Clinical Activity
Related Nephrology Links
- For more information about the clinical activities of the Division of Nephrology, visit the Division's clinical web pages.
- For more information about fellowship opportunities in nephrology, visit the Division's fellowship pages.
The Division of Nephrology and Hypertension at Cincinnati Children's Hospital Medical Center has had a long-standing interest in the relationship between the human complement system and immune-mediated renal disease. This emphasis extends to the Division's clinical laboratory, which provides a number of services helpful in the diagnosis and management of patients with immune-mediated disease, suspected immunodeficiency, and a variety of renal disorders.
For extensive information, visit the Clinical Laboratory's Services Page.
Serum Protein Profile (SPP)
A quantitative nephrometric determination of eight serum proteins (IgG, 19A, IgM, C3, C4, Albumin, Transferrin, and C reactive protein), which may be ordered singly or as a group. The measurements are of value in diagnosis of acquired or congenital immunodeficiencies, iron deficiency. and they aid in distinguishing the various forms of glomerulonephritis including lupus, membranoproliferative and acute poststreptoccal. The SPP may also be abnormal with certain viral infections, IgA nephropathy, nephrotic syndrome, and in conditions associated with chronic inflammation. A physician interprets all SPPs.
Complete Complement Profile
Measurement of 15 of the 19 proteins that make up the serum complement system. Of value in distinguishing the various types of Gomeru1onephritis (Membranoproliferative types I, II and III, acute poststreptoccal and lupus) and in detecting inherited complement deficiencies, which may predispose to hereditary angioneurotic edema, lupus or lupus-like illness and recurrent infection, particularly neisserial. A physician interprets all complement profiles.
C3 Nephritic Factor
An autoantibody that depresses the level of serum C# and other complement components. In general, the measurement, together with the complement profile, aids in distinguishing the various hypocomplementemic glomerulonephritides. Measurement is of particular value in distinguishing membranoproliferative glomerulonephritis (MPGN) type II from MPGN type III. The autoantibody may produce the nephritis but the level is not closely associated with the clinical course.
Glomerular Filtration Rate (GFR)
Offers a precise determination of kidney function. Our lab offers two methods for GFRs, nuclear and non-nuclear. The nuclear method is done in conjunction with the Nuclear Medicine Department at CHMC. A precisely measured amount of radioactive technetium 99m is injected into the patient. After two hours, three timed blood samples are drawn. The amount of radioactivity in each sample is measured and the GFR is calculated.
Urine Microalbumin
Quantitation of low rates of albumin excretion helpful in detecting early diabetic nephropathy and mot1itoring its course.
IgG Subclasses
A nephelometric measurement of total IgG and of the four IgG subclasses, deficiencies of which can be associated with recurrent infection, particularly of the respiratory tract. A physician interprets the results.
Urine Orthostatic Protein Excretion Test
This test distinguishes orthostatic proteinuria, a benign condition, from proteinuria associated with glomerular disease. A specimen of first morning voided urine and that formed later in the day after activity are collected on each of three days and the protein concentrations compared.
Hereditary Angioneurotic Edema (Hane) Profile
Immunological (RID) measurement of C1 inhibitor, C2, C3 and C4. Distinguishes HANE from other urticarias.
Nutritional Complement Profile
Distinguishes low levels of C3 resulting from undernutrition from those due to complement activation. Immunological (RID) measurement of C3, factor B, factor H and factor 1.
The Division of Nephrology's clinical activity has been varied and busy. At Cincinnati Children's main campus, outpatient activity is centered in the Pediatric Kidney Institute Clinical Center in the new Nephrology Treatment Center in Location A. The Division also conducts outpatient clinical care at Cincinnati Children's Outpatient locations in Fairfield, Mason, and Turfway. Our total outpatient volume experienced another increase in the past year. At these outpatient sites, care is provided for children with the gamut of urinary tract disorders, especially in the areas of our particular expertise such as glomerulonephritis and nephrotic syndrome, complex urinary tract anomalies in young infants, and disorders of mineral metabolism.
The division's inpatient activity reflects the overall increase in complexity of care in the institution. Acute renal failure is a common accompaniment of critical illness in children, and the division faculty has particular expertise in the new extracorporeal filtration methods to treat this complication. John Bissler, MD, has published some of the earliest technical descriptions of the use of these methods in children, and Dr. Bissler continues to work on a project whose aim is to improve such equipment.
Cincinnati Children's End-Stage Renal Disease Program also continues to be busy. The dialysis program, directed by C. Frederic Strife, MD, and the transplant program, medically directed by Jens Göbel, MD, have recently expanded their service area and are among the largest such programs is any pediatric hospital in the United States.
Faculty in the division are also exploring cardiovascular and metabolic issues as it relates to the long-term outcome of pediatric kidney transplant recipients. This includes efforts by Jens Göbel, MD, to design and modify immunosuppressive protocols for these patients and to improve their overall long-term management to minimize the significant late complications this population experiences. Of note, Dr. Göbel continues efforts to link these clinical research efforts with more basic work in a truly translational, "bench-to-bedside-and-back" sense.
