Kidney Week 2025 Annual Meeting-Influence of Lower Urinary Tract on Pediatric Kidney Health

Video Transcription

Video Summary

This session reviewed how lower urinary tract disorders influence pediatric kidney outcomes, focusing on vesicoureteral reflux (VUR), urinary tract infection (UTI) prevention, fetal bladder outlet obstruction (BOO), and kidney transplantation in children with complex bladders.<br /><br />David Haynes summarized evidence from the placebo-controlled RIVUR trial: continuous TMP-SMX prophylaxis roughly halved recurrent UTIs but increased resistant organisms, with no clear effect on renal scarring (a secondary, underpowered outcome). He argued against “one-size-fits-all” prophylaxis and highlighted precision approaches using genetics and clinical features to stratify UTI risk. Using copy-number variation analyses and specific loci such as DEFA1A3 (alpha-defensins), his group found lower copy numbers associated with UTI susceptibility and possible interaction with prophylaxis. New analyses of RIVUR suggested recurrent UTIs—especially without prophylaxis—may be associated with stepwise GFR decline, reframing UTIs as potential AKI-like insults that erode renal reserve.<br /><br />Brian Becknell reviewed UTI prevention strategies amid rising antimicrobial resistance, emphasizing “excellence in plumbing” (bowel/bladder dysfunction management) and antibiotic stewardship. He outlined emerging non-antibiotic approaches: blocking E. coli (FimH) adherence (mannosides, monoclonal antibodies), cranberry PACs (modest pediatric evidence), microbiome-based strategies (probiotics, fecal transplant in refractory adult cases), antimicrobial peptides (e.g., RNase 7 induction via HDAC inhibitors in models), bacteriophages, and vaccines (e.g., MV140).<br /><br />Meredith Hsu discussed genetics in fetal BOO/LUTO, stressing that prenatal imaging poorly predicts postnatal function. She reviewed testing pathways (microarray → exome/genome), logistical challenges (e.g., amniowash culture time), and how diagnoses can change counseling and intervention decisions (e.g., FOXF1 causing lethal alveolar capillary dysplasia; ACTG2-related MMIHS).<br /><br />Armando Lorenzo addressed transplantation in abnormal/dysfunctional bladders, arguing for early proactive bladder management (often avoiding augmentation), use of CIC/Botox, and surgical techniques (ureteroureterostomy, venting ureterostomy) to protect allografts and manage tiny bladders.

Asset Subtitle

Moderator(s): Meredith Atkinson, Keri Drake

Presentation(s):

Effects of Febrile Urinary Tract Infections on Kidney Health: Updates from the RIVUR Study - David Hains
Urinary Tract Infection Prevention: Novel Insights - Brian Becknell
Genetics of the Developing Urinary Tract: What Do We Know and What Do We Need to Learn? - Meredith Schuh
Kidney Transplantation in Children with Complex Lower Urinary Tract Anatomy - Armando Lorenzo

Meta Tag

Date 11/6/2025

Pathway 1 Pediatric Nephrology

Pathway 2 Genetic Diseases and Development

Session ID 507341

Keywords

lower urinary tract disorders

pediatric kidney outcomes

vesicoureteral reflux (VUR)

RIVUR trial

TMP-SMX prophylaxis

recurrent urinary tract infection (UTI) prevention

antimicrobial resistance

renal scarring

GFR decline

copy-number variation (CNV)

DEFA1A3 alpha-defensins

bowel and bladder dysfunction management

FimH anti-adhesion therapy (mannosides)

fetal bladder outlet obstruction (BOO) / LUTO genetics

pediatric kidney transplantation in complex bladders