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Renal allograft calcification -- prevalence and etiology in pediatric patients
Sandra Habbig1, Bodo B Beck, Markus Feldkötter
1Department of Pediatrics, Division of Pediatric Nephrology, University Hospital, Cologne, Germany.
Insights
Renal allograft calcification occurs in 44.4% of pediatric kidney transplant (KTx) patients. This study found no specific risk factors or negative impact on graft function, though long-term observation is needed.
Area of Science:
- Nephrology
- Transplantation
- Pediatric Medicine
Background:
- Renal allograft calcification prevalence varies widely (2-60%) in adult kidney transplant (KTx) recipients.
- Hyperparathyroidism, hypercalcemia, and hypercalciuria are known risk factors in adults.
- The prevalence and risk factors in pediatric KTx recipients remain unclear.
Purpose of the Study:
- To determine the prevalence of renal calcification in pediatric kidney transplant recipients.
- To identify potential risk factors for calcification in this population.
- To assess the impact of calcification on graft function.
Main Methods:
- Histological examination of routine graft biopsies from pediatric KTx patients using Kossa stain.
- Analysis of urinary excretion of lithogenic (oxalate, calcium) and stone-inhibitory (citrate) substances.
Main Results:
- Tubular calcification was detected in 16 out of 36 (44.4%) pediatric KTx biopsies.
- No singular risk factor was associated with transplant calcification.
- Calcification did not correlate with a worse transplant outcome in this cohort.
Conclusions:
- Pediatric KTx calcification incidence aligns with adult rates.
- Hypercalciuria was not identified as a risk factor in children.
- The long-term impact of renal allograft calcification on graft function requires further investigation.
Background:
Calcification of renal allografts has been reported in adult kidney transplant (KTx) recipients with a widely differing prevalence (2-60%). Persistent hyperparathyroidism, hypercalcemia and concomitant hypercalciuria were identified as major risk factors. We aimed to determine the prevalence and risk factors for such calcifications in children.
Methods:
We investigated histological stains of routine graft biopsies from pediatric KTx patients for renal calcifications and determined the urinary excretion of lithogenic (oxalate, calcium) and stone-inhibitory substances (citrate).
Results:
In our series of transplant patients, tubular calcification was found in 16 of the 36 (44.4%) KTx biopsies by an additional Kossa stain. This transplant calcification was not associated with any singular risk factor and was not correlated to a worse transplant outcome.
Conclusion:
Although our pediatric findings confirm the reported incidence rates of KTx calcification in adults, we could neither identify hypercalciuria as a risk factor nor confirm any negative influence on graft function. However, long-term studies are clearly needed to prove or disprove a negative impact of calcifications on graft function.
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