Prasad Devarajan, MD

The research of Prasad Devarajan, MD, includes 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 National Institutes of Health (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 several research projects in the areas of acute kidney injury, cardio-renal syndromes, and kidney fibrosis, with participation from recognized teams of investigators from multiple disciplines. Also included are high-resource gene expression, proteomics, biomarker, enhancement, and training cores with core leaders of international repute. During the past year, the center received renewed funding from the NIH for another five years. Dr. Devarajan is the nephrology lead investigator for several NIH-funded prospective clinical studies. He established a unique kidney biomarker laboratory which now performs more than 50 distinct assays for acute and chronic kidney disease biomarkers. Dr. Devarajan is also the director and principal investigator (PI) of the NIH T32-funded Nephrology/Hypertension Fellowship, funding for which was successfully renewed last year for another five years. Dr. Devarajan’s research on biomarkers and new therapeutic targets in kidney diseases yielded over 20 publications and new patent applications during the last fiscal year. He is currently the PI or Co-PI on eight NIH grants.

Stuart L. Goldstein, MD

Stuart Goldstein, MD, FAAP, FNKF, is the director of the Center for Acute Care Nephrology (CACN), and had a very productive research year, with achievements that spanned the scope of the CACN’s research missions. The nephrotoxic medication acute kidney injury (AKI) reduction project, NINJA, resulting in a seven-year sustained reduction in AKI and prevention in more than 800 children, spread to 13 US pediatric centers. This collaborative already observed a 23% sustained decrease in nephrotoxic medication exposure and associated AKI. Based on these results, implementation began in the 140 pediatric hospital Solutions for Patient Safety Collaborative. The CACN reported on the importance of assessing urine output for AKI development, which is often overlooked, in a study published in Pediatric Critical Care Medicine titled, “Comprehensive Ascertainment of Acute Kidney Injury Requires Assessment of Serum Creatinine and Urine Output in Critically Ill Children”.

The CACN successfully integrated its real-time AKI risk stratification system, the renal angina index (RAI), to guide novel AKI biomarker testing in critically ill patients in the PICU. The system received funding by the Nephrology P50 Center of Excellence grant to use the RAI/NGAL data in real time to drive clinical decision support. The CACN pioneered applications of specialized techniques, such as aquapheresis and the Molecular Adsorbent Recirculating System, for liver support. The CACN participated in a three center retrospective study detailing pediatric application of the Aquadex device, published in the Clinical Journal of the American Society of Nephrology. The CACN also launched an LDL-apheresis program to treat patients with refractory FSGS and offered this therapy for the first time to adults with Lipoprotein-A elevations, which increases risk for atherosclerotic heart disease. The CACN remains the only single center in the US to offer all of these specialized novel extracorporeal techniques. In addition, the CACN demonstrated unparalleled commitment to education via the CRRT University Simulation course, offered to more than 700 RNs and MDs from all over the world. Finally, the CACN hosted three separate workshops for major CRRT device manufacturers, leveraging our simulation center to perform essential usability testing that was part of the FDA submission process for pediatric device approval.

Mark Mitsnefes, MD MS

The research interest of Mark Mitsnefes, MD, MS, is to define biologic targets for interventions to prevent progression of cardiovascular disease in children with chronic kidney disease (CKD), 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. During the past year, he published in the Journal of Pediatrics a critical study showing high prevalence of metabolic syndrome in children with CKD. Another high-impact study published in Hypertension examined changes in blood pressure (BP) in children with CKD over last decade, showing no improvement in BP control despite better awareness about side effects of elevated BP.

Dr. Mitsnefes also serves as a co-investigator and training program director of AHA-funded Ship Ahoy study (Study of High BP in Pediatrics; Adult Hypertension Onset in Youth). An important publication last year includes a study predicting ambulatory hypertension by clinic BP published in Hypertension. The study determined that clinic systolic BP of 85th percentile is the optimal threshold at which to perform ambulatory BP monitoring.

In the past year, the Division of Nephrology and Hypertension under Dr. Mitsnefes’ leadership, launched an innovative ambulatory blood pressure monitoring (ABPM) clinic, which resulted in increased ABPM utilization by 50% compared to the previous year. Dr. Mitsnefes also completed the first 10-month educational course on pediatric hypertension for primary care physicians through the ECHO program led by the Center for Telehealth.

Dr. Mitsnefes continues as program director for the Schubert Research Clinic at Cincinnati Children's. In this capacity, he is leading the Participant and Clinical Interactions (PCI) core of the (CCTST) at the University of Cincinnati.