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Prevalence of Renal Dysfunction Among Pediatric Liver Transplant Recipients
Mitra Basiratnia, Seyed Mohsen Dehghani, Fatemeh Razmjoee
1Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. dornaderakhshan@yahoo.com.
Insights
Hypertension and renal dysfunction are common after pediatric liver transplants, often linked to immunosuppressants. Regular monitoring using ambulatory blood pressure monitoring and Cystatin C for GFR is crucial for early detection and management.
Area of Science:
- Nephrology
- Pediatric Gastroenterology
- Transplantation Medicine
Background:
- Renal dysfunction is a significant complication post-liver transplantation, frequently driven by immunosuppressive therapies.
- Hypertension is also a prevalent issue in pediatric liver transplant recipients.
Purpose of the Study:
- To determine the prevalence of hypertension and renal dysfunction in pediatric liver transplant recipients.
- To assess glomerular and tubular renal function in this patient cohort.
Main Methods:
- 46 pediatric liver transplant recipients underwent ambulatory blood pressure monitoring (ABPM) and renal function tests.
- Glomerular filtration rate (GFR) was estimated using both creatinine-based and Cystatin C-based equations.
- Tubular function was evaluated through various urine parameters.
Main Results:
- 43.5% of patients exhibited hypertension based on ABPM.
- Abnormalities in tubular function, including hyperuricosuria and hypercalciuria, were observed.
- Cystatin C-based equations provided lower estimated GFR compared to creatinine-based formulas.
- A significant negative correlation was found between hypercalciuria, microalbuminuria, fractional excretion of magnesium (FeMg), and GFR.
Conclusions:
- Hypertension and renal impairment are common in pediatric liver transplant recipients.
- Ambulatory blood pressure monitoring (ABPM) and Cystatin C for GFR estimation are recommended for early detection and management of renal complications.
Introduction:
Renal dysfunction is among the common and considerable complications after liver transplantation and is principally attributable to immunosuppressive medications .The purpose of this study was to define the prevalence of hypertension and renal dysfunction among pediatric liver transplant recipients.
Methods:
46 pediatric liver transplant recipients were assessed for hypertension utilizing ambulatory blood pressure monitoring (ABPM), and glomerular, and tubular renal function at the transplant clinic of Shiraz University of Medical Sciences. Results were analyzed using SPSS 19 and P value < .05 was considered statistically significant.
Results:
The mean age of the patients was 12.2 ± 3.3 years and 24 of them were female. Considering ABPM measurements 20 patients (43.5%) were hypertensive, 37% were systolic and 36.6% were diastolic non-dippers respectively. eGFR was calculated based on different formulations and Cystatin C-based equation estimated lower GFR than Cr-based equation. Micro-albuminuria was noticed in 26.1%. Additional parameters of tubular dysfunction included hyperuricosuria (4.3%), hypercalciuria (6.5%), abnormal fractional excretion of Mg (FeMg) (43.5%), abnormal tubular reabsorption of phosphate (TRP) (4.3%), and abnormal fractional excretion of uric acid (FEUA) in 13% of the patients. We noticed a statistically significant negative correlation between hypercalciuria, microalbuminuria, FeMg (P < .05) and GFR.
Conclusion:
Renal function impairment and hypertension are frequent complications amongst pediatric liver transplant recipients. Using Cyctatin C instead of Cr based formula for GFR estimation, and blood pressure monitoring by ABPM and regular screening of renal function are essential measures for recognition and treatment of renal dysfunction in these patients.
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