Mini-sternotomy for direct right atrial dialysis catheter placement in a child with central venous occlusion

Mini-sternotomy for direct right atrial dialysis catheter placement in a child with central venous occlusion | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Mini-sternotomy for direct right atrial dialysis catheter placement in a child with central venous occlusion Maria Nucera, Sibylle Tschumi, Matthias Siepe This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7333614/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Dec, 2025 Read the published version in Pediatric Nephrology → Version 1 posted 5 You are reading this latest preprint version Abstract We report the case of a pediatric patient with end-stage renal disease and bilateral central venous occlusion, in whom conventional dialysis access was no longer feasible. Following multidisciplinary evaluation, a dialysis catheter was surgically inserted directly into the right atrium via a lower mini-sternotomy. A custom-made bovine pericardial conduit was used to facilitate extrathoracic tunnelling and protect the catheter. The procedure was technically successful, and the catheter remained functional postoperatively. This case highlights a viable salvage option for dialysis access in children with exhausted vascular access sites. pediatric hemodialysis vascular access central venous occlusion right atrial catheter Figures Figure 1 BACKGROUND Establishing and maintaining reliable vascular access remains a significant challenge in pediatric patients undergoing long-term hemodialysis. Repeated central venous catheter placements frequently lead to progressive thrombosis and eventual occlusion of major central veins, thereby limiting conventional access sites. We report a rare case of direct right atrial catheter placement via lower mini-sternotomy in a child with complete occlusion of both the superior and inferior vena cava. CASE PRESENTATION The patient was a 5-year-old boy with end-stage renal disease since birth on chronic hemodialysis. The child had previously undergone a kidney transplantation, with a prompt graft failure due to arterial vascular occlusion and consecutive bleeding. Following graft loss, the patient returned on hemodialysis therapy, since peritoneal dialysis was not succsessfull anymore after multiple abdominal interventions Multiple central venous catheter placements over time had led to complete occlusion of both the superior and inferior vena cava, as confirmed by imaging (Figure?). An endovascular attempt to recanalize the occluded vessels was unsuccessful. With no remaining conventional central venous access options and both peritoneal dialysis and retransplantation deemed unfeasible, a multidisciplinary team decided to proceed with surgical placement of a dialysis catheter directly into the right atrium. Surgical Procedure A lower mini-sternotomy was carried out. After opening the pericardium, the right atrium was exposed. A tangential clap was applied, and a longitudinal incision of approximately 1cm was made. An 8 x 3 cm bovine pericardial path was fashioned into a tube and sutured to the atrial incision, creating a direct conduit. A radiopaque marker was attached at the atrial entry site for future imaging reference (Fig. 1 ). The pericardial tube was then tunnelled subcostally through a second incision to the right side of the chest (Fig. 2). A guidewire was introduced through the pericardial tube into the right atrium. Over the guidewire, an 8 Fr dialysis catheter was advanced. Under fluoroscopic guidance and contrast injection, the catheter tip was positioned so that the distal end was directed toward the superior vena cava, while the proximal portion resided approximately 1cm within the right atrium. Initially, flow through the catheter was suboptimal, due to overly tight fixation. After adjusting, both lumens could be freely aspirated and flushed. The sternum and the incisions were closed and the catheter was securely fixed to the skin (Fig. 3). Postoperative phase and follow-up The postoperative course was initially uneventful, and the catheter remained fully functional with good flow. However, two month later, during a routine dressing change, the catheter was accidentally transected. The patient was taken back to the operating room. Through the original subcostal incision, the pericardial tube was re-identified and carefully dissected free. Using the Seldinger technique, a guidewire was first introduced through the lumen of the existing catheter prior to its removal. Subsequently, a