New findings in patients with pediatric kidney failure

Nov 28 2005

Two studies just released by physicians at Texas Children's Hospital are addressing new findings in patients with pediatric kidney failure, and on the growing prevalence of high blood pressure in children.

Dr. Stuart L. Goldstein, medical director of the Renal Dialysis Unit at Texas Children's Hospital, and associate professor of pediatrics, Baylor College of Medicine, and Dr. Daniel I. Feig, chief of the Pediatric Hypertension Clinic's at Texas Children's and Ben Taub General Hospital, and assistant professor of pediatrics, Baylor College of Medicine, were two of only five physicians nationwide to have their pediatric projects selected for the conference's pediatric briefing.

Dr. Goldstein's study "Mild Renal Insufficiency is Associated with Poor Outcome in Children with Acute Decompensated Heart Failure: Evidence for a Pediatric Syndrome" stems from a collaboration between the Renal and Cardiology departments. While adults frequently develop acute renal failure (ARF) during episodes of acute decompensated heart failure (ADHF), data has lacked for children. The research done by Dr. Goldstein and his colleagues aimed to determine the incidence and severity of ARF in children with ADHF, and to see if ARF development affects patient outcome.

The study found that very mild degrees of kidney failure was indeed associated with significant risk of poor outcome for children, including longer hospital stays and an increased incidence of in-hospital death. The findings also show that detecting kidney injury early is key to improving the outcome of children with ADHF. "These findings are new for pediatrics, and are really on the cutting edge for all of medicine, as a similar finding was recently found in adult patients," said Dr. Goldstein. The Texas Children's team is one of only two pediatric groups currently involved in these studies, and Dr. Goldstein estimates that nearly 4,000 children a year develop acute kidney failure. He notes however that the research is also applicable in adult patients, where the numbers are much higher.

Dr. Feig's study, "Hypertension in Children and Adolescents Is Not A Silent Disease," focuses on the rising number of children with high blood pressure. "Previously thought of as a silent disease, the study aimed to prove that appropriate screening and management of high blood pressure in children can relieve a lot of non-specific suffering of children, and by extension, their parents," explains Dr. Feig. Findings from the research showed that 64 percent of hypertensive children complain of one or more frequent symptoms, which is three times more often than children with normal blood pressure. According to the study, the most common symptoms of hypertension in children are headaches, difficulty falling asleep, daytime tiredness, chest pain and abdominal pain. Dr. Feig also notes that for most hypertensive children who go un-treated, becoming hypertensive adults and being at risk for heart disease, stroke and renal disease isn't a matter of if but a matter of when.

Conclusions of the research show that lowering high blood pressure in children is achievable if taken seriously. This means that children's blood pressure must be screened at every check-up and that possible physical symptoms must be monitored and treated accordingly. As one of the largest hypertension clinics in North America, the Texas Children's clinic currently follows close to 1,000 hypertensive children and evaluates five to eight new patients each week.