title: The consequences of pediatric renal transplantation on bone metabolism and growth.
abstract: OBJECTIVE
  During childhood, growth retardation, decreased final height and renal osteodystrophy are common complications of chronic kidney disease (CKD). These problems remain present in patients undergoing renal transplantation, even though steroid-sparing strategies are more widely used. In this context, achieving normal height and growth in children after transplantation is a crucial issue for both quality of life and self-esteem. The aim of this review is to provide an overview of pathophysiology of CKD-mineral bone disorder (MBD) in children undergoing renal transplantation and to propose keypoints for its daily management.
  
  
  RESULTS
  In adults, calcimimetics are effective for posttransplant hyperparathyroidism, but data are missing in the pediatric population. Fibroblast growth factor 23 levels are associated with increased risk of rejection, but the underlying mechanisms remain unclear. A recent meta-analysis also demonstrated the effectiveness of rhGH therapy in short transplanted children.
  
  
  CONCLUSIONS
  In 2013, the daily clinical management of CKD-MBD in transplanted children should still focus on simple objectives: to optimize renal function, to develop and promote steroid-sparing strategies, to provide optimal nutritional support to maximize final height and avoid bone deformations, to equilibrate calcium/phosphate metabolism so as to provide acceptable bone quality and cardiovascular status, to correct all metabolic and clinical abnormalities that can worsen both bone and growth (mainly metabolic acidosis, anemia and malnutrition), promote good lifestyle habits (adequate calcium intake, regular physical activity, no sodas consumption, no tobacco exposure) and eventually to correct native vitamin D deficiency (target of 25-vitamin D >75 nmol/l).
authors.affiliation: aInstitut de Génomique Fonctionnelle de Lyon (IGFL), Ecole Normale Supérieure bUniversité de Lyon, Lyon cCentre de Référence des Maladies Rénales Rares, Service de Néphrologie, Rhumatologie et Dermatologie Pédiatriques dService de Chirurgie Pédiatrique, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Bron, France.
authors.forename: Justine
authors.initials: J
authors.lastname: Bacchetta
authors.forename: Bruno
authors.initials: B
authors.lastname: Ranchin
authors.forename: Delphine
authors.initials: D
authors.lastname: Demède
authors.forename: Lise
authors.initials: L
authors.lastname: Allard
mesh_terms: D000818:Animals; D001846:Bone Development; D001842:Bone and Bones / Q000378:metabolism*; D006801:Humans; D007674:Kidney Diseases / Q000209:etiology; D016030:Kidney Transplantation / Q000009:adverse effects; D011788:Quality of Life