Post-renal transplant urolithiasis in children: an increasingly diagnosed complication: a retrospective cohort study
Sophia Ma1,2, Amir Taher1, Benjamin Zhu1
1Nephrology, Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Insights
Kidney stones are increasingly common in pediatric renal transplant recipients. Early detection and management are crucial to prevent allograft loss, with no cases lost in this study.
Area of Science:
- Nephrology
- Pediatric Urology
- Transplantation
Background:
- Urolithiasis poses a risk of allograft loss in renal transplant (RTx) recipients.
- The trend of increasing urolithiasis prevalence in pediatric RTx patients is not well-defined.
Purpose of the Study:
- To investigate the frequency, risk factors, and characteristics of urolithiasis in pediatric RTx recipients.
- To determine if urolithiasis is increasing in this population over time.
Main Methods:
- Retrospective chart review of pediatric RTx recipients from 1995-2016.
- Analysis of stone diagnosis, patient demographics, clinical presentation, stone characteristics, and treatment outcomes.
Main Results:
- Urolithiasis occurred in 5.6% of recipients (8/142), with a higher incidence in the latter decade.
- Common presentations included hematuria and pain; stones were often calcium oxalate, associated with hypercalciuria.
- No allograft loss occurred due to urolithiasis; cystolithotripsy and citrate supplementation were common treatments.
Conclusions:
- Urolithiasis appears to be increasing in frequency among pediatric RTx recipients.
- A high index of suspicion is necessary due to potentially atypical symptoms.
- The findings align with the rising trend of urolithiasis in the general pediatric population.
Objective:
Urolithiasis in renal transplant (RTx) recipients is a potential cause of allograft loss if obstruction is untreated. It is not clear if paediatric transplant recipients are following the global trend for increased prevalence of urolithiasis over time.
Design/Setting/Patients:
A retrospective chart review was undertaken to evaluate the frequency, risk factors and characteristics of post-RTx urolithiasis over two decades (1995-2016), in a tertiary Australian paediatric hospital.
Results:
Stones were diagnosed in 8 of 142 (5.6%) recipients, 6 of whom were transplanted in the latter decade. All patients were male, with a median age 4.9 years and median weight 11.8 kg. Presentation was with haematuria (n=4), pain (n=2), dysuria (n=2), stone passage (n=1) and asymptomatic (n=1). Time to presentation was bimodal; three stones were identified in the initial 3 months post RTx and the remainder after 31-53 months. Two stones were in association with retained suture material and two patients had recurrent urinary tract infections. The average stone size was 8.4 mm. Five stones were analysed; all contained calcium oxalate, three were mixed, including one with uric acid. Five (83.3%) children had hypercalciuria but none had hypercalcaemia. Cystolithotripsy was the the most common treatment (n=5), in combination with citrate supplementation. No graft was lost due to stones.
Conclusions:
Calculi occur with increasing frequency after renal transplantation. Clinicians need a high index of suspicion as symptoms may be atypical in this population. The cause for the increased frequency of stones in transplant recipients is not clear but is in keeping with the increase seen in the general paediatric population.
Related Concept Videos
01:24Serum Studies: Renal Function Tests
01:24Diagnosing Acidosis and Alkalosis
First, the pH level is assessed to determine whether the blood pH is normal (7.35–7.45), low (acidosis), or high (alkalosis).
Next, the PCO2 and...
01:24Hemodialysis II: Procedure and Complications
01:15Diabetes: Symptoms, Diagnosis, and Complications
01:30Pneumonia III: Complications and Assessment
01:24Asthma-III: Symptoms and Complications
Classification of Asthma