Prasad Devarajan, MD
Dr. Devarajan has continued with a wide spectrum of approaches to kidney health and disease processes, spanning from molecular, genomic and proteomic approaches to human observational and clinical trials. Dr. Devarajan is the Director of the newly NIH-funded P50 Center of Excellence in Nephrology, a unique multi-disciplinary research program designed to support basic, translational, and clinical research on critical pediatric kidney diseases that have major unmet needs. The proposal includes three Primary Research projects are proposed in the areas of acute kidney injury, proteinuric kidney disease, and lupus nephritis, with participation from recognized teams of investigators from multiple disciplines. Also included are high-resource Gene Expression, Proteomics, and Biomarker Cores with Core Leaders of international repute to support the study of the three focus areas. In addition, six Pilot and Feasibility projects will be funded in the three areas of research focus. Dr. Devarajan is the center PI and/or nephrology lead investigator for several NIH-funded prospective clinical studies. He has established a Kidney Biomarker Laboratory which now performs more than 40 distinct assays for acute and chronic kidney disease biomarkers. Dr. Devarajan’s ground-breaking research on biomarkers and new therapeutic targets in kidney diseases has yielded over 20 publications and several patent applications during the last fiscal year.
Stuart L. Goldstein, MD
Dr. Goldstein is the Director of the Center for Acute Care Nephrology (CACN), and has had a very productive research year, with achievements that spanned the scope of the Center’s research missions. The nephrotoxic medication acute kidney injury (AKI) reduction project, NINJA, resulted in a 33% reduction in AKI, and the associated manuscript was accepted for publication in Pediatrics. The CACN also is coordinating the international pediatric contribution to the DIRECT study, which is a genome wide association study for nephrotoxic medication associated AKI; currently 15 pediatric centers have signed on to this project. The CACN is also coordinating the NICHD sponsored Pediatric Opportunistic Pharmacokinetic Study arm of the Pediatric Trials Network. Other ongoing research projects include validation of the Renal Angina risk stratification concept in the Pediatric ICU population, validation of novel AKI biomarkers in the ICU, and well as international multicenter AKI trials as part of the Prospective Pediatric AKI Research Group, which is housed in the CACN.
Elizabeth C. Jackson, MD
Dr. Jackson is the Director of the Healthy Bladder Clinic, and continues her active research program in optimizing the management of nocturnal enuresis. She is completing a randomized prospective trial comparing the effectiveness of the voice recordable alarm with the buzzer alarm for nocturnal enuresis. Preliminary results suggest that the voice alarm may lead to a lower dropout rate, and have been presented at national scientific meetings.
Bradley Dixon, MD
Dr. Dixon’s laboratory is focused on the mechanisms by which cells protect themselves from hyperosmolality in order to survive. One aspect of Dr. Dixon’s research is whether hyperosmolality of the bladder environment may interfere with the identification of damage to a cell’s DNA, leading to accumulation of mutations and ultimately an increased risk of cancer. Another aspect of Dr. Dixon’s laboratory research is studying how kidney cells can sense the degree of hyperosmolality around them in order to switch on vital cellular programs to withstand these conditions. Finally, Dr. Dixon is involved in clinical research with a focus on disorders of blood vessel inflammation and clotting known as thrombotic microangiopathies. Dr. Dixon is particularly interested in making clinical testing for the two major forms of thrombotic microangiopathy, aHUS and TTP, more efficient and meaningful as well as investigating new tests that can help to distinguish these two disease processes.
Mark Mitsnefes, MD, MS
Dr. Mitsnefes’ research interest has been to define biologic targets for interventions to prevent progression of cardiovascular disease in children with chronic kidney disease, through epidemiological and translational studies. Dr. Mitsnefes is a co-investigator and co-chair of the Cardiovascular Subcommittee in the multicenter NIH funded study of chronic kidney disease in children, the CKiD study. In one published study, the CKiD investigators examined the frequency of hypertension based on both office and 24-hour ambulatory blood pressure monitoring (ABPM). This study indicated that ABPM should be used to monitor blood pressure and guide treatment of hypertension in children with chronic kidney disease. Another published CKiD study provided evidence that children with chronic kidney disease are at increased cardiovascular risk, because the majority of these children were hypertensive and dyslipidemic, and over a quarter of them were either overweight or obese. In addition, these children had significantly greater carotid artery intima-medial thickness, an early marker of atherosclerosis.