new dialysis catheter was advanced and positioned successfully under echocardiographic guidance. Intraoperative testing confirmed proper catheter function, and the postoperative course remained stable thereafter. For another 3 months after the revision, the catheter is fully functional. DISCUSSION Central venous occlusion represents a significant and increasingly common challenge in pediatric patients undergoing long-term dialysis, particularly when repeated catheter placements have rendered conventional access sites unusable. In such complex clinical scenarios, alternative techniques must be considered to maintain life-sustaining dialysis therapy. Direct right atrial catheterization, though rarely performed in children, emerges as a potential salvage option when all standard vascular access routes has been exhausted. While this approach is invasive and technically demanding, it offers a viable and durable solution in select cases. In the present case, the use of a bovine pericardial tube as a conduit provided dual benefits: it served as a protective sheath and facilitated extrathoracic tunnelling of the catheter, thereby potentially reducing the risk of infection. The existing literature on this technique remains limited, consisting mainly of isolated case reports in both pediatric and adult populations. Detering et al. reported the successful placement of a Hickman catheter via thoracotomy into the right atrium of an 11-year old girl, which functioned effectively for parenteral nutrition [ 1 ]. Similarly, Negoi et al. described a case in which a tunnelled right atrial catheter remained functional for 14 month in an adult dialysis patient with no remaining vascular access, without any reported complications [ 2 ]. These reports, along with the current case, underscore the feasibility of right atrial catheterization in highly selected patients. However, both the European Society for Paediatric Nephrology Dialysis Working Group and the National Kidney Foundation Kidney Disease Outcomes Quality Initiative emphasize that such procedures should be strictly reserved for patients with no other viable access options and should be carried out by experienced multidisciplinary teams. In conclusion, while direct right atrial access should not be considered routine, it may provide a crucial lifeline in otherwise untenable situations. CONCLUSION To our knowledge, this is the first case described using direct right atrial catheter placement using a bovine pericardial conduit via mini-sternotomy in a child. This approach may be considered a salvage option in pediatric dialysis patients with bilateral central venous occlusion. SUMMARY - What is new? Novel salvage access: direct right atrial catheter placement for dialysis in a pediatric patient with bilateral central venous occlusion. Declarations Funding: No funds, grant, or other support was received. Competing Interests: The authors have no competing interests to declare. Consent to Publish: The patient’s legal guardians provided informed consent for the publication of clinical data and photographs. References Datering SM, Lassay L, Vazquez-Jimenez JF, Schnoering H (2011) Direct right atrial insertion of a Hickman catheter in an 11-year-old girl. Interact Cardiovasc Thorac Surg 12(2):321–322 Negoi D, Schmaltz R, Misra M (2005) Successful use of a right atrial catheter for hemodialysis. Am J Med Sci 329(2):104–106 Shroff R, Calder F, Bakkaloglu S et al (2019) Vascular access in children requiring maintenance haemodialysis: a consensus document by the European Society for Paediatric Nephrology Dialysis Working Group. Nephrol Dial Transpl 34(10):1746–1765 Lok CE, Huber TS, Lee T et al (2020) KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis 75(4 Suppl 2):S1–S164 Cite Share Download PDF Status: Published Journal Publication published 09 Dec, 2025 Read the published version in Pediatric Nephrology → Version 1 posted Editorial decision: Major Revisions Needed 05 Sep, 2025 Reviewers agreed at journal 17 Aug, 2025 Reviewers invited by journal 14 Aug, 2025 Editor assigned by journal 12 Aug, 2025 First submitted to journal 09 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7333614","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":500349325,"identity":"b1bcf813-bc79-4208-8012-5e6c279a0fb5","order_by":0,"name":"Maria