Methylprednisolone Exposure in Pediatric Renal Transplant Patients

Seikku, Paula; Raivio, Taneli; Jänne, Olli A.; Neuvonen, Pertti J.; Holmberg, Christer

doi:10.1111/j.1600-6143.2006.01316.x

Cited by 15 publications

(11 citation statements)

References 40 publications

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“…1 In infants, the kidney graft can be placed intraperitoneally (a) or extraperitoneally (b) [44]. The other possibility is to switch to low-dose (0.1 mg/kg/ day), every-other-day medication, which also effectively abolishes the steroid side effects [45,46].…”

Section: Peri-and Postoperative Managementmentioning

confidence: 99%

Renal transplantation in infants

2015

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Renal transplantation (RTx) has become an accepted mode of therapy in infants with severe renal failure. The major indications are structural abnormalities of the urinary tract, congenital nephrotic syndrome, polycystic diseases, and neonatal kidney injury. Assessment of these infants needs expertise and time as well as active treatment before RTx to ensure optimal growth and development, and to avoid complications that could lead to permanent neurological defects. RTx can be performed already in infants weighing around 5 kg, but most operations occur in infants with a weight of 10 kg or more. Perioperative management focuses on adequate perfusion of the allograft and avoidance of thrombotic and other surgical complications. Important long-term issues include rejections, infections, graft function, growth, bone health, metabolic problems, neurocognitive development, adherence to medication, pubertal maturation, and quality of life. The overall outcome of infant RTx has dramatically improved, with long-term patient and graft survivals of over 90 and 80 %, respectively.

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Section: Peri-and Postoperative Managementmentioning

confidence: 99%

Renal transplantation in infants

2015

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“…Steroid therapy inhibits growth by both interfering with the hypothalamus-pituitary/growth hormone/insulin-like growth factor axis and having a direct effect on bone formation (see below). Pharmacokinetic studies of methylprednisolone in pediatric liver and kidney transplant recipients have demonstrated that the area under the serum concentration–time curve (AUC) rather than dose was predictive for growth retardation [30, 31]. However, this correlation between AUC and growth was not unanimously found in transplanted children treated with prednisone or prednisolone [32].…”

Section: Factors Influencing Growth Post-transplantationmentioning

confidence: 99%

Growth after renal transplantation

Harambat

Cochat

2009

Pediatr Nephrol

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Growth may be severely impaired in children with chronic renal insufficiency. Since short stature can have major consequences on quality of life and self-esteem, achieving a 'normal' height is a crucial issue for renal transplant recipients. However, despite successful renal transplantation, the final height attained by most recipients is not the calculated target height. Catch-up growth spurts post-transplantation are usually insufficient to compensate for the retardation in growth that has occurred during the pretransplant period. Longitudinal growth post-transplantation is therefore influenced by the age at transplantation but also by subsequent allograft function and steroid exposure, both of which interfere with the growth hormone/insulin-like growth factor axis. The management of growth retardation in renal transplant recipients includes adequate nutritional intake, correction of metabolic acidosis, prevention of bone disease, steroid-sparing strategies and a supraphysiological dose of recombinant human growth hormone in selected cases.

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“…(40) Because GC exposure varies individually and control of adverse effects is important, measurement of serum GC bioactivity may give an additional tool for monitoring GC exposure. (41) Also, variable results have been obtained with different GC preparations used in children. (42) Overall, the effects of GC on a growing skeleton are still quite unclear.…”

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Bone Health in Children and Adolescents After Renal Transplantation

Valta

Mäkitie

Rönnholm

et al. 2009

Journal of Bone and Mineral Research

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ABSTRACT:The basis for lifelong bone health is established in childhood and adolescence. Whereas pediatric renal transplant (RTx) patients are at risk for impaired bone mass gain and fractures, scarce data on this subject are available. We performed a cross-sectional and longitudinal study of bone health in a national cohort of 106 pediatric RTx patients (median age, 12.6 yr; median follow-up, 5.1 yr after RTx). The patients underwent clinical evaluation, DXA for BMD, and spinal imaging for vertebral fractures. In longitudinal analysis, the median lumbar spine BMD Z-score was lowest (median, 21.0) at 1 yr postoperatively but increased to a peak value of 20.2 at 5 yr. In boys, the lumbar spine BMD Z-score increased also during puberty but decreased in girls. In cross-sectional analysis, the lumbar spine, hip, and whole body BMD Zscores were < 22 SD in 4%, 6%, and 6% of the patients, respectively. Sixteen percent had sustained peripheral fractures, and 8% had vertebral fractures. Female sex and age >15 yr (OR, 56.26; 95% CI, 5.17-611.82; p = 0.0007) as well as high plasma PTH levels (OR, 4.03; 95% CI, 1.37-11.85; p = 0.009) were significant predictors for low BMD. Three-year cumulative glucocorticoid dose, outside the immediate postRTx years, was not associated with BMD parameters. The observed BMD results were satisfactory. However, the high (8%) prevalence of vertebral fractures warrants careful evaluation of bone health in these patients.

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Methylprednisolone Exposure in Pediatric Renal Transplant Patients

Cited by 15 publications

References 40 publications

Renal transplantation in infants

Renal transplantation in infants

Growth after renal transplantation

Bone Health in Children and Adolescents After Renal Transplantation

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