Edward Nehus, MD, MS
Dr. Nehus’ research interest is in comparative effectiveness research with special emphasis on long-term outcomes of pediatric kidney transplant recipients. Other research interests include pharmacokinetic alterations that occur in children receiving continuous renal replacement therapy and the use of novel technologies for the estimation of kidney function. This past year, he completed the first nationwide study that investigated trends and graft outcomes of steroid avoidance in children who receive kidney transplants. Dr. Nehus’ research demonstrated that steroid avoidance can be safely practiced without conferring increased risk of graft failure, and therefore is an attractive option to avoid steroid-related morbidity. He also published two analyses evaluating cystatin C for the estimation of kidney function in high-risk patient populations.
Michael Bennett, PhD
Dr. Bennett is the Director of the Cincinnati Children’s Hospital Medical Center Biomarker Laboratory and Co-Director of the Center of Excellence in Pediatric Nephrology Proteomics Core. His primary research interests include biomarkers and mechanisms of nephrotic syndrome and lupus nephritis. A major accomplishment this past year was the discovery of an investigational panel of biomarkers that can distinguish steroid sensitive from steroid resistant nephrotic syndrome. This panel has the potential to assist physicians in the early diagnosis of steroid resistance and help them to tailor more appropriate treatment plans for patients with this serious and progressive disease.
David Hooper, MD, MS
Dr. Hooper’s research interests lie in improving clinical outcomes for children with kidney disease through the design of reliable healthcare systems. His primary focus is to combine clinical outcomes research with quality improvement methodology to reliably prevent cardiovascular disease, the leading cause of long-term death and disability in children with kidney disease. During the past year, Dr. Hooper has published two important papers describing the variation in preventive cardiology care across six pediatric nephrology centers and demonstrating the ability to improve population cholesterol control by applying reliable systems of chronic disease management. Dr. Hooper has developed the capability to study the impact of care transformation on blood pressure control in kidney transplant recipients. Additionally, Dr. Hooper has helped design a sophisticated comprehensive web-based pre-visit planning tool that integrates medical record data, medication pharmacokinetic data and patient adherence data to provide decision support in kidney transplant care.
Rene Vandevoorde, MD
Dr. Vandevoorde is the Medical Director of Dialysis. His research interest lies in the different sequelae of chronic kidney disease in children with a focus on end stage renal disease and dialysis. He participates in multi-center studies or registry based analysis of interventions and outcomes. Particular areas of study include anemia management, bone and mineral disease, growth, psychosocial development, and associated morbidities of dialysis. He is the lead investigator for two current studies looking at the safety and efficacy of drugs in advanced chronic kidney disease: an intravenous iron supplement currently used in adults and a calcimimetic agent which binds the calcium-sensing receptor of the parathyroid gland. Our dialysis unit is also one of 27 pediatric units examining factors to reduce the rate of peritonitis in children receiving peritoneal dialysis. This project has shown a 27% reduction in infection rates so far after only one year of analysis. With this success, we are now embarking on applying similar interventions to reduce the rate of blood stream infections with hemodialysis catheters.
Jens Goebel, MD
Dr. Goebel is the Clinical Director of Nephrology and Medical Director of Kidney transplantation. His research interests focus on a better understanding of immune mechanisms affecting transplant outcomes. He has continued to advance knowledge about immunosuppressive agents used in pediatric kidney transplantation, and about renal issues in pediatric bone marrow transplantation. Examples for the former include the use of pharmacogenetics to better predict patients’ responses to drugs such tacrolimus or mycophenolate and the application of advanced immune phenotyping to further characterize possibly tolerogenic effects of sirolimus. Examples for the latter are ongoing work in pediatric bone marrow transplantation to further characterize the role of BK virus as a significant pathogen in that field and to develop novel insights into thrombotic microangiopathy, a dreaded complication seen in patients who receive bone marrow transplants. Dr. Goebel also remains actively involved in work focusing on adherence and quality improvement in pediatric kidney transplantation, and he continues his role as center-PI for the CKID study, a large, NIH-sponsored effort to better understand the effects of chronic kidney disease in children over time.