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Hyponatremia, hypo-osmolality, and seizures in children early post-kidney transplant
Keri Drake1, Edward Nehus1, Jens Goebel1
1Division of Pediatric Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Insights
Post-transplant seizures in young kidney recipients are rare but serious. Mild hyponatremia and rapid osmolality shifts in the first 24 hours are key risk factors for these neurological complications.
Area of Science:
- Nephrology
- Neurology
- Transplant Surgery
Background:
- Post-transplant seizures are infrequent but serious complications in pediatric kidney transplant recipients.
- These seizures can indicate severe outcomes, including cerebral edema and mortality.
Observation:
- A retrospective review compared 3 kidney transplant recipients who experienced seizures within 24 hours post-transplant with 33 controls.
- Key parameters monitored included electrolyte levels (sodium, calcium, magnesium), blood urea nitrogen (BUN) clearance, osmolality shifts, and blood pressure control during the initial 24 hours.
Findings:
- Patients who seized exhibited significantly more pronounced decreases in serum sodium and serum osmolality compared to controls (p < 0.001).
- Specifically, seizure cases showed sodium drops exceeding 15 mmol/L, reaching nadir values between 124-131 mmol/L.
- No significant differences were observed in corrected serum calcium, serum magnesium, urine output, or blood pressure management between the groups.
Implications:
- Mild hyponatremia and acute reductions in serum osmolality are identified as critical risk factors for post-transplant neurological complications.
- Optimizing peri-transplant management to prevent or mitigate these electrolyte and osmolality disturbances is crucial for improving patient outcomes.
Abstract:
Post-transplant seizures are uncommon in young kidney transplant recipients but can be harbingers of devastating outcomes such as cerebral edema and death. We reviewed all transplants performed at our institution from January 2013 to January 2014 and compared three patients who seized within 24 h post-transplant (cases) with the remaining 33 transplant recipients (controls). Records were reviewed for hyponatremia, hypocalcemia, hypomagnesemia, BUN clearance, osmolality shifts, and blood pressure control in the first 24 h post-transplant. All cases had more pronounced (p < 0.001) shifts in serum sodium and calculated serum osmolality, with their sodium decreasing by >15 mmol/L to nadir values of 124, 131, and 131 mmol/L, respectively. There were no differences in serum calcium corrected for hypoalbuminemia, serum magnesium, urine output, or blood pressure control between the groups. Our study suggests that mild hyponatremia and an acute decrease in serum osmolality are risk factors for potentially severe postoperative neurologic complications following kidney transplantation. Thus, peri-transplant management should be optimized to anticipate and prevent these abnormalities.
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