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Article ; Online: Ethical Concerns for Amnioinfusions.

Atkinson, Meredith A / Miller, Jena L

2023 Volume 330, Issue 15, Page(s) 1492–1493

MeSH term(s)	Female ; Humans ; Pregnancy ; Amnion ; Infusions, Parenteral/ethics ; Obstetric Surgical Procedures/ethics ; Obstetric Surgical Procedures/methods ; Pregnancy Outcome ; Prenatal Care/ethics
Language	English
Publishing date	2023-10-17
Publishing country	United States
Document type	Letter ; Research Support, N.I.H., Extramural ; Comment
ZDB-ID	2958-0
ISSN	1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
ISSN (online)	1538-3598
ISSN	0254-9077 ; 0002-9955 ; 0098-7484
DOI	10.1001/jama.2023.15927
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Article ; Online: Anemia after kidney transplantation.

Guzzo, Isabella / Atkinson, Meredith A

Pediatric nephrology (Berlin, Germany)

2022 Volume 38, Issue 10, Page(s) 3265–3273

Abstract: Anemia is a frequent complication in pediatric kidney transplant recipients (KTR) with a variable reported prevalence estimated between 20 and 80% depending on how defined. Causes of and risk factors for post-transplantation anemia (PTA) are ... ...

Abstract	Anemia is a frequent complication in pediatric kidney transplant recipients (KTR) with a variable reported prevalence estimated between 20 and 80% depending on how defined. Causes of and risk factors for post-transplantation anemia (PTA) are multifactorial with iron deficiency being the primary cause of early PTA (within the first 6 months after transplantation) and impaired glomerular filtration rate (GFR) commonly responsible for late PTA (after 6 months). Medications, viral infections, chronic inflammation, and comorbidities also play a role. PTA has relevant long-term consequences and is a potential risk factor for allograft dysfunction, cardiovascular morbidity, and mortality. Thus, an anemia evaluation, approximately 3 months post-transplantation, is recommended in order to start early treatment and improve prognosis. Iron status, vitamin B
MeSH term(s)	Humans ; Child ; Kidney Transplantation/adverse effects ; Erythropoietin/therapeutic use ; Anemia/diagnosis ; Anemia/epidemiology ; Anemia/etiology ; Iron/therapeutic use ; Risk Factors
Chemical Substances	Erythropoietin (11096-26-7) ; Iron (E1UOL152H7)
Language	English
Publishing date	2022-10-25
Publishing country	Germany
Document type	Journal Article
ZDB-ID	631932-4
ISSN	1432-198X ; 0931-041X
ISSN (online)	1432-198X
ISSN	0931-041X
DOI	10.1007/s00467-022-05743-7
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Article ; Online: Single-center Incidence and Patterns of Stroke in Early Renal Anhydramnios after Serial Amnioinfusions.

Lammert, Dawn B / Miller, Jena L / Atkinson, Meredith A / Sun, Lisa R

The Journal of pediatrics

2024 , Page(s) 114053

Abstract: The Renal Anhydramnios Fetal Therapy (RAFT) trial is a study of serial amnioinfusions to prevent lethal neonatal pulmonary hypoplasia from early renal anhydramnios. Infant neurologic outcomes were not originally evaluated. We describe the high incidence ... ...

Abstract	The Renal Anhydramnios Fetal Therapy (RAFT) trial is a study of serial amnioinfusions to prevent lethal neonatal pulmonary hypoplasia from early renal anhydramnios. Infant neurologic outcomes were not originally evaluated. We describe the high incidence of stroke observed among infants in the treatment arm of the trial at our center.
Language	English
Publishing date	2024-04-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2024.114053
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Article ; Online: Fetal Therapy for Renal Anhydramnios.

Miller, Jena L / Baschat, Ahmet A / Atkinson, Meredith A

Clinics in perinatology

2022 Volume 49, Issue 4, Page(s) 849–862

Abstract: The most severe forms of congenital anomalies of the kidney and urinary tract present in fetal life with early pregnancy renal anhydramnios and are considered lethal due to pulmonary hypoplasia without fetal therapy. Due to the high rate of additional ... ...

