform infrared spectroscopy. Independent associations were evaluated using multivariable logistic regression, alongside a sensitivity analysis restricting controls to Han Chinese (N = 198). RESULTS: A total of 237 children were included (Tibetan, n = 121; non-Tibetan, n = 116). Calcium oxalate was the most frequently identified component in both groups (84.0%). Ammonium urate was significantly more prevalent among Tibetan children (35.5% vs. 14.7%, P < 0.001), with this disparity most pronounced among males (38.9% vs. 17.7%, P = 0.004) and toddlers (47.2% vs. 10.3%, P = 0.003). In multivariable logistic regression, Tibetan ethnicity was independently associated with the ammonium urate component across all models (adjusted OR 2.32, 95% CI 1.12-4.80, P = 0.023). The sensitivity analysis restricted to Han Chinese and Tibetan children (N = 198) yielded consistent and stronger effect estimates (adjusted OR 4.10, 95% CI 1.47-11.49, P = 0.007). Tibetan children also exhibited lower Prognostic Nutritional Index scores (P = 0.004) and serum uric acid levels (P = 0.002) across analyses. CONCLUSION: Tibetan children exhibit a distinct urolithiasis profile with elevated prevalence of ammonium urate. This association, most pronounced in young children and males, may reflect nutritional and environmental factors linked to high-altitude residence, underscoring the need for ethnicity-informed prevention strategies.
Hearing loss (HL) and chronic kidney disease (CKD) are conditions with high prevalence worldwide. Patients with oto-renal disorders are reported to have both syndromic forms of HL and kidney dysfunction due to common mol...Hearing loss (HL) and chronic kidney disease (CKD) are conditions with high prevalence worldwide. Patients with oto-renal disorders are reported to have both syndromic forms of HL and kidney dysfunction due to common molecular signaling pathways. The major shared genetic factors, common developmental pathways, and physiological mechanisms adversely affect the auditory and kidney systems. This review consolidates the common morphogenic origins of the kidney and the cochlea, which focus on the major shared genes, networks, and oto-renal disorders that affect the cilia, collagen networks, and transport channels in both systems. This article shines a spotlight on mechanisms and pathophysiology of the major congenital disorders causing HL and kidney diseases. In addition to this, other risk factors including hemodialysis and certain drugs increase the risk of HL in patients with CKD. This review can help clinicians navigate options for differential diagnosis of oto-renal disorders. An interdisciplinary approach across nephrologists, audiologists, pediatricians, and geneticists can pave the way for effective screening, diagnosis, and treatment interventions. This also underscores the importance of future research on the ear-kidney axis to understand molecular signaling, biomarker discovery, and clinical management.