Research

The American Family Children’s Hospital pediatric kidney transplant program, currently under the direction of Rachel Engen, MD, is a national leader in advocating for children with late-stage kidney disease. Our program has a strong focus on minimizing the effects of kidney disease on children by emphasizing preemptive transplantation, maximizing access to living donor transplantation, and minimizing the side effects of immunosuppressing medications. Ongoing research efforts include strategies to improve long-term transplant outcomes, identify biomarkers of immune function, and evaluate the effects of national transplant policies on pediatric kidney transplant recipients. Engen is currently leading a multicenter study in post-kidney transplant patients that tests for torque teno virus (TTV) as a biomarker for immune function. The study aims to improve the assessment of overall immune status and better balance the risks of rejection and infection after transplant.

Another active research area in the division is the identification of genetic factors impacting kidney transplant health. Despite generally excellent outcomes, the average survival of a transplanted kidney is only 10–20 years. As such, kidney transplant recipients often require multiple episodes of transplant in their lifetimes. Unfortunately, each subsequent transplant is associated with progressively poorer outcomes. This research effort strives to maintain the health of the first transplanted kidney. As part of this mission, Benjamin Spector, MD, MS, is conducting active research to identify the genetic and molecular pathways that affect kidney transplant health. Through the knowledge gained in his Gene Expression in Transplant Health (GET Health) study, he hopes to extend the lifespan of the transplanted kidney in children and adults towards the ultimate goal of “one kidney for life” for transplant patients.

The Pediatric Kidney Stone Clinic at American Family Children’s Hospital is one of only a handful of clinics nationally dedicated to the workup and management of children with kidney stones. Led by Neil Paloian, MD, the clinic draws children from across the state, treats children of all ages with kidney stones, and uses a multidisciplinary approach that includes dietary management, medications, and surgery. Paloian is a leader in the field of pediatric kidney stone disease: having published multiple papers on risk factors for pediatric kidney stones, and having published the only dedicated pediatric kidney stone textbook. His research in this area is focused on clinical risk factors and new therapies for children with kidney stones.

Advances in pediatric nephrology have led to incredible gains in survival for children with kidney disease. Unfortunately, efforts to ensure that children with kidney disease are living well in addition to living longer haven’t quite caught up to technology. Taylor House, MD, is working to address that gap. Her THRIVE KiDs Research Group focuses on improving the quality of life and quality of care for children with kidney disease through the holistic integration of nephrology-specific palliative care. She is building the nation’s first kidney supportive care clinic for children with advanced kidney disease that will enable their flourishing and focus on “adding life to their years.”

As this intervention is further refined, future work will focus on training and enabling pediatric nephrologists to use this intervention to support holistic, family-centered care as well as the development and dissemination of this curriculum for pediatric nephrologists around the country.

While the goal for all children with kidney failure is a transplant, many children must receive dialysis for some time before they receive a new kidney. As medical director of pediatric dialysis, Allison Redpath, MD, has worked to ensure that dialysis is available, safe, and effective for children with kidney failure. Our dialysis program offers both in-home and in-hospital hemodialysis and peritoneal dialysis, as well as a pediatric continuous renal replacement therapy (CRRT) program at American Family Children’s Hospital. Recent advancements in pediatric dialysis at the UW can be attributed to Redpath’s quality improvement research and initiatives. Her ongoing QI efforts continuously help improve care for children with kidney failure.

The Chronic Kidney Disease in Children Cohort Study (CKiD) is an NIH-funded, multicenter, observational, prospective cohort of children, adolescents, and young adults with a history of mild to moderately impaired kidney function. The study, which has been funded by the NIH since 2003, includes more than 50 pediatric nephrology centers across the U.S. and Canada and has enrolled more than 1,100 children with mild to moderate CKD. Sharon Bartosh, MD, is site PI at the University of Wisconsin. Now in its fourth cohort, the study aims to understand the risk factors for decline in kidney function in childhood and young adulthood, the impact of childhood CKD on the development of cardiovascular disease, the trajectories of markers of metabolic bone disease, and the successful transfer from pediatric to adult nephrology care.

Additionally, Bartosh is the site PI for the CureGN study, or the Cure Glomerulopathy Network, which is an NIH-funded, multicenter, observational study focused on glomerular diseases, specifically minimal change disease, focal segmental glomerulosclerosis, membranous nephropathy, and IgA nephropathy with the aim to improve understanding, diagnosis, treatment, and outcomes for children with these chronic kidney conditions.

Neil Paloian, MD, is the director of the Pediatric Bone and Mineral Metabolism Clinic at American Family Children’s Hospital. He and his multidisciplinary team see about 200 patients a year with acquired or genetic bone disorders caused by an imbalance of calcium and phosphate. The clinic is frequently involved in research for data collection and in clinical trials of new drugs. Currently, Paloian is involved in multiple industry-sponsored research studies focused on a hypophosphatasia registry, an X-linked hypophosphatemia disease-monitoring program, and a drug trial assessing the efficacy and safety of Setrusumab in pediatric patients with osteogenesis imperfecta.