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Glucocorticoid pharmacokinetics and growth retardation in children with renal transplants

Claire Chavatte1, Geneviève Guest, Virginie Proust

  • 1Service Pharmacie, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris, France.

Pediatric Nephrology (Berlin, Germany)
|June 16, 2004
PubMed

Insights

Glucocorticoid medication can cause growth problems in children after kidney transplants. Measuring drug levels in the body does not reliably predict these growth issues in pediatric renal transplant patients.

Area of Science:

  • Pediatric Nephrology
  • Pharmacokinetics
  • Endocrinology

Background:

  • Long-term glucocorticoid therapy, including prednisone (PN), is associated with growth retardation in children post-renal transplantation.
  • Understanding the pharmacokinetic factors influencing growth is crucial for managing pediatric transplant recipients.

Purpose of the Study:

  • To investigate if plasma and urine concentrations of prednisone (PN), prednisolone (PL), and 6-beta-hydroxyprednisolone (betaOH-PL) can predict growth in children after renal transplantation.
  • To analyze the relationship between pharmacokinetic parameters and growth kinetics (catch-up, stable, decline) in this patient population.

Main Methods:

  • Studied pharmacokinetics of PN and PL in plasma and PN, PL, and betaOH-PL in urine in 36 children (5-15 years) on daily (D) or alternate-day (AD) PN treatment.
  • Evaluated statural growth velocity over 1 year and compared clinical and pharmacokinetic parameters across growth kinetics groups.
  • Utilized multiple linear regression to identify predictors of height 1 year post-inclusion.

Main Results:

  • Initial height, creatinine clearance, and D/AD treatment regimen explained 94.2% of height variance at 1 year.
  • Prednisolone (PL) clearance showed an association with growth evolution, but its inclusion did not significantly improve the predictive model.
  • No significant improvement in predicting height variance was observed by incorporating PL clearance into the multivariate model.

Conclusions:

  • Glucocorticoid pharmacokinetics are not recommended as a reliable tool for predicting growth retardation in pediatric renal transplant recipients.
  • Clinical factors like baseline height, renal function (creatinine clearance), and dosing schedule (D vs. AD) are stronger predictors of growth outcomes.
  • Further research may be needed to identify other factors influencing growth in this vulnerable population.

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