title: Fludrocortisone as a new tool for managing tubulopathy after pediatric renal transplantation: a series of cases.
abstract: BACKGROUND
  The management of tubulopathies after renal transplantation (RTx) may require high doses of sodium and bicarbonate, reducing the quality of life and therapeutic compliance of the patient. Some studies on adult patients have highlighted the benefits of fludrocortisone (fludro) in the treatment of severe tubulopathies.
  
  
  METHODS
  This study was a retrospective review of the medical charts of 15 children, aged 12.4 (range 3.6-17.4) years who received fludro after RTx.
  
  
  RESULTS
  With the administration of fludro, both sodium bicarbonate and chloride supplementation decreased, from 10 (range 0-14) to 0 (0-5) g/day, and from 9 (0-20) to 0 (0-3) g/day, respectively (both p < 0.001). Serum potassium also significantly decreased (4.6 ± 0.4 vs. 3.3 ± 0.6 mmol/L; p < 0.001), but there was no significant effect on renal function. Both systolic and diastolic blood pressure increased significantly. Fludro therapy was stopped in six patients due to side-effects (arterial hypertension, hypokalemia during acute diarrhea, gastric pain, n = 3), parental decision (n = 1), inefficacy and/or non-compliance (n = 1) and scheduled withdrawal (n = 1). Four of these patient had subsequent increasing requirements for bicarbonate and/or sodium supplementation, which ultimately required the re-introduction of fludro in two of these patients.
  
  
  CONCLUSIONS
  Based on our findings, fludro would appear to be an effective therapy in most cases of severe tubulopathy after RTx. Further prospective studies are required to validate this indication and to determine the optimal dose and timing of treatment to avoid side-effects as well as the clinical and biological follow-up.
authors.affiliation: Centre de Référence des Maladies Rénales Rares, Service de Néphrologie et Rhumatologie Pédiatriques, Hôpital Femme Mère Enfant, 59 Bd Pinel, 69677, Bron Cedex, France, justine.bacchetta@chu-lyon.fr.
authors.forename: Justine
authors.initials: J
authors.lastname: Bacchetta
authors.forename: Odile
authors.initials: O
authors.lastname: Basmaison
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Leclerc
authors.forename: Aurélia
authors.initials: A
authors.lastname: Bertholet-Thomas
authors.forename: Pierre
authors.initials: P
authors.lastname: Cochat
authors.forename: Bruno
authors.initials: B
authors.lastname: Ranchin
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005438:Fludrocortisone / Q000627:therapeutic use*; D006801:Humans; D007674:Kidney Diseases / Q000188:drug therapy*; D016030:Kidney Transplantation; D007684:Kidney Tubules / Q000473:pathology; D008297:Male; D012189:Retrospective Studies
chemical_list: D000893:Anti-Inflammatory Agents; D005438:Fludrocortisone