Abstract	The most severe forms of congenital anomalies of the kidney and urinary tract present in fetal life with early pregnancy renal anhydramnios and are considered lethal due to pulmonary hypoplasia without fetal therapy. Due to the high rate of additional structural anomalies, genetic abnormalities, and associated syndromes, detailed anatomic survey and genetic testing are imperative when stratifying which pregnancies are appropriate for fetal intervention. Restoring amniotic fluid around the fetus is the principal goal of prenatal treatment. The ongoing multi-center Renal Anhydramnios Fetal Therapy (RAFT) trial is assessing the safety and efficacy of serial amnioinfusions to prevent pulmonary hypoplasia so that the underlying renal disease can be addressed.
MeSH term(s)	Pregnancy ; Female ; Humans ; Oligohydramnios/therapy ; Kidney/abnormalities ; Fetal Therapies ; Amniotic Fluid ; Delivery, Obstetric ; Ultrasonography, Prenatal
Language	English
Publishing date	2022-10-09
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	193116-7
ISSN	1557-9840 ; 0095-5108
ISSN (online)	1557-9840
ISSN	0095-5108
DOI	10.1016/j.clp.2022.08.001
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Article ; Online: Survey of Neonatal Management After Amnioinfusion for Anhydramnios.

Bendel-Stenzel, Ellen M / Keiser, Amaris M / McKenna, Kristin J / Chock, Valerie Y / Lopez, Suzanne / Miller, Jena L / Atkinson, Meredith A

JAMA pediatrics

2024 Volume 178, Issue 4, Page(s) 412–414

MeSH term(s)	Pregnancy ; Infant, Newborn ; Female ; Humans ; Oligohydramnios ; Delivery, Obstetric ; Surveys and Questionnaires
Language	English
Publishing date	2024-02-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701223-2
ISSN	2168-6211 ; 2168-6203
ISSN (online)	2168-6211
ISSN	2168-6203
DOI	10.1001/jamapediatrics.2023.6403
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Article ; Online: Use of renin angiotensin aldosterone system inhibitors in children with lupus and time to glucocorticoid discontinuation.

Chang, Joyce C / Weiss, Pamela F / Xiao, Rui / Atkinson, Meredith A / Wenderfer, Scott E

Kidney international

2022 Volume 102, Issue 2, Page(s) 395–404

Abstract: There is little data to inform use of renin angiotensin aldosterone system (RAAS) inhibitors in pediatric patients with systemic lupus erythematosus (SLE). Here, we sought to characterize RAAS inhibitor use in pediatric SLE and determine whether early ... ...

Abstract	There is little data to inform use of renin angiotensin aldosterone system (RAAS) inhibitors in pediatric patients with systemic lupus erythematosus (SLE). Here, we sought to characterize RAAS inhibitor use in pediatric SLE and determine whether early RAAS inhibitor initiation among children with incident lupus nephritis is associated with decreased duration of chronic glucocorticoid exposure. A retrospective cohort study was performed of children (ages 5-18) with SLE and/or lupus nephritis in the Truven MarketScan™ Medicaid and Commercial databases (2013-2018) and estimated RAAS inhibitor use. Among incident nephritis cases, we used competing risk hazard models with inverse probability of treatment weighting to estimate the association between RAAS inhibitor initiation less than 180 days after diagnosis and time to glucocorticoid discontinuation with kidney failure as a competing event. Among 592 children with nephritis and 1407 children with non-kidney SLE, 67% and 15% ever received RAAS inhibitors, respectively. Median duration of RAAS inhibitor use among 323 incident users was 14 and 9 months in children with and without nephritis, respectively. Medicaid enrollment was independently associated with greater likelihood of RAAS inhibitor use, irrespective of nephritis. Among 158 incident nephritis cases, early RAAS inhibitor initiation was significantly associated with a faster rate of glucocorticoid discontinuation (adjusted sub-distribution hazard ratio 1.81, 95% confidence interval [1.09 - 3.00]). Thus, early initiation of RAAS inhibitors may have a role in children newly diagnosed with lupus nephritis; not only those with refractory proteinuria after induction therapy. Hence, integrated health systems data could be leveraged to confirm these findings and optimize adjunctive therapies in pediatric lupus.
MeSH term(s)	Adolescent ; Aldosterone ; Angiotensin-Converting Enzyme Inhibitors/adverse effects ; Antihypertensive Agents ; Child ; Child, Preschool ; Glucocorticoids/adverse effects ; Humans ; Lupus Erythematosus, Systemic/drug therapy ; Lupus Nephritis/drug therapy ; Renin-Angiotensin System ; Retrospective Studies
Chemical Substances	Angiotensin-Converting Enzyme Inhibitors ; Antihypertensive Agents ; Glucocorticoids ; Aldosterone (4964P6T9RB)
Language	English
Publishing date	2022-05-23
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	120573-0
ISSN	1523-1755 ; 0085-2538
ISSN (online)	1523-1755
ISSN	0085-2538
DOI	10.1016/j.kint.2022.04.023
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Zs.A 797: Show issues

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Article ; Online: The association of a scholarly concentrations program with medical students' matched residencies.

