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Published on: April 28, 2013
Delayed acute renal failure in post-transplant period in young children from unexplained etiology
1Department of Pediatrics, University of Minnesota, Minneapolis 55455, USA.
Insights
This study identifies delayed acute renal failure (DARF) in young children post-kidney transplant, unrelated to rejection. Supportive care, including dialysis, is crucial for recovery in these pediatric transplant patients.
Area of Science:
- Pediatric Nephrology
- Transplantation Immunology
Background:
- Delayed acute renal failure (DARF) is a rare complication in pediatric kidney transplant recipients.
- Understanding the etiology and clinical presentation of DARF is crucial for timely management.
Observation:
- Six young children developed DARF in the early post-kidney transplant period without acute rejection or other identifiable causes.
- Clinical signs included diminished urine output, fever, and thrombocytopenia, with renal biopsies showing tubular ectasia and vascular congestion.
Findings:
- DARF occurred between post-operative days 4-8, independent of acute rejection.
- Five patients required dialysis, with recovery of renal function taking approximately 2 weeks.
- One patient treated with OKT3 for suspected rejection experienced graft loss due to vascular thrombosis.
Implications:
- This study highlights an undetermined cause of DARF in pediatric kidney transplantation.
- Prompt recognition and supportive care, including dialysis, are essential for managing this complication.
- Avoiding unnecessary anti-rejection treatments can prevent adverse outcomes in these vulnerable patients.
Abstract:
This report describes six young children (5 male) who developed delayed acute renal failure (DARF) in the early post-kidney-transplant (Tx) period in the absence of acute rejection (AR) or other diagnosable conditions. These young children, aged 16.5 +/- 3.1 (12-21) months [mean +/- SD, (range)] and weighing 8.5 +/- 1.7 (7.1-11.4) kg received a primary renal Tx (5 living-related donor, 1 cadaver) between 1984 and 1992. Immunosuppression included prednisone, azathioprine, and Minnesota antilymphocyte globulin (MALG, n = 5); one patient received cyclosporine and no MALG. Initially, all patients had good urine output (UO). They became systemically ill and abruptly developed diminished UO on post-operative day (POD) 6.5 +/- 1 (4-8). DARF was accompanied by fever (39.1-40.4 degrees C, n = 6), thrombocytopenia (platelets < 100,000/mm3, n = 6), leukocytosis, or leukopenia (white cell count > 20,000/mm3, n = 4 or < 1,000/mm3, n = 1). Four patients had diarrhea. Three had ascites and one was surgically explored for suspected urinary leak. None showed significant urinary obstruction by renal ultrasound. Renograms showed intact blood flow. Renal biopsy showed tubular ectasia (n = 6), vascular congestion (n = 5), focal glomerular endothelial swelling (n = 4), and capillary thrombi (n = 3). None showed AR. Five patients required dialysis for 11 +/- 4 (7-15) days. All patients survived. One patient, treated for suspected AR with the monoclonal antibody OKT3, developed shock and lost her graft on POD 12 due to vascular thrombosis. Renal functional recovery in the remaining five patients took 14 +/- 5 (6-20) days and their serum creatinine at discharge was 0.7 +/- 0.5 (0.3-1.6) mg/dl. We report DARF from undetermined etiology occurring in the first 2 weeks of renal Tx in young children. Treatment is supportive care including dialysis. Recognition of this complication will help avoid risky investigations or unnecessary treatment for rejection.
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