Chronic kidney disease does not just affect adults but can occur during childhood as well. It is important to identify children with impaired kidney function early and manage the disease to prevent adverse outcomes including poor growth, malnutrition, high blood pressure, bone disease, and cardiovascular disease. Our goal is to monitor the children that have been identified as having chronic kidney disease over time to identify areas for improvement in their healthcare and quality of life.

Management of high blood pressure is important to maintain good cardiovascular health. With 24 hour blood pressure monitoring we are gaining new insight into normal and abnormal blood pressure patterns and how this could adversely affect health. This non-invasive tool can be used in many groups of patients and currently we are studying blood pressure abnormalities in pediatric chronic kidney disease patients and pediatric long-term cancer survivors with many other future applications available.


Hypertension Canada's 2017 Guidelines for the Diagnosis, Assessment, Prevention, and Treatment of Pediatric Hypertension.
Dionne JM and Harris KC and Benoit G and Feber J and Poirier L and Cloutier L and Nakhla M and Rabi DM and Daskalopoulou SS and Fournier A and Hypertension Canada Guideline Committee
DOI: 10.1016/j.cjca.2017.03.007
PubMed: 28449829

Hypertension Canada's 2017 Guidelines for Diagnosis, Risk Assessment, Prevention, and Treatment of Hypertension in Adults.
Leung AA and Daskalopoulou SS and Dasgupta K and McBrien K and Butalia S and Zarnke KB and Nerenberg K and Harris KC and Nakhla M and Cloutier L and Gelfer M and Lamarre-Cliche M and Milot A and Bolli P and Tremblay G and McLean D and Tobe SW and Ruzicka M and Burns KD and Hypertension Canada
DOI: 10.1016/j.cjca.2017.03.005
PubMed: 28449828

Pediatric Hypertension

Endovascular pharmacomechanical thrombolysis - A novel treatment for circumaortic left renal vein and inferior vena cava thrombosis in a pediatric patient with relapsing nephrotic syndrome
BJR Case Rep

Management of severe hypertension in the newborn.
Arch Dis Child
DOI: 10.1136/archdischild-2015-309740

AAP Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

Exome Sequencing and the Management of Neurometabolic Disorders.
Tarailo-Graovac M and Shyr C and Ross CJ and Horvath GA and Salvarinova R and Ye XC and Zhang LH and Bhavsar AP and Lee JJ and Drögemöller BI and Abdelsayed M and Alfadhel M and Armstrong L and Baumgartner MR and Burda P and Connolly MB and Cameron J and Demos M and Dewan T and van Karnebeek CD
DOI: 10.1056/nejmoa1515792
PubMed: 27276562

Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, Assessment of Risk, Prevention, and Treatment of Hypertension.
Leung AA and Nerenberg K and Daskalopoulou SS and McBrien K and Zarnke KB and Dasgupta K and Cloutier L and Gelfer M and Lamarre-Cliche M and Milot A and Bolli P and Tremblay G and McLean D and Tobe SW and Ruzicka M and Burns KD and Vallée M and Prasad GV and Lebel M and CHEP Guidelines Task Force
DOI: 10.1016/j.cjca.2016.02.066
PubMed: 27118291

Hypertension Canada's 2016 Canadian Hypertension Education Program Guidelines for Blood Pressure Measurement, Diagnosis, and Assessment of Risk of Pediatric Hypertension.
DOI: 10.1016/j.cjca.2016.02.075
PubMed: 27118292

Can office blood pressure readings predict masked hypertension?
Mitsnefes MM and Pierce C and Flynn J and Samuels J and Dionne J and Furth S and Warady B and CKiD study group
DOI: 10.1007/s00467-015-3212-5
PubMed: 26416480

Evidence-based guidelines for the management of hypertension in children with chronic kidney disease.
Dionne JM
DOI: 10.1007/s00467-015-3077-7
PubMed: 25752760

RMND1 deficiency associated with neonatal lactic acidosis, infantile onset renal failure, deafness, and multiorgan involvement.
Janer A and van Karnebeek CD and Sasarman F and Antonicka H and Al Ghamdi M and Shyr C and Dunbar M and Stockler-Ispiroglu S and Ross CJ and Vallance H and Dionne J and Wasserman WW and Shoubridge EA
DOI: 10.1038/ejhg.2014.293
PubMed: 25604853

BC Kidney Care Pediatric Renal Replacement Modality Education Module
BC Renal Agency

Vitamin D insufficiency and deficiency in pediatric renal transplant recipients.
Ebbert K and Chow J and Krempien J and Matsuda-Abedini M and Dionne J
DOI: 10.1111/petr.12527
PubMed: 26011664

BC Kidney Care Guideline: Depression and Anxiety: The Role of Kidney Care Clinics
BC Renal Agency

Sustaining life or prolonging dying? Appropriate choice of conservative care or renal replacement therapy for children in end stage kidney disease: An ethical framework
Pediatr Nephrol
DOI: 10.1007/s00467-014-2977-2

BC Kidney Care Guideline: Ordering, Reviewing & Follow-Up of Lab Work. 1-24.
BC Renal Agency

Hypertensive crises in children: Is it of acute or chronic origin.
J Clin Hypertens

