How have the past 5?years of research changed clinical practice in paediatric nephrology?

Clinical practice in paediatric nephrology is continuously evolving to mirror the research output of the 21st century. The management of antenatally diagnosed renal anomalies, urinary tract infections, nephrotic syndrome and hypertension is becoming more evidence based. Obesity and related hypertension is being targeted at primary and secondary care. The evolving field of molecular and cytogenetics is discovering genes that are facilitating clinicians and families with prenatal diagnoses and understanding of disease processes. The progression of chronic kidney disease in childhood to end‐stage renal failure (ESRF) can be delayed using medical treatment to reduce proteinuria and treat hypertension. Pre‐emptive living‐related renal transplantation has become the treatment of choice for children with ESRF, thereby reducing the morbidity and mortality associated with peritoneal and haemodialysis. Although peritoneal dialysis, which is performed in the patient''s home, is the preferred modality for children for whom there is no living or deceased donor for transplantation, home nocturnal haemodialysis is becoming a feasible option. Imaging modalities with the use of magnetic resonance and computerised tomography are continuously improving. As mortality for renal and vasculitic diseases improves, the gauntlet is now thrown down to reduce morbidity with secondary prevention of longer‐term complications such as atherosclerosis and hyperlipidaemia. Clinical and drug trials in the fields of hypertension, nephrotic syndrome, systemic lupus erythematosus, vasculitis and transplantation are producing more effective treatments, thereby reducing the morbidity resulting from the disease processes and the side effects of drugs.Clinical research influences our clinical practice as paediatricians. Although the practicalities of embarking on research are becoming more bureaucratic, the foundation of the Medicines for Children Research Network with local infrastructure will continue to increase the number of randomised controlled trials in paediatric practice, thereby guiding therapeutic regimens. Therefore, those clinical questions will be answered (to the high standards attained by our paediatric oncological colleagues) and clinical practice will become more evidence based, instead of the continued extrapolation of data produced from research in adult patients. Research in the past 5 years has been extensive in the field of paediatric nephrology, with an increased incidence of systematic reviews and meta‐analyses challenging current beliefs, and genetic testing making rapid diagnosis for patients, families and clinicians involved, which sometimes influences clinical decision making with respect to therapeutic interventions. In this article, I will highlight only some of the more relevant articles in the published literature that have affected clinical practice of the general paediatric and paediatric nephrology communities.