About

Michelle Denburg, MD, MSCE, is an Associate Professor of Pediatrics (Nephrology) at the Children's Hospital of Philadelphia. She serves as an Attending Physician in the Division of Nephrology and is a Senior Scholar in the Clinical Epidemiology Unit of the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania. Dr. Denburg is also a core faculty member of Clinical Futures at the Children's Hospital of Philadelphia, where she holds multiple leadership roles including Director of Research in the Division of Nephrology, Co-Director of the Pediatric Center of Excellence in Nephrology, and Co-Director of the Penn-CHOP Kidney Innovation Center. Her educational background includes a B.S. from Yale University, an M.D. from Weill Medical College of Cornell University, and an M.S.C.E. in Clinical Epidemiology from the University of Pennsylvania. Her research focuses on pediatric nephrology, clinical epidemiology, and disparities in kidney disease, contributing to the understanding and treatment of kidney conditions in children.

Research topics

• Intensive care medicine
• Medicine
• Internal medicine
• Pediatrics

Selected publications

• Contemporary Treatment Responses of Recurrent Focal Segmental Glomerulosclerosis or Steroid Resistant Nephrotic Syndrome in Children after Kidney Transplantation: Phase 2 of a Multicenter Electronic Health Record Data Analysis

  Research Square · 2026-04-20

  preprintOpen accessSenior author
  PublisherOA PDFDOI

• Comparative Effectiveness of Antihypertensive Medications in Children With Chronic Kidney Disease

  JAMA Pediatrics · 2026-03-16 · 1 citations

  articleOpen access1st authorCorresponding

  Importance: Hypertension is a major modifiable factor for kidney function decline in chronic kidney disease (CKD). Comparative trials of antihypertensive medications in pediatric CKD are lacking. Objective: To evaluate the comparative effectiveness of renin-angiotensin-aldosterone system inhibition (RAASi) vs calcium channel blockade (CCB), the most widely used first-line antihypertensive treatment approaches in pediatric CKD, on preservation of kidney function. Design, Setting, and Participants: Using target trial emulation methods, this comparative-effectiveness study emulated a pragmatic, open-label clinical trial using electronic health record data from the Preserving Kidney Function in Children with CKD (PRESERVE) study from January 2009 through December 2020. Thirteen health care institutions from 5 PCORnet Clinical Research Networks were represented. Children and adolescents aged 2 to 20.9 years with CKD stage 2-4 and systolic blood pressure higher than the 90th percentile or with a hypertension diagnosis who initiated treatment with RAASi or CCB were included. Exclusion criteria included kidney replacement therapy, renal artery stenosis, malignancy, and pregnancy. Data analysis was completed in July 2025. Exposures: Incident RAASi or CCB treatment. Randomization was emulated by propensity score weighting to balance groups on sociodemographic factors, institution, year, CKD etiology, proteinuria, CKD stage, obesity, health care use, medications, comorbidities, and blood pressure control (percentage of time at greater than the 90th percentile). Main Outcomes and Measures: The primary outcome was progression to kidney replacement therapy within 2 years of follow-up, ascertained through linkage with the United States Renal Data System. The secondary outcome was a composite of kidney replacement therapy, 50% decline in estimated glomerular filtration rate, or estimated glomerular filtration rate less than 15 mL/min/1.73 m2. Cox proportional hazards regression with propensity score stratification was used to estimate adjusted hazard ratios (aHRs) in the intention-to-treat analysis. Adjusted analyses also compared systolic blood pressure control within 2 years of follow-up. Results: Of 2762 children and adolescents, 1757 initiated RAASi (median [IQR] age, 13.1 [9.2-15.5] years; 897 [51.1%] male) and 1005 initiated CCB (median [IQR] age, 12.6 [8.4-15.3] years; 500 [49.8%] male). In adjusted analyses, RAASi was associated with reduced risk of both kidney replacement therapy (aHR, 0.58; 95% CI, 0.40-0.84, P = .004) and the secondary composite outcome (aHR, 0.67; 95% CI, 0.53-0.83). Systolic blood pressure control was better with RAASi than CCB (29% vs 39% of time >90th percentile). Conclusions and Relevance: In this comparative-effectiveness study, RAASi was associated with lower risk of CKD progression and better blood pressure control compared to CCB. Findings support first-line use of RAASi for antihypertensive treatment in pediatric CKD.

