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Boletín Médico del Hospital Infantil de México

2013, Number 2

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Bol Med Hosp Infant Mex 2013; 70 (2)

Pre- and post-renal transplant bone mineral metabolism in children and adolescents

Díaz-Barriga D, Hernández-Sánchez AM, Rico-Argüello Y, Ortiz-Vázquez LM, Aldana-Vergara R, Velásquez-Jones L, Valverde-Rosas S, Velásquez-Forero F, Medeiros M

Language: Spanish
References: 22
Page: 116-123
PDF size: 381.84 Kb.


ABSTRACT

Background. Information regarding chronic kidney disease–mineral bone disorder (CKD-MBD) in children who undergo renal transplant is scarce. Despite successful renal transplantation, bone disorders have been described and attributed to immunosuppressive drugs (steroids and calcineurin inhibitors). Therefore, it is important to determine the prevalence and outcome of bone mineral disorders pre- and post-renal transplant. The aim of the study was to describe the prevalence and type of bone mineral disorders in children pre-renal transplant and outcomes.
Methods. The Institutional Review Board and Ethics Committee approved the study. Signed consent/assent was obtained from all participants. Patients ‹18 years of age and under investigation for a first renal transplant were invited to participate. At transplant and 6 and 12 months after transplantation, anthropometric data were collected and blood samples were collected for serum creatinine, slope levels of tacrolimus, serum calcium, phosphorus, magnesium and alkaline phosphatase. Intact parathyroid hormone (PTH) was measured before transplant.
Results. Thirty-one patients were included with a mean age of 14.6 ± 3.2 years. Females represented 52%, 18 patients had peritoneal dialysis (58%), eight hemodialysis (26%) and five patients were listed as pre-emptive transplantation (16%). All received induction with basiliximab and triple maintenance therapy with prednisone, mycophenolate mofetil and tacrolimus. One patient was changed to cyclosporine at the third post-transplant month due to diabetes mellitus. Pre-transplant PTH values were ‹150 pg/ml in 51.6% suggestive of low turnover bone lesions, 38.7% had PTH ›300 pg/ml suggestive of high turnover bone lesions and only 9.6% had PTH between 150 and 300 pg/ml. When pre- and post-transplant studied parameters were compared, serum creatinine was statistically lower during follow-up. No difference was found in serum calcium and alkaline phosphatase, but magnesium and phosphorus values were significantly lower after transplant. Twelve patients (38.7%) had post-transplant hypophosphatemia and required supplementation. Ten patients (32%) had hypomagnesemia, seven of them with concomitant hypophosphatemia. Z-score for weight increased significantly after renal transplant; nevertheless, only patients with no hypophosphatemia during follow-up improved their Z-score for height. Glomerular filtration rate had a positive correlation with serum calcium and a negative correlation with phosphorus and magnesium (p ‹0.05). Tacrolimus slope levels had a significantly negative correlation with serum magnesium (r = -0.431, p ‹0.0001).
Conclusions. Glomerular filtration rate had a negative correlation with serum phosphorus at transplant. Tacrolimus slope levels had a negative correlation with magnesium serum values. Patients with no hypophosphatemia during the fi rst year had better growth than those with hypophosphatemia. It is important to monitor and opportunely treat bone mineral disorders in children who undergo transplantation.


REFERENCES

  1. Hruska KA, Choi ET, Memon I, Davis TK, Mathew S. Cardiovascular risk in chronic kidney disease (CKD): the CKD-mineral bone disorder (CKD-MBD). Pediatr Nephrol 2010;25:769-778.

  2. Klaus G, Watson A, Edefonti A, Fischbach M, Rönnholm K, Schaefer F, et al. Prevention and treatment of renal osteodystrophy in children on chronic renal failure: European guidelines. Pediatr Nephrol 2006;21:151-159.

  3. Moe S, Drüeke T, Cunningham J, Goodman W, Martin K, Olgaard K, et al. Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2006;69:1945-1953.

