Kidney function in cyclosporine-treated pediatric heart transplant recipients.
BACKGROUND
End-stage kidney disease may develop in 1% to 3% of cyclosporine-treated heart transplant recipients, and most patients show a decreased glomerular filtration rate. There are little data on kidney function in pediatric recipients, although good function is needed for their optimal development.


METHODS
Kidney function was prospectively investigated in 10 children receiving triple immunosuppression (cyclosporine, azathioprine, methylprednisolone) during the first 18 months after heart transplantation. The early cyclosporine trough level target was 300 to 500 micrograms/L and 100 to 200 micrograms/L after the first year. 51Chromium-ethylenediamine tetraacetic acid, para-amino hippuric acid, lithium, and sodium clearances, measurements of serum and urinary electrolytes, and urinary concentration tests were performed. Renal biopsy specimens were obtained from four patients after 18 months.


RESULTS
Heart function was good in all patients. Six patients (60%) remained rejection-free at 18 months. The mean glomerular filtration rate was 92.4 ml/min/1.73 m2 before transplantation, increased to 115 by 6 months (p < 0.05), and thereafter remained stable. The mean renal plasma flow was 487 ml/min/1.73 m2 after 18 months. Hypertension was seen in all patients at discharge but in only one at 18 months. Mild hyperuricemia was the most common sign of tubular dysfunction occurring in five patients at discharge but in only two patients at 18 months. The result of kidney histopathologic study was normal in three of four patients, and cyclosporine nephrotoxicity was not diagnosed.


CONCLUSIONS
Triple immunosuppression with cyclosporine adequately protects the graft against acute rejection. It is compatible with normal glomerular function and leads to only minor tubular disturbances.
Laine
J
J
Children's Hospital, University of Helsinki, Finland.
Jalanko
H
H
Leijala
M
M
Sairanen
H
H
Holmberg
C
C
D000293:Adolescent; D001379:Azathioprine / Q000627:therapeutic use; D001706:Biopsy; D002614:Chelating Agents; D002648:Child; D002675:Child, Preschool; D002860:Chromium Radioisotopes; D016572:Cyclosporine / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D004492:Edetic Acid; D004573:Electrolytes / Q000097:blood / Q000652:urine; D005919:Glomerular Filtration Rate / Q000187:drug effects; D005938:Glucocorticoids / Q000627:therapeutic use; D006084:Graft Rejection / Q000517:prevention & control; D016027:Heart Transplantation / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000209:etiology; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use*; D007668:Kidney / Q000187:drug effects / Q000473:pathology / Q000502:physiology*; D007676:Kidney Failure, Chronic / Q000139:chemically induced; D007684:Kidney Tubules / Q000187:drug effects / Q000503:physiopathology; D008094:Lithium / Q000652:urine; D008775:Methylprednisolone / Q000627:therapeutic use; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D017595:Renal Plasma Flow / Q000187:drug effects / Q000502:physiology; D012964:Sodium / Q000652:urine; D014527:Uric Acid / Q000097:blood; D010130:p-Aminohippuric Acid / Q000652:urine
D002614:Chelating Agents; D002860:Chromium Radioisotopes; D004573:Electrolytes; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D019275:Radiopharmaceuticals; D014527:Uric Acid; D016572:Cyclosporine; D008094:Lithium; D004492:Edetic Acid; D012964:Sodium; D001379:Azathioprine; D008775:Methylprednisolone; D010130:p-Aminohippuric Acid