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The quest to improve outcomes of chronic kidney disease – and train the next generation of providers – drives our nationally ranked division of Nephrology.

One out of every six adults in the U.S. has chronic kidney disease (CKD) – and for a growing number of these adults, the problems begin in childhood.

Nephrologists at Seattle Children’s are working to develop new therapies for these diseases in children – with a goal of stemming the 500% higher risk of premature death from heart attack or stroke faced by adults with CKD.

Dr. Allison Eddy is a driving force behind the push to find novel therapies for childhood renal disease that will improve outcomes for children and adults far beyond the Northwest.

Raising the divison’s profile

Eddy Nephrology 220x130 Eddy has grown her team to continue the legacy of innovation started nearly 50 years ago when Dr. Robert Hickman, inventor of the Hickman catheter, founded Children’s Division of Nephrology.

Under her leadership, the division boasts one of the largest and most productive pediatric basic science and clinical research programs in the nation and offers two highly sought after fellowship spots each year.

Eddy’s commitment to providing exceptional patient care launched the division into the national spotlight in 2010. Children’s is second in the nation for treating kidney disorders, according to U.S. News and World Report’s annual America’s Best Children’s Hospitals issue.

Spearheading international collaboration

After a six-year stint as deputy editor of the Journal of the American Society of Nephrology, Eddy was elected to the council of the International Society of Nephrology (ISN) in 2009. She is only the second pediatric nephrologist to hold this position in an organization that was founded 50 years ago.

Currently, she is helping to establish collaborative agreements between the ISN and the International Society of Pediatric Nephrology (ISPN), so that the two organizations can begin partnering on joint education and training missions to improve outcomes for adult and pediatric patients with chronic kidney disease (CKD) around the world.

Broad breadth of research at Children’s

Halting scarring of the kidney: Eddy’s research investigates the cellular and molecular pathways that cause organ scarring in congenital and acquired kidney disease.

“I’d like to find new ways to prevent people from losing their kidneys,” she says.

Making transplanted kidneys last:

McDonald Nephrology 220x130Drs. Ruth McDonald and Jodi Smith are advancing the standard of care and improving outcomes for children and teens with transplanted organs.

The duo pushed for individualized immunosuppression protocols for all Children’s transplant patients. Their work to tailor medications for each child – both pre- and post-transplant – is unique among transplant centers and is one reason why Children’s long-term outcomes for patient and organ survival are outstanding for a center of our size and degree of patient medical complexity.

Smith and McDonald were instrumental in pioneering viral surveillance methods that have improved outcomes for transplant patients. Today, these screenings are standard of care. Children and teens across the nation are routinely screened for common viruses that can attack the body and transplanted kidney if immunosuppression levels are too high.

The pair also led the way for steroid-free immunosuppression protocols – an advance that reduced the risk of high blood pressure and eliminated unwanted side effects such as weight gain and stunted growth.

They recently received a National Institutes of Health (NIH) grant to study why teens have a hard time taking their medications and to develop strategies that will help them succeed. One feature of the ‘TAKE-IT’ study will be the use of technology to inform providers how often teens open their pill boxes!

Tracking the kidney’s response to viruses:

Jodi Smith 220x130Smith’s latest published research investigates subclinical levels of viruses that produce no symptoms. The results from both single-center and multi-center studies indicate that children who carry these viruses have more kidney damage two years after transplant than other transplanted kids – an important finding in the quest to extend the life of the organ. The study, which was the result of an NIH K23 or “mentored” grant for junior faculty members, was published in the Journal of the American Society of Nephrology in 2010.

“The body’s immune system ramps up to get to get rid of a virus,” explains Smith. “But when the immune response ramps up, it may cause inflammation in the kidney, which can lead to permanent scarring and loss of function.”

Smith is awaiting NIH R01 grant funding as an independent investigator to study how the virus damages the kidney. Her goal is to find a way – perhaps a drug therapy – to prevent the injury from ever taking place.

Reducing the pressure:

Persistent high blood pressure, or hypertension, kills millions of adults every year. The incidence of hypertension in children has increased 500% in the past 30 years. It’s now more common than Type II diabetes and, if unchecked, will result in an entire generation of kids having heart and kidney disease in their 30s and 40s. Although some childhood hypertension is related to congenital heart or kidney conditions, most of the increase is linked to the obesity epidemic.

Dr. Joseph Flynn is working to understand how this devastating trend affects children.

An expert on pediatric hypertension, Flynn helped develop the national clinical guidelines for how pediatric hypertension should be treated. He joined Children’s in 2007 and started the region’s only clinic aimed at addressing the needs of the growing number of children afflicted with hypertension.

His latest research, published in Pediatrics, shows there’s an increased prevalence of hypertension in African-American children and that their symptoms are more severe. When their blood pressure is elevated, it’s higher than in other groups of children; and they are more likely to suffer from left-ventricular hypertrophy, a dangerous thickening of the heart muscle.

Flynn hopes the findings put pediatricians on alert: black children with hypertension may develop complications – like heart and kidney disease – quicker or more severely than children of other races.

There's been a 500% increase in the number of children with hypertenstion since 1980.

Training the next generation

Today there is a national shortage of pediatric nephrologists in the United States. Fewer than 200 providers devote 75% of their time to clinical practice and half of them are older than 55, giving nephrologists the oldest average age of any pediatric subspecialty.

To help replenish this critical resource shortage, Eddy and the rest of the faculty members in the division are passionate about training junior pediatricians for careers in clinical nephrology practice and research at academic medical centers.

“Our program is different from a lot of other programs because our mission is to train people who will have a passion for teaching and research,” says Eddy. “It’s really fun to guide young and enthusiastic pediatricians.”

Since 1990, the division has trained 26 NIH-funded fellows, and 100% of them are working full-time in pediatric nephrology – a track record that is unique among peer programs. Nearly 90% of program graduates have university faculty appointments; the rest work in children’s hospitals not affiliated with academic institutions. Currently, seven pediatricians are enrolled in our nephrology fellowship program.

“Training is a lifelong investment in people,” says Eddy. “I recently got a phone message from a graduate saying, ‘I just want you to know that this is my first week on call and I feel so well prepared for this position. You guys offer such a great training program.’ That call made my day and reminded me that we’re a big extended family doing important work all across the country.”