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Low-Grade Persistent Hyperparathyroidism After Pediatric Renal Transplant
Kaan Gulleroglu1, Esra Baskin, Gokhan Moray
1From the Pediatric Nephrology Department, Baskent University, Ankara, Turkey.
Insights
Persistent hyperparathyroidism after kidney transplant is linked to longer dialysis duration and lower serum bicarbonate levels. Identifying these factors is crucial for managing bone health in pediatric recipients.
Area of Science:
- Nephrology
- Endocrinology
- Pediatric Medicine
Background:
- Hyperparathyroidism is a common complication of chronic kidney disease.
- It often persists even after successful renal transplantation.
- This condition can negatively impact bone health and growth, especially in pediatric patients.
Purpose of the Study:
- To investigate parathyroid hormone levels post-renal transplant.
- To identify clinical and biochemical risk factors for persistent hyperparathyroidism.
- To understand the implications for pediatric renal transplant recipients.
Main Methods:
- Study included 44 pediatric renal transplant recipients with stable graft function.
- Median follow-up was 17.5 months; no routine vitamin D/calcium supplements were given.
- Bone mineral densitometry (lumbar spine) was performed.
Main Results:
- 34% of patients had elevated parathyroid hormone levels (>70 pg/mL).
- Longer pre-transplant dialysis duration was associated with persistent hyperparathyroidism.
- Lower serum bicarbonate and lower z scores correlated significantly with higher parathyroid hormone levels.
Conclusions:
- Persistent hyperparathyroidism is associated with extended dialysis, lower serum bicarbonate, and lower z scores.
- Pre-transplant dialysis duration is a key predictor.
- Early identification of risk factors can guide strategies to mitigate negative effects on bone health and growth.
Objectives:
Hyperparathyroidism, a frequent complication of chronic kidney disease, persists after renal transplant. Our aims were to examine the status of parathyroid hormone levels and to determine the clinical and biochemical risk factors of persistent hyperparathyroidism after transplant.
Materials And Methods:
Our study included 44 pediatric renal transplant recipients with stable graft function. Median follow-up after transplant was 17.5 months (range, 12-126 mo). Patients did not receive routine vitamin D or calcium supplements after transplant, and none had undergone previous parathyroidectomy. Bone mineral densitometry of the lumbar spine was measured.
Results:
Fifteen patients (34%) had parathyroid hormone levels greater than 70 pg/mL (normal range, 10-70 pg/mL). Duration of dialysis before transplant was longer in patients with persistent hyperparathyroidism. Mean serum bicarbonate levels were significantly lower in patients with persistent hyperparathyroidism than in patients without persistent hyperparathyroidism after transplant. A significant negative correlation was noted between parathyroid hormone level and serum bicarbonate level. Another significant negative correlation was shown between parathyroid hormone level and z score.
Conclusions:
We found that persistent hyperparathyroidism is related to longer dialysis duration, lower serum bicarbonate level, and lower z score. Pretransplant dialysis duration is an important predictor of persistent hyperparathyroidism. Early identification of factors that contribute to persistent hyperparathyroidism after transplant could lead to treatment strategies to minimize or prevent its detrimental effects on bone health and growth in pediatric transplant recipients.
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