Alkhatib, Hosam H / Beach, Mary Catherine / Gebo, Kelly A / Bass, Eric B / Park, Jenny R / Atkinson, Meredith A / Kudchadkar, Sapna R / Sozio, Stephen M

Medical education online

2023 Volume 28, Issue 1, Page(s) 2234651

Abstract: Purpose: Many medical school curricula include Scholarly Concentrations (SC) programs. While studies have examined how these programs affect students' future research involvement, the association of SC programs with students' specialty choices is ... ...

Abstract	Purpose: Many medical school curricula include Scholarly Concentrations (SC) programs. While studies have examined how these programs affect students' future research involvement, the association of SC programs with students' specialty choices is uncertain. This study examines the SC program factors associated with congruence between the specialty focus of students' SC projects and the clinical specialty they matched into for residency. Methods: The authors conducted a retrospective cohort study of all students participating in the SC program at Johns Hopkins University School of Medicine for graduating classes 2013-2020. They used data from program questionnaires to categorize students' specialty interests (baseline) and SC program experiences (post-program). The authors categorized each student's project into specialties according to their faculty mentors' primary appointments, abstracted student publications from SCOPUS, and abstracted residency program rankings from Doximity Residency Navigator. The authors used multivariable logistic regression to calculate adjusted odds ratios (aOR) for specialty-congruent matching (same specialty as SC project) and for matching into a Doximity-ranked top 20 or top 10 program. Results: Overall, 35.3% of the 771 students matched into the same specialty as their SC projects. Increased odds of specialty-congruent matching occurred with 'definite' interest in the specialty at baseline [aOR (95% CI): 1.76 (0.98-3.15)] ( Conclusions: Baseline certainty of specialty interest and research productivity were associated with specialty congruence. However, as completing an SC project in a given specialty was not associated with increased odds of matching into that specialty nor into a higher Doximity-ranked program, SC program directors should advise students to pursue SC projects in any topic of personal interest.
MeSH term(s)	Humans ; Students, Medical ; Internship and Residency ; Retrospective Studies ; Curriculum ; Schools, Medical
Language	English
Publishing date	2023-07-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2052877-2
ISSN	1087-2981 ; 1087-2981
ISSN (online)	1087-2981
ISSN	1087-2981
DOI	10.1080/10872981.2023.2234651
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Article ; Online: Anemia in chronic kidney disease.

Atkinson, Meredith A / Warady, Bradley A

Pediatric nephrology (Berlin, Germany)

2017 Volume 33, Issue 2, Page(s) 227–238

Abstract: Anemia is common and associated with adverse outcomes in children with chronic kidney disease (CKD). Many factors contribute to declining hemoglobin as CKD progresses, but impaired production of erythropoietin by failing kidneys is a central cause. ... ...

Abstract	Anemia is common and associated with adverse outcomes in children with chronic kidney disease (CKD). Many factors contribute to declining hemoglobin as CKD progresses, but impaired production of erythropoietin by failing kidneys is a central cause. Hepcidin-mediated iron restriction also contributes to anemia by downregulating both intestinal iron absorption and release of stored iron for erythropoiesis. The core components of anemia management remain erythropoiesis-stimulating agents (ESA) and iron supplementation, but despite these therapies, a substantial number of children remain anemic. Although escalating ESA dose to target higher hemoglobin has been associated with adverse outcomes in adults, no trials have investigated this association in children, and maintaining hemoglobin levels in a narrow range with conservative ESA dosing is challenging. Judicious use of iron supplementation can enhance the response to ESAs, but the iron storage markers most commonly used in clinical practice have limitations in distinguishing which patients will benefit most from additional iron. Several novel anemia therapies, including hypoxia-inducible factor stabilizers, prolyl hydroxylase inhibitors, and dialysate-delivered iron supplements, have been developed and may offer options for alternative anemia management. However, the safety and efficacy of these agents in children with CKD has yet to be assessed.
MeSH term(s)	Anemia/drug therapy ; Anemia/etiology ; Child ; Hematinics/therapeutic use ; Humans ; Renal Insufficiency, Chronic/complications
Chemical Substances	Hematinics
Language	English
Publishing date	2017-04-15
Publishing country	Germany
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Review
ZDB-ID	631932-4
ISSN	1432-198X ; 0931-041X
ISSN (online)	1432-198X
ISSN	0931-041X
DOI	10.1007/s00467-017-3663-y
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Article ; Online: Pubertal luteinizing hormone levels in children with chronic kidney disease and association with change in glomerular filtration rate.

