Discussion P W6 Reply to peer 2

Assessment of glomerular filtration rate (GFR) is fundamental to clinical practice, public health, and research. The kidney has several critical functions; GFR is used as an overall assessment of these kidney functions. GFR is used to diagnose, stage, and manage chronic kidney disease (CKD) (Inker & Titan, 2021). GFR is most commonly assed through markers and creatinine levels. Strengths: GFR is a well-established clinical laboratory practice, particularly in the neonatal population. It is a property of the kidney, has a large range, and is affected by physiological, pharmacologic, and pathologic conditions. Limitations: Methods to measure GFR are laborious, expensive, and not broadly available (Bjornstad et al, 2018).  A major challenge to diagnose early kidney disease is the lack of individuals that participate in yearly doctor visits as well as those who live with hypertension unknowingly will result in kidney failure. Creatinine and/or cystatin C are most accurate once GFR is <60ml/min/1.73m2, a point at which half of renal function is already lost. Accurate measurement of GFR is also important to stratify renal injuries, monitor nephrotoxicity and guide medication dosing (Bjornstad et al, 2018). Often certain medication drugs that are nephrotoxic can lead to acute renal failure (AKI), creatinine levels, BMP as well as GFR levels must be monitor on a weekly basis to be able to treat the patient accordingly.

About 1-3% of all infants and children have a condition called vesicoureteral reflux (VUR), which means some of their urine flows in the wrong direction after entering the bladder. Some of the urine flows back up toward the kidneys and can increase the chance of developing a urinary tract infection (UTI) (2024). Most pediatric UTIs are caused by Gram negative coliform bacteria arising from fecal flora colonizing the perineum, which enter and ascend the urinary tract. Escherichia coli (E. coli) is the most common uropathogen, responsible for approximately 80% of pediatric UTIs (Tallus, 2019). Other common uropathogens include Klebsiella, Proteus, Enterobacter and Enterococcus species (Kaufman et al., 2019). Refluxing ureteral endings show structural and functional anomalies: previous studies have shown a significant decrease in alfa actin, miosin and desmin contents as well as a high rate of atrophy and muscular degeneration with disorganized muscular fibres (Arena et al., 2016). VRU can also be caused by an abnormal embryological development occurring during the early stage of fetal life. VRU occurs on both sexes however females are prone to have more UTIs due to their anatomy and a shorter urethra, in males a circumcision will favor in the prevention of UTIs.

References

Inker, L. A., & Titan, S. (2021, November). Measurement and estimation of GFR for use in clinical practice: Core curriculum 2021 – American journal of kidney diseases. National Kidney Foundation.

https://www.ajkd.org/article/S0272-6386(21)00707-1/fulltext

Bjornstad, P., Karger, A. B., & Maahs, D. M. (2018). Measured GFR in Routine Clinical Practice-The Promise of Dried Blood Spots. Advances in chronic kidney disease, 25(1), 76–83.

https://doi.org/10.1053/j.ackd.2017.09.003

Vesicoureteral reflux (VUR) in Infants & Children. National Kidney Foundation. (2024, October 26).

https://www.kidney.org/kidney-topics/vesicoureteral-reflux-vur-infants-children

Kaufman, J., Temple-Smith, M., & Sanci, L. (2019, September 24). Urinary tract infections in children: An overview of diagnosis and management. BMJ pediatrics open.

https://pmc.ncbi.nlm.nih.gov/articles/PMC6782125/

Tullus K. Fifteen-minute consultation: why and how do children get urinary tract infections? Arch Dis Child Educ Pract Ed (2019. 10.11)36/archdischild-2018-315023.

Arena, S., Iacona, R., Impellizzeri, P., Russo, T., Marseglia, L., Gitto, E., & Romeo, C. (2016, November 29). Physiopathology of vesico-ureteral reflux. Italian journal of pediatrics.

https://pmc.ncbi.nlm.nih.gov/articles/PMC5129198/