Nucera","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA40lEQVRIiWNgGAWjYJCCA3DWBwMgwc7AwEy0FsYZIC3MRGiBA2YeBiK06LaffXjgB8OdxP723oefbQru2PMzMzB+LsCjxexMusHBHoZniTPOHDeWzjF4ljizmYFZegY+LQfSGA7wMBxO3CCRxgDUcjjB4DADG8SFuLScf8Zw8A9Ii/wz5t8WBoft7QlquZHGcBhiCxubNIPBYcYNzAS1PGM4LGNw2HjGmTQ2yx6Dw4kzDjM2S+N3WBrzxzcVh2X7248x3/jx57A9f3vzwc/4tECAAQqPsYGghlEwCkbBKBgF+AEAdjBJJYxI/ZcAAAAASUVORK5CYII=","orcid":"https://orcid.org/0000-0002-5941-2232","institution":"Inselspital Universitätsspital Bern: Inselspital Universitatsspital Bern","correspondingAuthor":true,"prefix":"","firstName":"Maria","middleName":"","lastName":"Nucera","suffix":""},{"id":500349326,"identity":"8ac3548e-2cdc-4fb3-bf5e-133f81ebe87b","order_by":1,"name":"Sibylle Tschumi","email":"","orcid":"","institution":"Inselspital Universitatsspital Bern","correspondingAuthor":false,"prefix":"","firstName":"Sibylle","middleName":"","lastName":"Tschumi","suffix":""},{"id":500349327,"identity":"07f32cd9-7a4f-4030-ae17-06b0ffd6ede8","order_by":2,"name":"Matthias Siepe","email":"","orcid":"","institution":"Inselspital Universitätsspital Bern: Inselspital Universitatsspital Bern","correspondingAuthor":false,"prefix":"","firstName":"Matthias","middleName":"","lastName":"Siepe","suffix":""}],"badges":[],"createdAt":"2025-08-09 11:37:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7333614/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7333614/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s00467-025-07104-6","type":"published","date":"2025-12-09T15:57:37+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":89592943,"identity":"9fac7632-8b05-4fa0-81c9-a335e74213f6","added_by":"auto","created_at":"2025-08-21 16:13:43","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":137159,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA-B:\u003c/strong\u003e Intraoperative image showing the pericardial tube with the radiopaque marker (black arrow), the right atrium (*) and the access sites: the lower mini-sternotomy and the subcostal incision (blue arrow). \u003cstrong\u003eC:\u003c/strong\u003eChest X-ray image showing the dialysis catheter with the radiopaque marker (black arrow).\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-7333614/v1/191ceb51b69f1e2b708523ef.jpg"},{"id":98244081,"identity":"833a636c-be88-4290-bde5-51a1f661af61","added_by":"auto","created_at":"2025-12-15 16:12:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":382970,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7333614/v1/cfe0bc0d-5a9e-4bbf-9499-dbba58d9be50.pdf"}],"financialInterests":"","formattedTitle":"Mini-sternotomy for direct right atrial dialysis catheter placement in a child with central venous occlusion","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eEstablishing and maintaining reliable vascular access remains a significant challenge in pediatric patients undergoing long-term hemodialysis. Repeated central venous catheter placements frequently lead to progressive thrombosis and eventual occlusion of major central veins, thereby limiting conventional access sites.\u003c/p\u003e\u003cp\u003eWe report a rare case of direct right atrial catheter placement via lower mini-sternotomy in a child with complete occlusion of both the superior and inferior vena cava.\u003c/p\u003e"},{"header":"CASE PRESENTATION","content":"\u003cp\u003eThe patient was a 5-year-old boy with end-stage renal disease since birth on chronic hemodialysis. The child had previously undergone a kidney transplantation, with a prompt graft failure due to arterial vascular occlusion and consecutive bleeding. Following graft loss, the patient returned on hemodialysis therapy, since peritoneal dialysis was not succsessfull anymore after multiple abdominal interventions Multiple central venous catheter placements over time had led to complete occlusion of both the superior and inferior vena cava, as confirmed by imaging (Figure?).\u003c/p\u003e\u003cp\u003eAn endovascular attempt to recanalize the occluded vessels was unsuccessful. With no remaining conventional central venous access options and both peritoneal dialysis and retransplantation deemed unfeasible, a multidisciplinary team decided to proceed with surgical placement of a dialysis catheter directly into the right atrium.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eSurgical Procedure\u003c/h2\u003e\u003cp\u003eA lower mini-sternotomy was carried out. After opening the pericardium, the right atrium was exposed. A tangential clap was applied, and a longitudinal incision of approximately 1cm was made. An 8 x 3 cm bovine pericardial path was fashioned into a tube and sutured to the atrial incision, creating a direct conduit. A radiopaque marker was attached at the atrial entry site for future imaging reference (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eThe pericardial tube was then tunnelled subcostally through a second incision to the right side of the chest (Fig.