Chronic Kidney Disease and PUV Care

Uh, I just wanna thank Doctor Reddy and Nicole for inviting me to be a part of this amazing team. Um, again, I'm Donna Clace, and I am one of the pediatric nephrologists here at Cincinnati Children's Hospital. Um, so my, um, interest, academic interest is in chronic kidney disease and end-stage renal disease. Um, so one, again, I am very blessed to work at Cincinnati Children's and to have such a strong relationship with urology. But definitely kidneys and bladders go together. And so therefore we work together to really provide the best care we can. Um, before we get started, I do just want to make a quick definition of chronic kidney disease. So, the true definition of chronic kidney disease is a state of renal dysfunction for greater than or equal to 3 months. That's the chronic part of this, that leads to further renal dysfunction. So again, if your baby is born with PUV, by definition, they've had that longer than 3 months. So again, they would have some chronic kidney disease. And what we know is that chronic kidney disease is a progressive illness, so it can and will lead to further dysfunction. Um, and one of the endpoints is definitely it can lead to what's called end-stage renal disease, which is where the kidneys can no longer support basic, um, life in terms of the ability to keep the blood clean, and as well as to provide appropriate fluid balance. Um, and so end-stage renal disease is, again, is a lifelong treatment, requires lifelong treatment with either a kidney transplant or some form of dialysis. And the goal of nephrology care is really directed to slow down the progression of the loss of kidney function. So again, we, there is no cure for chronic kidney disease, but what we can do is try to medically manage patients so that way we can protect their kidneys and try to help them maintain their normal kidney function or, or kidney function for as long as possible and really try to slow that decline. So one of the things again working with Dr. Reddy and Nicole is we did come up with some basic screening for the PUV centers. Um, so we know that about 80% of the patients at Cincinnati Children's with PUV appear to have pretty normal kidney function, which is what we would call CKD stage 1. So again, someone who has some abnormality on imaging, um, but has otherwise normal kidney function. Um, but what we have instituted is again, a screening protocol within urology that involves getting a year, a yearly urinalysis and at minimum, um, yearly blood work that helps us understand if there is any loss of kidney function, um, as well as getting a good blood pressure. And so we've definitely set into place that. Um, a referral to nephrology is indicated in patients with PUV who either have CKD stages 2 through 5. So again, these are patients whose kidney function is a little bit less than normal. Um, again, normal kidney function, we say is greater than 90% of normal, um, who have an elevated blood pressure or hypertension or who have some elevated protein in the urine, also called proteinuria.