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Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration01:28

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Chronic Kidney Disease I: Introduction01:25

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Chronic Kidney Disease (CKD) arises when the kidneys progressively lose their ability to function, ultimately leading to end-stage renal disease. At this advanced stage, the kidneys can no longer filter waste or maintain essential body functions, requiring renal replacement therapy (RRT) through dialysis or a kidney transplant for survival.Early-stage chronic kidney disease and detection challengesIn CKD's early stages, symptoms often remain absent because healthy nephrons compensate for...
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Chronic kidney disease (CKD) requires collaborative and comprehensive management. CKD progresses through stages and can lead to end-stage kidney disease (ESKD) if untreated. Interprofessional collaboration and patient education are crucial, enabling patients to manage their health and improve their quality of life.Diagnostic approach for chronic kidney diseaseThe diagnosis of CKD primarily focuses on the glomerular filtration rate (GFR), which assesses kidney function by measuring how well...
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Chronic Kidney Disease II: Clinical Manifestations01:24

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Chronic Kidney Disease (CKD) progressively impairs multiple body systems due to the accumulation of uremic toxins, which disrupt cellular functions across various organs.Neurologic symptomsNeurologic symptoms often arise early in CKD, as uremic toxin buildup drives changes in cognitive and motor functions. Patients frequently experience fatigue, headache, confusion, difficulty concentrating, and, in severe cases, seizures. Peripheral neuropathy commonly manifests as burning sensations in the...
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Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
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Related Experiment Video

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GDF-15 and uEGF Independently Associate With CKD Progression in Children.

Julia Bartels1, Mansoureh Tabatabaeifar1, Marietta Kirchner2

  • 1Division of Pediatric Nephrology, Medical Faculty Heidelberg, Center for Pediatrics and Adolescent Medicine, Heidelberg University Hospital, Heidelberg University, Heidelberg, Germany.

Kidney International Reports
|October 27, 2025
PubMed
Summary

Predicting pediatric chronic kidney disease (CKD) progression is challenging. Higher serum growth differentiation factor 15 (GDF-15) and urinary epidermal growth factor (uEGF) levels indicate increased CKD risk in children.

Keywords:
CKD progressionchronic kidney diseaseepidermal growth factorgrowth differentiation factor 15pediatric CKD

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Area of Science:

  • Pediatric Nephrology
  • Biomarker Discovery
  • Chronic Kidney Disease Research

Background:

  • Predicting chronic kidney disease (CKD) progression in children remains a significant clinical challenge.
  • Previous research identified low urinary epidermal growth factor (uEGF) as a predictor of CKD progression in pediatric patients.
  • The potential of serum growth differentiation factor 15 (GDF-15) as a prognostic biomarker in pediatric CKD requires further investigation.

Purpose of the Study:

  • To investigate serum GDF-15 as a novel biomarker for CKD progression in children.
  • To explore the combined predictive value of GDF-15 and uEGF for pediatric CKD progression.
  • To validate findings in independent pediatric CKD cohorts.

Main Methods:

  • Serum GDF-15 levels were analyzed in 671 children with CKD (ages 6-17) from the 4C study.
  • A composite endpoint included kidney replacement therapy, 50% estimated glomerular filtration rate (eGFR) loss, or eGFR < 10 ml/min/1.73 m².
  • Results were validated in 329 participants from the ESCAPE trial, with an 8-year median follow-up.

Main Results:

  • Elevated serum GDF-15 levels were significantly associated with an increased risk of CKD progression (HR: 1.40; 95% CI: 1.10-1.77).
  • This association remained independent of established risk factors like age, sex, baseline eGFR, proteinuria, and blood pressure.
  • Combining GDF-15 and uEGF improved the predictive model's fit more than either biomarker alone.

Conclusions:

  • Serum GDF-15 and urinary EGF show promise as complementary biomarkers for predicting pediatric CKD progression.
  • These biomarkers may enhance risk stratification for personalized management strategies in pediatric CKD.
  • Future prognostic biomarker panels could incorporate GDF-15 and uEGF for improved clinical utility.