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[Diabetes induced by corticoids in 6 children after renal transplantation]
Insights
Corticosteroid therapy after renal transplantation can cause transient diabetes mellitus in children. Close monitoring of blood glucose levels is recommended, especially during the initial weeks of treatment.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Transplantation Immunology
Context:
- Renal transplantation is a critical treatment for pediatric kidney failure.
- Corticosteroids are essential immunosuppressants post-transplantation.
- New-onset diabetes mellitus is a potential complication in transplant recipients.
Purpose:
- To investigate the incidence and characteristics of diabetes mellitus in children undergoing corticosteroid therapy post-renal transplantation.
- To evaluate the duration, management, and long-term glycemic control of this complication.
- To assess the underlying factors and insulin response in affected pediatric patients.
Summary:
- Six children developed transient diabetes mellitus during corticosteroid therapy after renal transplantation, with hyperglycemia appearing early and persisting in some cases.
- All patients exhibited glycosuria without ketonuria; diabetes was manageable with insulin and diet.
- While most recovered, impaired glucose tolerance and inadequate insulin response were noted months later, with two children showing persistent hyperglycemia after 3 years.
Impact:
- Highlights the significant risk of corticosteroid-induced diabetes in pediatric renal transplant recipients.
- Emphasizes the need for vigilant glycemic monitoring in this vulnerable population.
- Informs clinical practice regarding early detection and management strategies for post-transplant diabetes in children.
Abstract:
We studied the occurrence of diabetes mellitus in 6 children receiving corticosteroid therapy after renal transplantation. The first hyperglycemic episode occurred in all cases before the fortieth day of treatment but other episodes were observed thereafter. All children were glycosuric, without ketonuria. The diabetes has always been transient, and easily managed with insulin treatment and usual diabetic diet. A glucose tolerance test was performed 3 to 6 months after these episodes; glycemic response to glucose was abnormal in 2 of 6 children; in all cases, the insulin response to the glucose load was inadequate. In 2 children, the fasting blood glucose is still abnormal after a follow-up of 3 years. The other patients have recovered despite sustained corticotherapy. No specific background (genetics, HLA groups) or specific circumstances of treatment were identified. Therefore, we recommend to follow closely glycemia in children after renal transplantation, with a daily glycemic determination especially during the first 3 weeks.