  PublisherOA PDFDOI

• Blood Pressure Control in Adolescents With CKD and Risk of Kidney Failure in Young Adulthood

  Kidney Medicine · 2026-05-06

  articleOpen access

  <h2>Abstract</h2><h3>Rationale & Objective</h3> Understanding risk factors for chronic kidney disease (CKD) progression during adolescence is essential to improve outcomes for these individuals as adults. The objective of the current study was to retrospectively analyze electronic health records (EHR) of children with CKD to understand the effect of cumulative systolic blood pressure (SBP) load during adolescence on time to kidney replacement therapy or death during young adulthood. <h3>Study Design</h3> Retrospective cohort study <h3>Setting & Participants</h3> Adolescents with chronic kidney disease were enrolled from 14 academic medical centers in the Preserving Kidney Function in Children with Chronic Kidney Disease (PRESERVE) study. Individuals between the ages of 1 and <18 years with ≥2 eGFRs between 30 and <90 mL/min/1.73m² separated by ≥90 days without an intervening eGFR value ≥90 mL/min/1.73m² were included. <h3>Exposure</h3> Cumulative systolic blood pressure (SBP) load was defined using area under and above the SBP curve (i.e., time and magnitude), and time-only approaches using the 50th, 75th, and 90th SBP percentiles. <h3>Outcomes</h3> Time to kidney replacement therapy (KRT, chronic dialysis initiation or kidney transplantation) or death were ascertained via linkage with the United States Renal Data System. <h3>Analytical Approach</h3> Cox proportional hazards models were used to investigate the relationship between BP control and the composite of KRT or death. <h3>Results</h3> The cohort included 2,585 individuals with a median follow-up of 7.45 years (IQR: 6.05-9.20), among whom 4.6% (n=118) met the KRT or death outcome between ages 18-30 years. In an adjusted Cox model, each unit increase (pp*time) in cumulative SBP load above the 90th percentile was associated with 1.36 (95% CI: 1.17, 1.58) times higher hazards of KRT or death between ages 18-19 years. SBP control to <90th percentile for 25%, 50%, and 100% of time between ages 14 to 18 years was associated with a 47%, 72%, and 92% risk reduction of KRT or death between ages 18 to 19 years compared to no SBP control. <h3>Limitations</h3> Misclassification of BP control related to white coat or masked hypertension. Adherence to prescribed anti-hypertensive medications was not assessed. <h3>Conclusions</h3> Worse SBP control during adolescence was associated with a markedly increased risk of kidney failure in young adulthood. Cumulative SBP load derived from EHR data can inform risk of adverse long-term kidney outcomes. <h3>Plain-Language Summary</h3> Chronic kidney disease is commonly accompanied by elevated blood pressure. Understanding risk factors for chronic kidney disease progression during adolescence is essential to improve outcomes for these individuals as adults. We used electronic health records to study the effect of systolic blood pressure load in adolescents with chronic kidney disease on risk of kidney failure in young adulthood. We found that worse systolic blood pressure control during adolescence is associated with a markedly increased risk of kidney failure in young adulthood. The study demonstrates that blood pressure readings from electronic health record data can be used to estimate the risk of adverse long-term kidney outcomes.

  PublisherOA PDFDOI

• Bile acid metabolites and carotid intima media thickness in the Chronic Kidney Disease in Children (CKiD) study

  Pediatric Nephrology · 2026-05-08

  articleOpen access
  PublisherOA PDFDOI

• Hypertension, proteinuria, and RAAS inhibition use in children with systemic lupus erythematosus: Data from a multi-institutional pediatric learning health system

  Lupus · 2025-05-20 · 2 citations

  articleOpen access

  Objectives To assess the potential of a multi-institutional pediatric learning health system for comparative effectiveness research in pediatric-onset systemic lupus erythematosus (SLE), we characterized renin angiotensin aldosterone system (RAAS) inhibitor utilization and the feasibility of ascertaining key treatment indications and outcomes, including hypertension and proteinuria. Methods We identified children with SLE and lupus nephritis (LN) at 6 PEDSnet institutions using previously developed computable phenotypes. A reference population of controls without SLE was randomly sampled from the same rheumatology/nephrology clinics ( N = 200 controls per site). We evaluated data completeness, plausibility, and conformance related to RAAS inhibitor treatment indications and outcomes: (a) percent of encounters with blood pressure (BP) readings, (b) percent of BP readings with paired height, (c) percent of patients with ≥1 urinalysis within 7 days of SLE diagnosis, (d) urinalyses for which proteinuria could be classified as normal or abnormal, and (e) RAAS inhibitor use. Results There were 1303 patients with SLE, including 457 with LN. BP measurements were available at 62% of encounters, of which 96% were paired with a height within 90 days. BP distributions were higher in patients with SLE and LN compared to controls without SLE. One third of SLE patients had a hypertension diagnosis. 60%–83% of patients at each site had a urinalysis protein measurement within 7 days of SLE diagnosis. A normal or abnormal result for proteinuria could be derived for 96% of measurements, and nearly all patients with LN had ≥1 abnormal result (range 94%–100% by site). RAAS inhibitors were prescribed to 31% of SLE and 71% of LN patients (range 60%–84% by site). Hypertension, elevated BP or proteinuria was identified in 90% of SLE cases at the time of RAAS inhibitor initiation. Conclusion We demonstrated the feasibility of ascertaining health measurement data relevant to pediatric lupus treatment and outcomes in a pediatric learning health system, as well as hospital-level variation in RAAS inhibitor use. This work will facilitate more efficient multi-institutional comparative effectiveness research and also highlights opportunities for increased treatment standardization.

