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Steroid-induced diabetes in pediatric renal transplant recipients
Insights
Steroid-induced diabetes occurred in 7 pediatric kidney transplant patients. Risk factors included Black children, cadaveric transplants, and higher prednisone doses, but diabetes was transient and manageable.
Area of Science:
- Nephrology
- Endocrinology
- Pediatric Transplantation
Background:
- Kidney transplantation is a vital treatment for pediatric end-stage renal disease.
- Immunosuppressive therapy, particularly corticosteroids like prednisone, is crucial post-transplant.
- Steroid use can lead to metabolic complications, including hyperglycemia.
Purpose of the Study:
- To investigate the incidence and characteristics of steroid-induced diabetes in children undergoing kidney transplantation.
- To identify risk factors associated with the development of hyperglycemia post-transplant.
- To assess the clinical course and potential complications of steroid-induced diabetes in this population.
Main Methods:
- Retrospective analysis of 79 children who received 101 kidney transplants.
- Monitoring for hyperglycemia and diagnosis of steroid-induced diabetes.
- Evaluation of patient demographics, transplant characteristics, and prednisone dosage.
- Oral glucose tolerance testing and assessment for autoimmune markers.
Main Results:
- Seven patients (7.9%) developed steroid-induced diabetes.
- Higher risk observed in Black children, recipients of cadaveric allografts, and those on higher prednisone doses.
- Diabetes was transient, easily controlled, and did not lead to permanent insulin dependence.
- No evidence of islet cell autoantibodies or specific HLA haplotypes associated with diabetes.
- Oral glucose tolerance tests showed hyperglycemia with inadequate insulin response.
- Three patients experienced unusual complications: two with cerebral vascular accidents and one with aspergillosis.
Conclusions:
- Steroid-induced diabetes is a notable complication in pediatric kidney transplant recipients.
- Specific patient and treatment factors increase the risk of hyperglycemia.
- While generally transient, steroid-induced diabetes may be linked to increased risk of serious complications in this vulnerable group.
Abstract:
Seven patients in a series of 79 children receiving 101 kidney transplants developed steroid-induced diabetes. Black children, recipients of cadaveric allografts, and patients receiving higher average daily prednisone dosage were more likely to develop hyperglycemia. The diabetes was transient and easily controlled. No patient developed permanent insulin dependence. No patients exhibited is let cell autoantibodies or an HLA haplotype associated with diabetes. Oral glucose tolerance testing demonstrated significant hyperglycemia with an inadequate insulin response. Three patients also exhibited unusual complications; two had cerebral vascular accidents (CVA) and one developed aspergillosis in a native kidney. Pediatric patients exhibiting steroid-induced diabetes following kidney transplantation may constitute a group at greater risk for complications.