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Hypertension in children after renal transplantation
Burcu Bulum1, Z Birsin Özçakar1, Aslı Kavaz1
1Department of Pediatric Nephrology, Ankara University School of Medicine, Ankara, Turkey.
Insights
Hypertension (HT) is common after pediatric renal transplantation, often developing early and predominantly at night. Ambulatory blood pressure monitoring (ABPM) is crucial for diagnosis and management.
Area of Science:
- Pediatric Nephrology
- Cardiovascular Health in Transplant Patients
- Hypertension Management
Background:
- Hypertension (HT) is a significant complication post-pediatric renal transplantation, increasing cardiovascular risks.
- This study investigates the clinical features of HT in children following kidney transplants.
Purpose of the Study:
- To evaluate the clinical characteristics of hypertension in pediatric renal transplant recipients.
- To identify the prevalence, timing, and patterns of hypertension post-transplant.
Main Methods:
- Retrospective analysis of 24 children with at least 6 months follow-up post-renal transplant.
- Data collected included demographics, lab results, casual BP, ambulatory BP monitoring (ABPM), medications, and left ventricular mass index (LVMI).
Main Results:
- Hypertension (HT) was detected in 87.5% of children post-transplant, with 50% having pre-existing HT.
- HT developed early in most cases (67% within a week, 95% within a month).
- All hypertensive children exhibited nocturnal HT; 42% achieved effective HT control, with a median LVMI of 42.3 g/m(2.7).
Conclusions:
- Severe, early-onset nocturnal hypertension is frequent after pediatric renal transplantation.
- Ambulatory blood pressure monitoring (ABPM) is essential for diagnosing and monitoring HT in this population.
- Regular ABPM in the first year post-transplant is recommended for effective management.
Background:
Hypertension (HT) is a common and serious complication following renal transplantation in children, and an important risk factor for cardiovascular morbidity and mortality. This study evaluated the clinical characteristics of HT in children after renal transplantation.
Methods:
Twenty-four children who were followed up at least 6 months after renal transplantation were enrolled in the study. From the clinical records, demographic and laboratory data, casual blood pressure (BP) measurement, ambulatory BP monitoring (ABPM), medication, and left ventricular mass index (LVMI) at echocardiogram were documented.
Results:
Mean age at time of transplantation was 12.6 ± 3.0 years and mean follow-up period was 19.6 ± 15.8 months. HT was detected in 21 children (87.5%) after renal transplantation. Twelve patients (50%) had HT both before and after transplantation and nine (38%) had HT only after transplantation. HT developed in 67% within the first week and in 95% within the first month. All hypertensive children had night-time HT and no child had isolated daytime HT. The efficacy of HT control was 42%. Median LVMI in patients with HT after renal transplantation was 42.3 g/m(2.7).
Conclusions:
Severe HT, an important complication, was frequently seen in the early period after renal transplantation. Predominance of nocturnal HT and the lack of isolated daytime HT after transplantation underline the importance of ABPM. ABPM should be performed regularly in the first year after transplantation, not only for diagnosis but also for evaluation of HT control.
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