Pediatric Nephrology Faculty Spotlight: Juhi Kumar, MD, Medical Director, Pediatric Kidney Transplant

Juhi Kumar, MD, MPH, joined the Division of Pediatric Nephrology at UPMC Children’s Hospital of Pittsburgh in August 2022, taking over the role of Medical Director of the Pediatric Kidney Transplant program.

Prior to joining UPMC Children’s, Dr. Kumar was an Associate Professor of Clinical Pediatrics and Population Health at Weill Cornell Medicine for 13 years. She served as the Medical Director of the Pediatric Kidney Transplant Program at Weill Cornell Medicine/New York Presbyterian Hospital for 2-years and was named Interim Division Chief of Pediatric Nephrology in January 2022.

Dr. Kumar earned her medical degree from LLRM Medical College in India. She did her residency training in pediatrics at SUNY-Downstate Medical Center, located in Brooklyn, New York, and then went on to complete a pediatric nephrology fellowship at Children’s Hospital at Montefiore in the Bronx, New York. She earned her Master’s in Public Health from the University of Medicine and Dentistry of New Jersey.

Clinical Background and Prior Work/Research

Dr. Kumar’s early career work was largely research oriented, having earned a National Institute of Health (NIH)/NIDDK, K23 career development award for clinical research which was focused on vitamin D deficiency and chronic kidney disease in children.

“A significant portion of my clinical research was focused on vitamin D and chronic kidney disease,” says Dr. Kumar. “Specifically, I had an interest in how CKD can influence and predispose patients to bone disease, and subsequently downstream effects like fractures and other clinical outcomes.”

Among other findings, Dr. Kumar’s K23 research revealed a significant prevalence of vitamin D deficiency among children suffering from chronic kidney disease. This deficiency was found to contribute to early elevations in parathyroid hormone levels and a greater deficiency in 1,25- di hydroxyvitamin D.

Kidney Rejection and Biomarker Surveillance

She is also the co-principal investigator along with Drs. Sandra Amaral and Brendan Keating (Children’s Hospital of Philadelphia) of an NIH/NICHD- R01-funded multicenter study called VIRTUUS that is examining the use of urinary biomarkers to monitor for early signs of rejection in pediatric kidney transplant recipients.

“This ongoing work was based on a lot of the pioneering work and seminal studies conducted on urinary messenger RNA biomarkers of kidney rejection in adults by one of my mentors at Weill Cornell Medicine, Dr. Manikkam Suthanthiran, MD, who leads the adult nephrology division and transplant program there,” says Dr. Kumar. “Working with Dr. Suthanthiran over the years was how I developed an interest in kidney transplantation.”

Acute rejection in kidney transplantation affects approximately 10-13% of pediatric patients. Lack of non-invasive, early markers of acute rejection makes it challenging to monitor the immune status of an allograft. Protocol biopsies are not often done in children at many centers.

“This is why we are very interested in pursuing research like in the VIRTUUS study because having a validated, sensitive, and noninvasive marker can help us appreciate acute rejection earlier and hopefully we can intervene sooner and limit damage to the kidney transplant."

Joining UPMC Children’s – Goals and Plans for Kidney Transplant Program

Dr. Kumar's transition from Weill Cornell to UPMC Children's was fueled by a desire for a more significant role in clinical research and program-building. The substantial patient base at UPMC Children's and expanding kidney transplant program presented opportunities for enhanced clinical research, a continuation of some of her existing studies, and the ability to interact with and care for more transplant patients.

“I look at my work with the kidney transplant program at UPMC Children’s as evolving along a three-fold strategy to grow the program and improve long-term outcomes for children,” says Dr. Kumar. “This encompasses work in the clinical, educational, and research aspects of the program.”

Clinical Goals

Clinically, Dr. Kumar aims to implement quality improvement measures and enhance patient satisfaction and expand outreach efforts to reach a larger referral base for patients in need, working alongside the transplant team at UPMC Children’s.

Dr. Kumar’s clinical work with the program will encompass both a broadening of geographies in which the Division typically sees patient referrals, and more outreach to the primary care physician communities and other centers in the region not equipped to handle pediatric transplantation.

“We’re also interested in finding ways to streamline the outpatient clinic workflow in order to reduce wait times and improve overall patient satisfaction and access to care,” says Dr. Kumar. “We’ll also be undertaking several new quality improvement initiatives designed to improve our longitudinal monitoring of our patient’s kidney and overall health.”

Educational Efforts

On the educational front, Dr. Kumar has plans for both fellows in training, but also for patients and families – in the early phases with respect to the transplant processes, but also in how to transition patients more effectively from pediatric to adult care when that time comes.

“The complexity, challenges, and sheer amount of information families and patients must digest when confronted with the need for a kidney transplant is overwhelming, but a lot of long-term success and health post-transplant is directly affected by what people know and understand early on,” says Dr. Kumar. “But setting up patients for eventual adult-based care is equally important because sooner or later it’s going to happen for these kids as they grow and get older. How we educate them along that journey, can help set them up for long-term success so we’ll have a significant focus on finding and testing ways to facilitate the transition period.”

Continuing Research to Improve Pediatric Transplant Medicine and Outcomes

In addition to research studies Dr. Kumar is currently working on such as VIRTUUS, she sees a continuing need to continue her personal research priorities that have driven much of her prior work, but has also taken over as the principal investigator of multicenter studies that UPMC Children’s is a part of as one of the leading pediatric transplant hospitals in the U.S.

She is the site PI for a study (CTOT-41-Advancing Transplantation Outcomes in Children, PI-David Briscoe, Boston Children’s Hospital) that is investigating an alternative immunosuppression protocol to the use of tacrolimus, which has the potential for injury to the kidney transplant in the long-term” says Dr. Kumar.

“I and our team also have an interest in continuing studies to investigate biomarkers of early kidney injury in our transplant patients,” says Dr. Kumar. “We hope to look at that longitudinally in a future grant application. Anything we can do to identify injury or signs of rejection earlier will improve our ability to more effectively intervene before significant damage occurs.”

Learn More

Read more about Dr. Kumar’s past research and clinical work by visiting her PubMed listing for peer-reviewed research.

Read more about Dr. Kumar’s prior K23 Award, the ongoing VIRTUUS study, and the BICARb Pilot Trial, and NIH R01 funded trial in which she is a co-principal investigator studying the use of potassium citrate as a means to treat or mitigate the effects on bone from chronic kidney disease.