Transient hyperphosphatasemia in pediatric renal transplant patients--is there a need for concern and when?
TH of infancy and early childhood is characterized by transiently increased S-ALP, predominantly its bone or liver isoforms. There are neither signs of metabolic bone disease or hepatopathy corresponding to the increased S-ALP, nor a common underlying/triggering disease. TH may also occur in children post-renal Tx, which may raise significant concerns and anxiety. We describe four patients aged 2.8-7 yr in whom the TH occurred at 11-34 (median = 28) months after Tx and lasted from 40 to 105 (median = 63) days. No obvious cause/trigger of TH could be found; the clinical status and bone turnover were not altered. In cases of TH post-Tx, we recommend the evaluation of basic biochemical indices and wrist X-ray. If these results are normal, TH is most likely the diagnosis and the S-ALP can be monitored over the next three months without further testing. In patients with persisting TH for more than three months and/or in children with pre-existing or suspected metabolic bone disease, further evaluation may be indicated. In conclusion, TH is a benign disorder in patients post-Tx. Detailed investigation including bone biopsy is only indicated in patients with persisting TH.
Kutílek
Stěpán
S
Department of Pediatrics, Pardubice Hospital, Pardubice, Czech Republic.
Skálová
Sylva
S
Vethamuthu
Jennifer
J
Geier
Pavel
P
Feber
Janusz
J
D000469:Alkaline Phosphatase / Q000097:blood; D001706:Biopsy; D001842:Bone and Bones / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D054559:Hyperphosphatemia / Q000209:etiology* / Q000628:therapy; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D009404:Nephrotic Syndrome / Q000628:therapy; D020033:Protein Isoforms; D011859:Radiography; D051437:Renal Insufficiency / Q000628:therapy*; D016896:Treatment Outcome; D014953:Wrist / Q000000981:diagnostic imaging
D020033:Protein Isoforms; D000469:Alkaline Phosphatase