Pediatric Hypertension

A novel heteroplasmic frame shift mutation in the COX2 gene leading to severe recurrent rhabdomyolysis in association with viral illness.
J Inherit Metab Dis

Hypertension in infancy: Diagnosis, management and outcome
Pediatr Nephrol
DOI: 10.1007/s00467-010-1755-z

Hypertension in the neonate

The effect of a multidisciplinary care clinic on the outcomes in pediatric chronic kidney disease.
Pediatr Nephrol
DOI: 10.1007/s00467-012-2209-6

Pharmaceutical cost distribution in childhood chronic kidney disease.
Pediatr Nephrol
DOI: 10.1007/s00467-012-2165-1

Ambulatory blood pressure monitoring in children
Indian Pediatr

Vitamin D insufficiency and deficiency in pediatric renal transplant patients.
Pediatr Transplant

Prevalence of hypertension in pediatric oncology survivors.
J Clin Hypertens

The effect of a multidisciplinary clinic on the outcomes in pediatric chronic kidney disease
Pediatr Nephrol

The role of the type I insulin-like growth factor receptor (IGF-1R) in glomerular integrity
Growth Horm IGF Res
DOI: 10.1016/j.ghir.2007.06.003

Atypical haemolytic uremic syndrome and acute lymphoblastic leukaemia can present simultaneously
J Investig Med

Blood pressure abnormalities in children with chronic kidney disease
Blood Press Monit
DOI: 10.1097/MBP.0b013e3283052fd0

Simultaneous occurrence of atypical hemolytic uremic syndrome and acute lymphoblastic leukemia: A case report and literature review.
Pediatr Nephrol
DOI: 10.1007/s00467-007-0703-z

Should gonadotropin releasing hormone analogue be administered to prevent premature ovarian failure in young women with systemic lupus erythematosus on cyclophosphamide therapy?
Arch Dis Child
DOI: 10.1136/adc.2007.131334

Malignant hypertension, polycythemia, and paragangliomas
J Pediatr
DOI: 10.1016/j.jpeds.2005.11.024

Oestradiol decreases rat apolipoprotein AI transcription via promoter site B
J Mol Endocrinol
DOI: 10.1677/jme.0.0250207

Renal leiomyoma associated with Epstein-Barr virus in a pediatric transplant patient
Am J Kidney Dis
DOI: 10.1053/j.ajkd.2005.04.028

Glucocorticoid increases rat apolipoprotein A-I promoter activity
J Lipid Res


Current Projects
With the assistance of a database manager, I have created a chronic kidney disease database for all pediatric patients followed at BC Children’s Hospital with a GFR of below 75 ml/min/1.73m2. We will prospectively be entering their medical information into the database to create a source of data for quality assurance studies as well as research intervention studies.

The major areas of focus of the database include renal disease progression, anemia management, renal bone disease, growth and nutrition, cardiovascular health, and morbidity and mortality. We hope to determine factors that contribute to the development or progression of abnormalities in the organ systems affected during renal failure.

On a related topic, we are joining a study by Canadian nephrologists looking at the prediction of risk of progression to dialysis or cardiovascular events or death in the chronic kidney disease population. This is a three year observational study looking at biomarkers of vascular health, inflammation, cardiac function/health and kidney dysfunction in samples of blood and urine taken at routine renal clinic visits. Outcomes identified will include initiation of renal replacement therapy, time to cardiovascular events, onset of cardiac dysfunction and death. The goal is to identify biomarkers that can predict progression of kidney disease or predict cardiac events in order to monitor or intervene if patients are identified as high risk.

24-hour ambulatory blood pressure monitoring (ABPM) has identified new ways to monitor and treat patients with hypertension. Blood pressure abnormalities that can be identified on ABPM include daytime and night-time hypertension, elevated blood pressure loads, and nocturnal blood pressure non-dipping. This non-invasive test is diagnostic for white-coat hypertension, masked hypertension, nocturnal hypertension or non-dipping, and autonomic dysfunction. Various blood pressure abnormalities are possible in patients that have received nephrotoxic medications or treatments. These patients are also at risk for permanent renal injury. Through a pediatric resident initiative, we have identified long-term survivors of childhood cancer as a group at risk for blood pressure and kidney abnormalities. In collaboration with the Oncology long-term follow-up clinic, we are going to review all patients at 5 years post-cancer diagnosis to determine if there are specific cancer diagnoses that have increased rates of clinic hypertension. Once these high-risk groups are identified, we will prospectively study blood pressure and renal function by simple methods including 24-hour ABPM, serum creatinine for estimated GFR, and urine microalbumin as a marker of renal damage. This study will determine the prevalence of renal injury and blood pressure abnormalities in long-term pediatric cancer survivors and the need for monitoring and treatment of identified issues to maintain good long-term health.

Honours & Awards

Honours in Research, Department of Medicine, University of Alberta. 2000

ASPN Trainee Basic Science Research Award, American Society of Pediatric Nephrology, 2005 The Fundamentals of Dialysis in Children: Case Conference Competition, Dialysis Annual Conference, 2005

Research Group Members

Meredith Cushing, Clinical Dietitian, Clinical Instructor
Alice So, Division Administrative Secretary