\u0026nbsp;2). A guidewire was introduced through the pericardial tube into the right atrium. Over the guidewire, an 8 Fr dialysis catheter was advanced. Under fluoroscopic guidance and contrast injection, the catheter tip was positioned so that the distal end was directed toward the superior vena cava, while the proximal portion resided approximately 1cm within the right atrium. Initially, flow through the catheter was suboptimal, due to overly tight fixation. After adjusting, both lumens could be freely aspirated and flushed. The sternum and the incisions were closed and the catheter was securely fixed to the skin (Fig.\u0026nbsp;3).\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003ePostoperative phase and follow-up\u003c/h3\u003e\n\u003cp\u003eThe postoperative course was initially uneventful, and the catheter remained fully functional with good flow.\u003c/p\u003e\u003cp\u003eHowever, two month later, during a routine dressing change, the catheter was accidentally transected.\u003c/p\u003e\u003cp\u003eThe patient was taken back to the operating room. Through the original subcostal incision, the pericardial tube was re-identified and carefully dissected free. Using the Seldinger technique, a guidewire was first introduced through the lumen of the existing catheter prior to its removal. Subsequently, a new dialysis catheter was advanced and positioned successfully under echocardiographic guidance. Intraoperative testing confirmed proper catheter function, and the postoperative course remained stable thereafter. For another 3 months after the revision, the catheter is fully functional.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eCentral venous occlusion represents a significant and increasingly common challenge in pediatric patients undergoing long-term dialysis, particularly when repeated catheter placements have rendered conventional access sites unusable. In such complex clinical scenarios, alternative techniques must be considered to maintain life-sustaining dialysis therapy.\u003c/p\u003e\u003cp\u003eDirect right atrial catheterization, though rarely performed in children, emerges as a potential salvage option when all standard vascular access routes has been exhausted. While this approach is invasive and technically demanding, it offers a viable and durable solution in select cases. In the present case, the use of a bovine pericardial tube as a conduit provided dual benefits: it served as a protective sheath and facilitated extrathoracic tunnelling of the catheter, thereby potentially reducing the risk of infection.\u003c/p\u003e\u003cp\u003eThe existing literature on this technique remains limited, consisting mainly of isolated case reports in both pediatric and adult populations. Detering et al. reported the successful placement of a Hickman catheter via thoracotomy into the right atrium of an 11-year old girl, which functioned effectively for parenteral nutrition [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Similarly, Negoi et al. described a case in which a tunnelled right atrial catheter remained functional for 14 month in an adult dialysis patient with no remaining vascular access, without any reported complications [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThese reports, along with the current case, underscore the feasibility of right atrial catheterization in highly selected patients. However, both the European Society for Paediatric Nephrology Dialysis Working Group and the National Kidney Foundation Kidney Disease Outcomes Quality Initiative emphasize that such procedures should be strictly reserved for patients with no other viable access options and should be carried out by experienced multidisciplinary teams.\u003c/p\u003e\u003cp\u003eIn conclusion, while direct right atrial access should not be considered routine, it may provide a crucial lifeline in otherwise untenable situations.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eTo our knowledge, this is the first case described using direct right atrial catheter placement using a bovine pericardial conduit via mini-sternotomy in a child. This approach may be considered a salvage option in pediatric dialysis patients with bilateral central venous occlusion.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSUMMARY - What is new?