  4. Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl 2009;113:S1-S130.

  5. Alshayeb HM, Josephson MA, Sprague SM. CKD-mineral and bone disorder management in kidney transplant recipients. Am J Kidney Dis 2013;61:310-325.

  6. Fukuda N, Tanaka H, Tominaga Y, Fukagawa M, Kurokawa K, Seino Y. Decreased 1,25-dihydroxyvitamin D3 receptor density is associated with a more severe form of parathyroid hyperplasia in chronic uremic patients. J Clin Invest 1993;92:1436-1443.

  7. Arnold A, Brown MF, Ureña P, Gaz RD, Sarfati E, Drüeke TB. Monoclonality of parathyroid tumors in chronic renal failure and in primary parathyroid hyperplasia. J Clin Invest 1995;95:2047-2053.

  8. van Staa TP, Cooper C, Leufkens HG, Bishop N. Children and the risk of fractures caused by oral corticosteroids. J Bone Miner Res 2003;18:913-918.

  9. Epstein S, Dissanayake IR, Goodman GR, Bowman AR, Zhou H, Ma Y, et al. Effect of the interaction of parathyroid hormone and cyclosporine a on bone mineral metabolism in the rat. Calcif Tissue Int 2001;68:240-247.

  10. Gouadon E, Lecerf F, German-Fattal M. Differential effects of cyclosporin A and tacrolimus on magnesium influx in Caco2 cells. J Pharm Pharm Sci 2012;15:389-398.

  11. Velasquez-Forero F, Mondragón A, Herrero B, Peña JC. Adynamic bone lesion in renal transplant recipients with normal renal function. Nephrol Dial Transplant 1996;11(suppl 3):58-64.

  12. Koch Nogueira PC, David L, Cochat P. Evolution of secondary hyperparathyroidism after renal transplantation. Pediatr Nephrol 2000;14:342-346.

  13. Sanchez CP, Kuizon BD, Goodman WG, Gales B, Ettenger RB, Boechat MI, et al. Growth hormone and the skeleton in pediatric renal allograft recipients. Pediatr Nephrol 2002;17:322-328.

  14. National Kidney Foundation. KDOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Children with Chronic Kidney Disease. Disponible en: https://www.kidney.org/professionals/kdoqi/guidelines_pedbone/index.htm

  15. Kelepouris E, Agus ZS. Hypomagnesemia: renal magnesium handling. Semin Nephrol 1998;18:58-73.

  16. Schwartz GJ, Brion LP, Spitzer A. The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 1987;34:571-590.

  17. Schwartz GJ, Furth SL. Glomerular filtration rate measurement and estimation in chronic kidney disease. Pediatr Nephrol 2007;22:1839-1848.

  18. Schwartz GJ, Haycock GB, Spitzer A. Plasma creatinine and urea concentration in children: normal values for age and sex. J Pediatr 1976;88:828-830.

  19. Torregrosa JV, Bover J, Cannata Andía J. Spanish Society of Nephrology recommendations for controlling mineral and bone disorder in chronic kidney disease patients (S.E.N.-M.B.D.). Introduction. Nefrologia 2011;31(suppl 1):1-2.

  20. Dimke H, Monnens L, Hoenderop JG, Bindels RJ. Evaluation of hypomagnesemia: lessons from disorders of tubular transport. Am J Kidney Dis 2012. PMID 23201160. doi: 10.1053/j.ajkd.2012.07.033

  21. Lee CT, Ng HY, Lien YH, Lai LW, Wu MS, Lin CR, et al. Effects of cyclosporine, tacrolimus and rapamycin on renal calcium transport and vitamin D metabolism. Am J Nephrol 2011;34:87-94.

  22. Van Laecke S, Van Biesen W, Verbeke F, De Bacquer D, Peeters P, Vanholder R. Posttransplantation hypomagnesemia and its relation with immunosuppression as predictors of new-onset diabetes after transplantation. Am J Transplant 2009;9:2140-2149.




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