Kim, Hannah S / Ng, Derek K / Matheson, Matthew B / Atkinson, Meredith A / Akhtar, Yasmin / Warady, Bradley A / Furth, Susan L / Ruebner, Rebecca L

Pediatric nephrology (Berlin, Germany)

2023 Volume 39, Issue 5, Page(s) 1543–1549

Abstract: Background: Children with chronic kidney disease (CKD) are at risk for abnormalities in pubertal development. We aimed to describe the timing of pubertal onset by luteinizing hormone (LH) levels and the association between hormonal onset of puberty with ...

Abstract	Background: Children with chronic kidney disease (CKD) are at risk for abnormalities in pubertal development. We aimed to describe the timing of pubertal onset by luteinizing hormone (LH) levels and the association between hormonal onset of puberty with changes in GFR. Methods: Data from the Chronic Kidney Disease in Children (CKiD) study were collected prospectively. GFR was estimated at annual visits and measured by iohexol clearance every other year. LH was measured from stored repository serum samples in a nested sample of 124 participants. Hormonal onset of puberty was defined as LH level greater than or equal to 0.3 IU/L. A mixed effects model with random intercepts and slopes was used to compare the slope of decline of GFR before and after hormonal onset of puberty. The model was adjusted for age, glomerular disease diagnosis, baseline proteinuria on the log scale, and BMI. Results: Median age at hormonal onset of puberty was 9.9 years (IQR 8.1, 11.9) in girls and 10.2 years (IQR 9.2, 11.0) in boys. The mixed effects model showed faster decline in both estimated GFR and measured GFR in boys after hormonal onset of puberty (p < 0.001), and a similar but attenuated accelerated estimated GFR decline was observed for girls with no difference for measured GFR. Conclusions: LH levels in the post-pubertal range were observed prior to clinical manifestations of puberty in children with CKD. Hormonal onset of puberty was associated with faster decline in GFR, particularly among boys with CKD.
MeSH term(s)	Male ; Child ; Female ; Humans ; Glomerular Filtration Rate ; Renal Insufficiency, Chronic/diagnosis ; Kidney Function Tests ; Kidney Glomerulus ; Luteinizing Hormone
Chemical Substances	Luteinizing Hormone (9002-67-9)
Language	English
Publishing date	2023-11-23
Publishing country	Germany
Document type	Journal Article
ZDB-ID	631932-4
ISSN	1432-198X ; 0931-041X
ISSN (online)	1432-198X
ISSN	0931-041X
DOI	10.1007/s00467-023-06210-7
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Article ; Online: Precarious hope: Ethical considerations for offering experimental fetal therapies outside of research after initial studies in humans.

Hendriks, Saskia / Althaus, Janyne / Atkinson, Meredith A / Baschat, Ahmet A / Berkman, Benjamin E / Grady, Christine / Wasserman, David / Wendler, David / Miller, Jena L

Prenatal diagnosis

2023 Volume 44, Issue 2, Page(s) 180–186

Abstract: Objective: Risks and benefits of experimental fetal therapies can remain uncertain after initial clinical studies, especially long-term effects. Nevertheless, pregnant individuals may request them, hoping to benefit their future child. Guidance about ... ...

Abstract	Objective: Risks and benefits of experimental fetal therapies can remain uncertain after initial clinical studies, especially long-term effects. Nevertheless, pregnant individuals may request them, hoping to benefit their future child. Guidance about offering experimental fetal therapies outside research (as "innovative therapy") is limited, despite their ethical complexity. We propose points for clinicians and reviewers to consider when deciding whether and how to offer experimental fetal therapies as innovative therapies after initial clinical studies. Method: We used conceptual analysis and a current case to develop points for consideration, grounded in broader debates on innovative therapy and the unique challenges associated with experimental fetal therapies. Results: Clinicians should evaluate whether offering experimental fetal therapies as innovative therapy is appropriate for a pregnant individual and their fetus. The anticipated risk-benefit ratio for the fetus should be favorable. For the pregnant individual, risks may outweigh benefits, within reasonable limits. Medical resources should be sufficient to ensure appropriate care. Clinicians should support pregnant individuals in making informed choices. Clinicians offering innovative therapies with more than minimal risk should collect and report data on outcomes. Independent review should take place. Conclusion: Considering these points may advance the interests of fetuses, future children, and their families.
MeSH term(s)	Pregnancy ; Female ; Child ; Humans ; Prenatal Care ; Fetus ; Fetal Therapies ; Risk Assessment ; Therapies, Investigational
Language	English
Publishing date	2023-12-09
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	82031-3
ISSN	1097-0223 ; 0197-3851
ISSN (online)	1097-0223
ISSN	0197-3851
DOI	10.1002/pd.6474
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