At Riley Children’s Health, a team of experts have developed a novel reverse translational research program to study the clinical effects and long-term outcomes of acute kidney injury (AKI) in neonates.
Reversing the traditional bench to bedside approach, the program, established by Riley nephrologists and researchers Michelle Starr, MD and Danielle Soranno, MD, and co-led by Riley neonatologist and researcher Cara Slagle, MD, is based on the development of pre-clinical animal models that match pathology observed at the bedside in infants with AKI. In turn, the pre-clinical models are studied to identify mechanisms or outcomes that can be taken back to the bedside to inform treatment or prompt longer-term clinical investigations, rounding out the bench-to-bedside-back-to-bench approach.
While reverse translational research is not new, Riley Children’s is at the forefront of using the research approach to investigate neonatal AKI. The research complements the robust multidisciplinary clinical program at Riley Children’s run by nurse practitioner Kathryn Lowe, NP, which follows patients from their inpatient care in the NICU through longitudinal follow-up in the Neonatal Kidney Health Program. By using standardized care guidelines and automated trigger alerts within the electronic health record to detect AKI, the novel Neonatal Kidney Health Program at Riley Children’s has increased the recognition of AKI in the NICU from 17% to 100% and has reduced the rates of AKI in the NICU by 50%.
In 2018, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) highlighted the reverse translational approach as a best practice for research and discovery related to AKI.
“In neonatal AKI, Riley is unique in that we have the full spectrum of bench to bedside research to complement our clinical program,” Dr. Starr said. “Not only do we have clinical deployment of a novel inpatient and outpatient program, we also have basic science, translational and health outcomes research to support this program.”
In more recent years, neonatal AKI research has led to impactful expertise in neonatal nephrology. Research highlights have included hosting a National Institutes of Health-sponsored consensus conference on outcomes in neonates with AKI, receiving funding from the Engineering in Medicine pilot program for the development of a novel peritoneal dialysis catheter. Another ongoing project aims to develop a blood-based dialysis device, which can be used in under-resourced clinical settings to provide treatment of kidney injury.
“While this type of research program is more difficult to set up, it’s more translatable because the animal model is a specific match of what we’re seeing at the bedside,” Dr. Soranno said. “When we study the models, and they present with certain conditions, our clinicians take that information back to the bedside to determine if they’re seeing the same things in our patients; it turns into a cyclical research and discovery process that enables us to study short- and long-term outcomes of AKI.”
In the field of neonatal AKI, Drs. Starr and Soranno are active collaborators in major multicenter efforts, including groundbreaking work in continuous kidney replacement therapy from the Worldwide Exploration of Renal Replacement Outcomes Collaborative in Kidney Disease (WE-ROCK) and the Pediatric Acute Disease Quality Initiative (pADQI), which resulted in a landmark consensus statement published in JAMA Open. The consensus statement presents the current state of AKI in children and makes recommendations for priorities in research, clinical practice, education and advocacy.
Looking ahead, the nephrology division at Riley Children’s will expand its scope and influence in pediatric nephrology research. Current areas of collaborative research include the interaction between kidney and lung disease and the role of maternal malnutrition on kidney outcomes in offspring.
A leader in pediatric nephrology
Among many distinctions, the nephrology program at Riley Children’s has expanded the available kidney support therapy for small children who require dialysis. As the 12th site in the nation to implement the dialysis machine for kidney replacement therapy in children, specialists are able to treat neonates who had previously been considered too small for therapy.
Explore the pediatric nephrology program at Riley Children’s.
