Kidney Week 2025 Annual Meeting-Pediatric Onconephrology

Video Transcription

Video Summary

The TSN Onconephrology session focused on kidney complications in pediatric and young adult cancer care, especially after hematopoietic stem cell transplant (HSCT), long-term cancer survivorship, solid organ transplant, and modern cancer therapies.<br /><br />Dr. Bradley Dixon reviewed HSCT-associated thrombotic microangiopathy (HSC-TMA) as a “perfect storm” of endothelial injury driven by GVHD/alloimmunity, infections, toxic exposures (conditioning, calcineurin/mTOR inhibitors), and amplified by inflammation, coagulation, and complement activation. Diagnosis is difficult; new consensus criteria use a menu of findings (e.g., anemia, thrombocytopenia, hypertension, proteinuria, elevated LDH, and elevated sC5b9). Complement-targeted treatments show promise: intensive eculizumab dosing has helped high-risk pediatric cohorts; ravulizumab and narsoplimab (MASP-2 inhibition) show partial/complete responses in early trials and compassionate use. Coagulation/endothelial approaches (defibrotide, soluble thrombomodulin, investigational endothelial-protective agents) may help, and standardized response definitions are emerging.<br /><br />Dr. Rita Deist-Swinford emphasized that childhood cancer survivors develop chronic conditions—including CKD and cardiovascular risk—much earlier than peers. CKD incidence across survivor cohorts often reaches ~20–30%, especially after HSCT, Wilms tumor therapy, and platinum chemotherapy. She highlighted that creatinine-based eGFR can overestimate function due to low muscle mass; cystatin C or measured GFR may better identify risk. Hypertension prevention/control and strong pediatric-to-adult transition programs are critical to avoid patients falling into an “AYA abyss.”<br /><br />Dr. Nancy Roddick discussed long-term cancer risk after pediatric kidney transplant. Cancer becomes a leading cause of death with functioning grafts; risks are driven by lifelong immunosuppression and oncogenic viruses (EBV, HPV). PTLD shows early and late peaks; prevention centers on minimizing excessive immunosuppression and EBV monitoring, with trials exploring prophylactic rituximab. Skin cancers and HPV-related anogenital/oropharyngeal cancers require education, sun protection, dermatology surveillance, and HPV vaccination pre-transplant whenever possible.<br /><br />Dr. Rimda Wanchu presented adult cases illustrating nephrotoxicity mechanisms relevant to pediatrics: cisplatin AKI and electrolyte wasting (evidence supports magnesium prophylaxis); anti-VEGF therapy causing hypertension/proteinuria and renal TMA (sometimes treated with complement blockade in reports); immune checkpoint inhibitor–associated interstitial nephritis/glomerular disease (treated with steroids, possible rechallenge with monitoring); and “pseudo-AKI” from transporter inhibition by targeted therapies where cystatin C clarifies true GFR.

Asset Subtitle

Moderator(s): Sai Sudha Mannemuddhu, Arwa Nada

Presentation(s):

Novel Approach to Thrombotic Microangiopathy in Stem-Cell Transplantation Among Children - Bradley Dixon
Long-Term Management of Children with Cancer and CKD - Rita Swinford
Management of Long-Term Cancer Risk in Children with a Solid-Organ Transplant - Nancy Rodig
Kidney Complications from Cancer Therapeutics: Review of Cases - Rimda Wanchoo

Meta Tag

Date 11/8/2025

Pathway 1 Pediatric Nephrology

Pathway 2 Onconephrology

Session ID 507769

Keywords

onconephrology

pediatric oncology

young adult cancer care

hematopoietic stem cell transplant

HSCT-associated thrombotic microangiopathy

endothelial injury

graft-versus-host disease

complement activation

eculizumab

ravulizumab

narsoplimab

childhood cancer survivorship

chronic kidney disease

post-transplant lymphoproliferative disorder

immune checkpoint inhibitor nephritis