\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eNovel salvage access: direct right atrial catheter placement for dialysis in a pediatric patient with bilateral central venous occlusion.\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"Declarations","content":"\u003cp\u003eFunding: No funds, grant, or other support was received.\u003c/p\u003e\n\u003cp\u003eCompeting Interests: The authors have no competing interests to declare.\u003c/p\u003e\n\u003cp\u003eConsent to Publish: The patient’s legal guardians provided informed consent for the publication of clinical data and photographs.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDatering SM, Lassay L, Vazquez-Jimenez JF, Schnoering H (2011) Direct right atrial insertion of a Hickman catheter in an 11-year-old girl. Interact Cardiovasc Thorac Surg 12(2):321\u0026ndash;322\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNegoi D, Schmaltz R, Misra M (2005) Successful use of a right atrial catheter for hemodialysis. Am J Med Sci 329(2):104\u0026ndash;106\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShroff R, Calder F, Bakkaloglu S et al (2019) Vascular access in children requiring maintenance haemodialysis: a consensus document by the European Society for Paediatric Nephrology Dialysis Working Group. Nephrol Dial Transpl 34(10):1746\u0026ndash;1765\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLok CE, Huber TS, Lee T et al (2020) KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update. Am J Kidney Dis 75(4 Suppl 2):S1\u0026ndash;S164\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"pediatric-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pnep","sideBox":"Learn more about [Pediatric Nephrology](http://link.springer.com/journal/467)","snPcode":"467","submissionUrl":"https://www.editorialmanager.com/pnep/default2.aspx","title":"Pediatric Nephrology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"pediatric hemodialysis, vascular access, central venous occlusion, right atrial catheter","lastPublishedDoi":"10.21203/rs.3.rs-7333614/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7333614/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWe report the case of a pediatric patient with end-stage renal disease and bilateral central venous occlusion, in whom conventional dialysis access was no longer feasible. Following multidisciplinary evaluation, a dialysis catheter was surgically inserted directly into the right atrium via a lower mini-sternotomy. A custom-made bovine pericardial conduit was used to facilitate extrathoracic tunnelling and protect the catheter. The procedure was technically successful, and the catheter remained functional postoperatively. This case highlights a viable salvage option for dialysis access in children with exhausted vascular access sites.\u003c/p\u003e","manuscriptTitle":"Mini-sternotomy for direct right atrial dialysis catheter placement in a child with central venous occlusion","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-21 16:13:39","doi":"10.21203/rs.3.rs-7333614/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Major Revisions Needed","date":"2025-09-05T09:18:24+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"","date":"2025-08-17T08:43:52+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-14T07:21:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-12T10:47:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"Pediatric Nephrology","date":"2025-08-09T07:37:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"pediatric-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pnep","sideBox":"Learn more about [Pediatric Nephrology](http://link.springer.com/journal/467)","snPcode":"467","submissionUrl":"https://www.editorialmanager.com/pnep/default2.aspx","title":"Pediatric Nephrology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"b7da8680-aec0-4dd4-96ee-850ea32e9184","owner":[],"postedDate":"August 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-12-15T16:05:56+00:00","versionOfRecord":{"articleIdentity":"rs-7333614","link":"https://doi.org/10.1007/s00467-025-07104-6","journal":{"identity":"pediatric-nephrology","isVorOnly":false,"title":"Pediatric Nephrology"},"publishedOn":"2025-12-09 15:57:37","publishedOnDateReadable":"December 9th, 2025"},"versionCreatedAt":"2025-08-21 16:13:39","video":"","vorDoi":"10.1007/s00467-025-07104-6","vorDoiUrl":"https://doi.org/10.1007/s00467-025-07104-6","workflowStages":[]},"version":"v1","identity":"rs-7333614","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7333614","identity":"rs-7333614","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}