Dr Matthew Harmer is a Consultant in Paediatric Nephrology at University Hospital Southampton and part of the Research Leaders Programme (RLP).

His research aims to improve care for children with long-term kidney problems, as well as to find ways to prevent kidney damage in children.

Getting answers faster

In his clinical role, Matthew looks after children with chronic kidney disease.

Children with chronic kidney disease can feel tired all the time, have difficulties concentrating or feel sick. It is a lifelong condition that gradually gets worse over time. There is no cure, but treatments can help to slow its progression.

“Kidney disease is a very under-recognised disease,” says Matthew. “It’s under-researched and under-funded, but it’s actually an increasing problem, both in children and adults.”

Treatments include new medicines or changes to the child’s diet. These can help to keep their kidneys functioning well for longer, delaying the need for dialysis or a kidney transplant.

However, there is one big problem. Currently, you need to wait for months or even years to be able to see whether such changes have had a positive effect on their kidney health.

Matthew intends to use his RLP award to identify biomarkers in blood and urine samples that indicates whether changes to a child’s care are helping to protect their kidneys.

These could be used to develop a test to guide decisions on the best care for these children.

Preventing acute kidney injury

Matthew is also using his RLP award to find ways to prevent acute kidney injuries. These can be caused by serious infections or side effects of treatments such as antibiotics.

“We’re all born with about a million nephrons, which are the functional units within the kidney,” Matthew explains. “Over time, after the age of about two, those nephrons start to decrease, and our kidney function slows down.”

This is usually not a problem, as most people are born with enough nephrons to ensure our kidneys continue to work well for our entire lives. However, in some cases, children are born with fewer nephrons or have an acute kidney injury.

Acute kidney injuries damage the kidneys, reducing the number of nephrons. This can mean children end up with too few nephrons later in life for their kidneys to function properly. Yet, when the acute kidney injury happens, they might not notice any symptoms at all.

“You have to lose up to 80 percent of your kidney function for you to see anything, so it’s very under-diagnosed, and we may only see acute impairment on blood tests,” says Matthew. “However, that doesn’t mean that it’s not having an effect on the body.”

If your kidneys stop working, even partly for a short period of time, that’s associated with longer stays in hospital. It also makes you more likely to develop chronic kidney disease later in life.

Matthew hopes that, through his research, he can find ways to reduce the number of episodes of acute kidney injury children have while they are being treated for infections in hospital.

“If you decrease the number of episodes, you’ll decrease the amount of time they spend in hospital and the complications that can result from acute kidney injury,” he says.

“You’ll also be protecting the longer-term kidney heath of these patients, when they’re not in paediatric services.”