  PublisherOA PDFDOI

• The Use of Extrapolation to Promote Clinical Trials in Pediatric Nephrology

  Journal of the American Society of Nephrology · 2025-09-05

  articleOpen access
  PublisherOA PDFDOI

• Hemolysis Monitoring Practices during Extracorporeal Membrane Oxygenation: A Survey Report

  Blood Purification · 2025-09-16 · 1 citations

  articleOpen access

  INTRODUCTION: Intravascular hemolysis is a significant complication of extracorporeal membrane oxygenation (ECMO), associated with adverse outcomes such as kidney failure and increased mortality. There is wide variability in the cited incidence of this complication. This survey study aimed to characterize the variability in hemolysis monitoring practices across ECMO centers. METHODS: The survey, distributed via the Extracorporeal Life Support Organization (ELSO) newsletter, received 26 responses from various healthcare professionals, including nurses, perfusionists, respiratory therapists, and physicians. Respondents represented both pediatric and adult ECMO units, primarily from academic centers in the USA (46%). RESULTS: Findings revealed that 92% of these centers use centrifugal pumps, with heparin and bivalirudin being the preferred anticoagulants. While 68% of respondents reported having a standard protocol for hemolysis monitoring, the specific protocols varied widely. Plasma-free hemoglobin was the most commonly monitored laboratory test. Definitions for what were considered significant hemolysis varied as well and were primarily identified by red urine and elevated plasma hemoglobin levels. Interventions to address hemolysis included adjusting pump speed, repositioning cannulas, replacing pump heads or oxygenators, and performing plasmapheresis. CONCLUSION: The study highlights the variability in hemolysis monitoring practices among ECMO centers. Further research is warranted to establish optimal monitoring protocols to detect and potentially treat the complication of hemolysis.

  PublisherOA PDFDOI

• Percutaneous Nephrolithotomy vs Ureteroscopy for Kidney Stones in Children

  JAMA Network Open · 2025-06-20 · 7 citations

  articleOpen access

  Importance: Based on expert opinion, clinical guidelines recommend percutaneous nephrolithotomy or shockwave lithotripsy for children and adolescents with kidney stones 20 mm or larger, without mention of ureteroscopy as an alternative. Objective: To compare clinical and patient-reported outcomes for percutaneous nephrolithotomy vs ureteroscopy in children and adolescents with kidney and/or ureteral stones. Design, Setting, and Participants: This prospective cohort study was performed at 31 medical centers in the US and Canada. Participants included patients aged 8 to 21 years undergoing surgery for kidney and/or ureteral stones between March 16, 2020, and July 31, 2023. Exposures: Percutaneous nephrolithotomy vs ureteroscopy. Main Outcomes and Measures: Stone clearance assessed by ultrasonography 6 (±2) weeks postoperatively. Secondary outcomes included patient-reported outcomes 1 week after surgery. Results: The study enrolled 1039 eligible patients (median age, 15.6 [IQR, 12.5-17.3] years; 629 female [60.5%]; 40 Black [3.8%]; 128 Hispanic [12.3%]; and 792 White [76.2%]). One hundred twenty-six urologists performed percutaneous nephrolithotomy for 98 kidneys and/or ureters and ureteroscopy for 1069, including 36 undergoing percutaneous nephrolithotomy and 43 undergoing ureteroscopy for stones larger than 15 mm. Stone clearance was 67.2% (95% CI, 46.0%-88.4%) for percutaneous nephrolithotomy and 73.4% (95% CI, 69.4%-77.4%) for ureteroscopy, a difference that was not statistically significant (risk difference, -6.2%; 95% CI, -27.7% to 15.4%). For stones larger than 15 mm, stone clearance was 94.0% (95% CI, 83.3%-100%) for percutaneous nephrolithotomy and 55.0% (95% CI, 32.9%-77.1%) for ureteroscopy, a statistically significant difference (risk difference, 39.0%; 95% CI, 14.4%-63.5%). Compared with ureteroscopy, percutaneous nephrolithotomy had significantly lower pain intensity (T score difference, -5.42; 95% CI, -10.38 to -0.46), pain interference (T score difference, -5.88; 95% CI, -11.02 to -0.75), anxiety (T score difference, -5.74; 95% CI, -9.26 to -2.22), psychological stress experiences (T score difference, -7.90; 95% CI, -13.13 to -2.67), sleep disturbance (T score difference, -5.57; 95% CI, -8.56 to -2.58), and urinary symptoms (symptom score difference, -6.37; 95% CI, -11.71 to -1.03) 1 week after surgery. Conclusions and Relevance: Compared with ureteroscopy, percutaneous nephrolithotomy had similar stone clearance and better lived experiences for children and adolescents and was associated with greater stone clearance of kidney stones larger than 15 mm. A future adequately powered prospective clinical trial is needed to reaffirm these results.

