title: Practice recommendations for the monitoring of renal function in pediatric non-renal organ transplant recipients.
abstract: The management of non-renal pediatric solid organ transplant recipients has become complex over the last decade with innovations in immunosuppression and surgical techniques. Post-transplantation follow-up is essential to ensure that children have functioning allografts for as long as possible. CKD is highly prevalent in these patients, often under recognized, and has a profound impact on patient survival. These practice recommendations focus on the early detection and management of hypertension, proteinuria, and renal dysfunction in non-renal pediatric solid organ transplant recipients. We present seven practice recommendations. Renal function should be monitored regularly in organ transplant recipients, utilizing assessment of serum creatinine and cystatin C. GFR should be calculated using the new Schwartz formula. Transplant physicians should also monitor blood pressure using automated oscillometric devices and confirm repeated abnormal measures with manual blood pressure readings and ambulatory 24-h blood pressure monitoring. Proteinuria and microalbuminuria should also be assessed regularly. Referrals to a pediatric nephrologist should be made for non-renal organ transplant recipients with repeated blood pressures >95th percentile using the Fourth Task Force reference intervals, microalbumin/creatinine ratio >32.5 mg/g (3.7 mg/mmol) creatinine on repeated testing and/or GFR <90 mL/min/1.73 m(2) .
authors.affiliation: Department of Paediatrics, Schulich School of Medicine & Dentistry, London, ON, Canada.|Department of Medicine, Schulich School of Medicine & Dentistry, London, ON, Canada.|Department of Pathology and Laboratory Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.
authors.forename: Guido
authors.initials: G
authors.lastname: Filler
authors.affiliation: Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Lower Saxony, Germany.
authors.forename: Anette
authors.initials: A
authors.lastname: Melk
authors.affiliation: Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Marks
mesh_terms: D000293:Adolescent; D000419:Albuminuria / Q000097:blood / Q000150:complications; D001794:Blood Pressure; D018660:Blood Pressure Monitoring, Ambulatory; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007165:Immunosuppression Therapy; D007668:Kidney / Q000502:physiology*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000175:diagnosis; D007677:Kidney Function Tests; D008297:Male; D009398:Nephrology / Q000379:methods*; D009991:Oscillometry; D017410:Practice Guidelines as Topic; D011507:Proteinuria / Q000150:complications; D066027:Transplant Recipients; D014180:Transplantation / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
chemical_list: D055316:Cystatin C; D003404:Creatinine
keywords: end-stage kidney disease; glomerular filtration rate; hypertension; microalbuminuria; proteinuria; renal function