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Renal function of children exposed to cyclosporin in utero
P L Giudice1, L Dubourg, A Hadj-Aïssa
1Département de pédiatrie, Hôpital Edouard Herriot and Université Claude Bernard, Lyon, France.
Insights
Children born to mothers using cyclosporin (CsA) after transplantation show normal kidney function. This study assessed renal health in pediatric patients exposed to CsA in utero, finding no adverse effects on their developing kidneys.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Transplant Medicine
Background:
- Cyclosporin (CsA) is crucial for transplant (Tx) graft survival but carries nephrotoxicity risks.
- Intrauterine growth retardation (IUGR) and in utero CsA exposure raise concerns about reduced nephron mass in newborns.
- This study investigated renal function in children over one year old born to mothers on CsA maintenance immunosuppression.
Purpose of the Study:
- To evaluate the long-term renal function of children exposed to cyclosporin (CsA) in utero.
- To determine if maternal CsA use during pregnancy impacts pediatric renal development and function.
- To assess key indicators of kidney health in offspring of transplanted women.
Main Methods:
- Investigated 12 children (aged 2.6+/-1.8 years) born to 12 transplant recipients on CsA.
- Utilized inulin clearance (C(in)) and para-aminohippuric acid clearance (C(PAH)) to assess glomerular filtration and tubular secretion.
- Measured microalbuminuria and electrolyte reabsorption rates to evaluate kidney damage and function.
Main Results:
- Renal function tests in 12 children showed normal blood pressure (94/55 mmHg) and filtration rates (C(in) 117 ml/min/1.73 m(2)).
- Glomerular filtration and tubular reabsorption rates were within normal ranges, with normal microalbuminuria (4.2 mg/mmol).
- Electrolyte tubular reabsorption and urine concentrating capacity were also normal in the studied children.
Conclusions:
- Children born to mothers undergoing CsA treatment for transplantation exhibit normal renal function.
- Prolonged in utero exposure to CsA does not appear to impair renal development or function in these children.
- These findings support the safety of CsA maintenance therapy in pregnant transplant recipients regarding offspring kidney health.
Background:
The use of cyclosporin (CsA) has improved graft survival in transplant (Tx) patients despite its potential nephrotoxicity. Children born to transplanted women may present with intrauterine growth retardation (IUGR). On the basis of potential reduced nephron mass both in IUGR and in newborn experimental animals exposed to CsA in utero, we investigated the renal function of children >1 year of age born to women under maintenance immunosuppression, including CsA.
Methods:
Fourteen children born to 12 Tx women (nine kidney, one pancreas-kidney, one heart, one liver) were investigated using inulin clearance (C(in)), para-aminohippuric acid clearance (C(PAH)), microalbuminuria, and electrolyte reabsorption rate.
Results:
Gestational age of the 14 infants was 34+/-3 weeks and birth weight 2018+/-620 g. During pregnancy, CsA trough blood level was 234+/-115 microg/l and plasma creatinine range was 96-136 micromol/l. Two children were excluded from the study because renal investigation led to a diagnosis of hereditary nephritis (one Alport syndrome, one familial dominant focal segmental glomerulosclerosis) that was retrospectively completed in the mother. Renal function tests were finally performed in 12 children at 2.6+/-1.8 years of age: BP 94+/-7/55+/-5 mmHg, C(in) 117+/-28 ml/min/1.73 m(2), C(PAH) 545+/-124 ml/min/1.73 m(2), filtration fraction 0.23+/-0.03, microalbuminuria 4.2+/-3.5 mg/mmol. Electrolyte tubular reabsorption rates and urine concentrating capacity were normal.
Conclusion:
These results suggest that in children born to transplanted women taking CsA, renal function develops normally despite prolonged exposure in utero.