  PublisherOA PDFDOI

• ASN Kidney Health Guidance on Potassium and Phosphorus Food Additives

  Journal of the American Society of Nephrology · 2025-09-18 · 6 citations

  article
  PublisherDOI

• Kidney Function Following COVID-19 in Children and Adolescents

  JAMA Network Open · 2025-04-11 · 8 citations

  articleOpen access

  Importance: It remains unclear whether children and adolescents with SARS-CoV-2 infection are at heightened risk for long-term kidney complications. Objective: To investigate whether SARS-CoV-2 infection is associated with an increased risk of postacute kidney outcomes among pediatric patients, including those with preexisting kidney disease or acute kidney injury (AKI). Design, Setting, and Participants: This retrospective cohort study used data from 19 health institutions in the National Institutes of Health Researching COVID to Enhance Recovery (RECOVER) initiative from March 1, 2020, to May 1, 2023 (follow-up ≤2 years completed December 1, 2024; index date cutoff, December 1, 2022). Participants included children and adolescents (aged <21 years) with at least 1 baseline visit (24 months to 7 days before the index date) and at least 1 follow-up visit (28 to 179 days after the index date). Exposures: SARS-CoV-2 infection, determined by positive laboratory test results (polymerase chain reaction, antigen, or serologic) or relevant clinical diagnoses. A comparison group included children with documented negative test results and no history of SARS-CoV-2 infection. Main Outcomes and Measures: Outcomes included new-onset chronic kidney disease (CKD) stage 2 or higher or CKD stage 3 or higher among those without preexisting CKD; composite kidney events (≥50% decline in estimated glomerular filtration rate [eGFR], eGFR ≤15 mL/min/1.73 m2, dialysis, transplant, or end-stage kidney disease diagnosis), and at least 30%, 40%, or 50% eGFR decline among those with preexisting CKD or acute-phase AKI. Hazard ratios (HRs) were estimated using Cox proportional hazards regression models with propensity score stratification. Results: Among 1 900 146 pediatric patients (487 378 with and 1 412 768 without COVID-19), 969 937 (51.0%) were male, the mean (SD) age was 8.2 (6.2) years, and a range of comorbidities was represented. SARS-CoV-2 infection was associated with higher risk of new-onset CKD stage 2 or higher (HR, 1.17; 95% CI, 1.12-1.22) and CKD stage 3 or higher (HR, 1.35; 95% CI, 1.13-1.62). In those with preexisting CKD, COVID-19 was associated with an increased risk of composite kidney events (HR, 1.15; 95% CI, 1.04-1.27) at 28 to 179 days. Children with acute-phase AKI had elevated HRs (1.29; 95% CI, 1.21-1.38) at 90 to 179 days for composite outcomes. Conclusions and Relevance: In this large US cohort study of children and adolescents, SARS-CoV-2 infection was associated with a higher risk of adverse postacute kidney outcomes, particularly among those with preexisting CKD or AKI, suggesting the need for vigilant long-term monitoring.

  PublisherOA PDFDOI

Recent grants

• Vitamin D Deficiency in Glomerular Disease

  NIH · $858k · 2012–2018

• Comparative effectiveness of balanced fluids versus normal saline to reduce acute and chronic kidney disease in children with sepsis

  NIH · $15.5M · 2017–2027

Frequent coauthors

• Susan L. Furth

  Children's Hospital of Philadelphia

  134 shared

• Mary B. Leonard

  Lucile Packard Children's Hospital

  87 shared

• Paul L. Kimmel

  National Institutes of Health

  50 shared

• Mark Mitsnefes

  University of Cincinnati

  48 shared

• Gregory E. Tasian

  45 shared

• Bradley A. Warady

  Children's Mercy Hospital

  44 shared

• Christopher B. Forrest

  Children's Hospital of Philadelphia

  43 shared

• Jarcy Zee

  Children's Hospital of Philadelphia

  43 shared