Kidney Week

Abstract: FR-PO0727

Association of Urine Uromodulin with CKD Progression in Children

Session Information

• Pediatric Nephrology: CKD, ESKD, and Glomerular Diseases
  November 07, 2025 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1900 Pediatric Nephrology

Authors

• Bharwani, Sanjna, Yale New Haven Health, New Haven, Connecticut, United States

Sanjna Bharwani, MD

• Xu, Yunwen, Johns Hopkins University, Baltimore, Maryland, United States

Yunwen Xu, MS, PhD

• Greenberg, Jason Henry, Yale New Haven Health, New Haven, Connecticut, United States

Jason Henry Greenberg, MD, FASN

• Abraham, Alison G., Johns Hopkins University, Baltimore, Maryland, United States

Alison G. Abraham, PhD

• Schelling, Jeffrey R., Case Western Reserve University, Cleveland, Ohio, United States

Jeffrey R. Schelling, MD

• Coca, Steven G., Icahn School of Medicine at Mount Sinai, New York, New York, United States

Steven G. Coca, DO, MS

• Schrauben, Sarah J., University of Pennsylvania, Philadelphia, Pennsylvania, United States

Sarah J. Schrauben, MD, MS

• Waikar, Sushrut S., Boston Medical Center, Boston, Massachusetts, United States

Sushrut S. Waikar, MD, MPH

• Gutierrez, Orlando M., The University of Alabama at Birmingham, Birmingham, Alabama, United States

Orlando M. Gutierrez, MD

• Shlipak, Michael, San Francisco VA Health Care System, San Francisco, California, United States

Michael Shlipak, MD, MPH

• Ix, Joachim H., University of California San Diego, La Jolla, California, United States

Joachim H. Ix, MD, FASN

• Warady, Bradley A., Children's Mercy Kansas City, Kansas City, Missouri, United States

Bradley A. Warady, MD

• Kimmel, Paul L., The George Washington University, Washington, District of Columbia, United States

Paul L. Kimmel, MD, FASN

• Bonventre, Joseph V., Brigham and Women's Hospital, Boston, Massachusetts, United States

Joseph V. Bonventre, MD, PhD, FASN

• Parikh, Chirag R., Johns Hopkins University, Baltimore, Maryland, United States

Chirag R. Parikh, MD, PhD, FASN

• Denburg, Michelle, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Michelle Denburg, MD

• Furth, Susan L., The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Susan L. Furth, MD, PhD

• Ramachandran, Vasan S., Boston University, Boston, Massachusetts, United States

Vasan S. Ramachandran

• Krasnow, Emily, Yale New Haven Health, New Haven, Connecticut, United States

Emily Krasnow, MD

Group or Team Name

• On behalf of the CKD Biomarker Consortium and CKiD Study Investigators.

Background

Chronic kidney disease (CKD) progression in children often leads to kidney failure and is associated with increased mortality. Uromodulin, also known as Tom- Horsfall protein, the most abundant protein in normal urine and a marker of tubular health, may serve as a noninvasive urine biomarker of CKD progression risk.

Methods

We analyzed the association between urine uromodulin levels and CKD progression using data from the CKD in Children cohort study, which enrolled children aged 6 months to 16 years with an eGFR of 30-90 ml/min/1.73m². Uromodulin levels were measured using a MesoScale Discovery assay at a median of 6 months post-enrollment and normalized to urine creatinine. The primary outcome was CKD progression, defined as a composite of 50% decline in eGFR or end stage kidney disease.

Results

Among the 665 children included, the median age was 12 years [IQR, 8 - 15], 39% were male, 31% had a glomerular cause of CKD, and baseline eGFR was 49ml/min/1.73m² [IQR, 37 - 63]. 40% reached CKD progression over a median follow-up of 6.8 years. After adjusting for covariates, children in the highest quartile (Q4) of uromodulin levels had an estimated 39% lower risk of CKD progression compared to the lowest quartile (Q1) (Table). The median uromodulin/Cr concentration for those with CKD progression was 8.9 [IQI: 3.7-20.6] versus those without was 13.0 [IQI: 5.2-24.8].

Conclusion

Lower urine uromodulin levels were associated with faster CKD progression independent of established risk factors. These findings suggest urine uromodulin may serve as a non-invasive biomarker for identifying children at higher risk of CKD progression and guiding intervention strategies.

Hazard ratio of CKD progression by uromodulin/ creatinine

Model adjusted for age, female sex, BMI z-score, BP stage, glomerular diagnosis, log2 UPCR, eGFR

Digital Object Identifier (DOI)

• doi: 10.1681/ASN.20255rdpgbzk