title: Hypervitaminosis a in pediatric hematopoietic stem cell patients requiring renal replacement therapy.
abstract: BACKGROUND
  Chronic renal failure patients have been known to develop vitamin A toxicity, but a descriptive study of hypervitaminosis A in patients with acute renal failure (ARF) has not yet been published. The authors observed hypervitaminosis A in pediatric hematopoietic stem cell transplant (HSCT) patients.
  
  
  METHODS
  All HSCT patients admitted between January 2001 and May 2006 who experienced ARF, received renal replacement therapy (RRT), and had a vitamin A level drawn were included in this retrospective, descriptive study. Molar ratios of vitamin A and retinol-binding protein (RBP) were calculated to more accurately assess vitamin A status. Nineteen patients met the criteria for this study.
  
  
  RESULTS
  At initial testing (generally between days 6 and 10 after initiation of RRT), 17 of the 19 patients had abnormally elevated vitamin A levels for their age. Molar ratios of vitamin A to RBP were elevated in 6 patients at initial testing. Prescribed vitamin A intake information (parenteral and enteral) was available for most patients; all but 3 had an average daily intake greater than 2000 IU/kg over the 30 days prior to RRT initiation. Many patients had symptoms possibly related to vitamin A toxicity, although interpretation of hair, skin, and liver abnormalities are difficult to ascertain in HSCT patients. Seven patients had other findings that may have been associated with vitamin A toxicity.
  
  
  CONCLUSIONS
  Children undergoing HSCT who receive nutrition support (predominantly parenteral nutrition), experience ARF, and require RRT are at risk for hypervitaminosis A and toxicity.
authors.affiliation: Seattle Childrens Hospital and Regional Medical Center, Seattle, WA 98105, USA. ann.lipkin@seattlechildrens.org
authors.forename: Ann Connell
authors.initials: AC
authors.lastname: Lipkin
authors.forename: Polly
authors.initials: P
authors.lastname: Lenssen
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications* / Q000628:therapy; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D006986:Hypervitaminosis A / Q000209:etiology*; D007223:Infant; D008297:Male; D018529:Nutritional Support; D017582:Renal Replacement Therapy / Q000379:methods; D012177:Retinol-Binding Proteins / Q000378:metabolism; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014801:Vitamin A / Q000008:administration & dosage / Q000009:adverse effects / Q000097:blood*
chemical_list: D012177:Retinol-Binding Proteins; D014801:Vitamin A