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.