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Chronic Kidney Disease (CKD) progressively impairs multiple body systems due to the accumulation of uremic toxins, which disrupt cellular functions across various organs.Neurologic symptomsNeurologic symptoms often arise early in CKD, as uremic toxin buildup drives changes in cognitive and motor functions. Patients frequently experience fatigue, headache, confusion, difficulty concentrating, and, in severe cases, seizures. Peripheral neuropathy commonly manifests as burning sensations in the...
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Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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CKD-MBD post kidney transplantation.

Dieter Haffner1, Maren Leifheit-Nestler2,3

  • 1Department of Paediatric Kidney, Liver and Metabolic Diseases, Paediatric Research Center, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. Haffner.Dieter@mh-hannover.de.

Pediatric Nephrology (Berlin, Germany)
|December 21, 2019
PubMed
Summary
This summary is machine-generated.

Complications of chronic kidney disease-associated mineral and bone disorders (CKD-MBD) in pediatric kidney transplant recipients cause significant morbidity. Management involves monitoring mineral levels, preserving graft function, and targeted therapies to improve bone health and growth.

Keywords:
CKD-MBDCalcificationChildrenFGF23GrowthParathyroid hormoneRenal transplantation

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Area of Science:

  • Nephrology
  • Pediatric Endocrinology
  • Bone Metabolism

Background:

  • Chronic kidney disease-associated mineral and bone disorders (CKD-MBD) present significant complications in pediatric kidney transplant recipients.
  • These complications include growth failure, bone deformities, fractures, osteonecrosis, and vascular calcification, leading to high morbidity.
  • Preexisting renal osteodystrophy, cardiovascular changes, glucocorticoid use, and reduced graft function contribute to post-transplant CKD-MBD.

Purpose of the Study:

  • To outline the complications of CKD-MBD in pediatric kidney transplant recipients.
  • To detail the monitoring strategies for these patients.
  • To recommend therapeutic approaches for managing CKD-MBD post-transplantation.

Main Methods:

  • Review of existing literature on CKD-MBD complications in pediatric kidney transplant recipients.
  • Analysis of factors contributing to post-transplant CKD-MBD.
  • Synthesis of current monitoring and treatment guidelines.

Main Results:

  • Elevated parathyroid hormone (PTH) and fibroblast growth factor 23 can cause hypophosphatemia and impair bone mineralization.
  • Recommended monitoring includes growth, physical deformities, and serum levels of calcium, phosphate, magnesium, alkaline phosphatase, 25-hydroxyvitamin D, and PTH.
  • Therapeutic strategies focus on physical activity, graft function preservation, steroid-sparing immunosuppression, vitamin D and mineral supplementation, and active vitamin D for hyperparathyroidism.

Conclusions:

  • Effective management of CKD-MBD in pediatric kidney transplant recipients requires comprehensive monitoring and tailored therapies.
  • Treatment aims to normalize mineral metabolism, suppress PTH levels, and prevent complications.
  • Recombinant human growth hormone may be considered for patients with inadequate catch-up growth post-transplant.