Abstract. The study was performed to evaluate the long- term renal function of children treated with cyclosporine after kidney transplantation. Renal function was ...
Pediatric Nephrology
Pediatr Nephrol (1992) 6: 339-344 9 IPNA 1992
Original article Renal function following kidney transplantation in children treated with eyelosporine Ulla B. Berg and Ann-Britt Bohlin Department of Paediatrics, Karolinska Institute, Huddinge University Hospital, S-14186 Huddinge, Sweden Received April 15, 1991; received in revised form October 29, 1991; accepted November 5, 1991
Abstract. The study was performed to evaluate the longterm renal function of children treated with cyclosporine after kidney transplantation. Renal function was determined with clearances of inulin and aminohippurate sodium for evaluating glomerular filtration rate (GFR) and effective renal plasma flow (ERPF). Thirty-six children aged 0.4-16.2 (median 6.9) years at transplantation were examined within 5 months of transplantation and then yearly over 0.3-7.1 years. Twenty-five children and young adults, 1.5-20 (median 7.7) years of age, with solitary kidneys because of renal agenesis or nephrectomy, served as controls. The GFR and ERPF within 1 year of transplantation were significantly lower than those of controls (65___19 and 345___88 vs 96+_12 and 474 + 91 ml/min per 1.73 m2, respectively). GFR remained constant 4 years after transplantation, but ERPF decreased significantly. Significant inverse correlations were found between GFR within 5 months of transplantation and the mean cyclosporine cohcentration and the number of rejection episodes. The frequency of hypertension decreased from 82% within 5 months of transplantation to 0% after 4 years. The absolute GFR increased during follow-up. In conclusion, kidney transplantation results in a reduced renal function compared with that of solitary native kidneys. The reduction in renal function correlated with the number of rejection episodes and the cyclosporine load. The increase in absolute GFR during follow-up suggests a remaining capacity for growth and/or compensatory hypertrophy. Key words: Renal function - Glomerular filtration rate Renal plasma flow - Kidney transplantation - Rejection Cyclosporine
Correspondence to: U. Berg
Introduction During the last few years cyclosporine has been shown to be superior to conventional immunosuppression with regard to graft survival after kidney transplantation [1-3]. The nephrotoxicity of cyclosporine is, however, of considerable concern [4], especially with regard to long-term graft survival. Since 1982, immunosuppression with cyclosporine and low-dose prednisolone has been employed after renal transplantation at Huddinge Hospital, and since 1987 triple therapy with azathioprine as well has been used. Because of the above-mentioned nephrotoxicity of cyclosporine, we thought it was of interest to follow regularly the renal function of children treated with cyclosporine after kidney transplantation.
Materials and methods Thirty-six children (16 girls and 20 boys) 0.4-16.2 (median 6.9) years of age at transplantation have been studied. Thirty-two children had their first kidney graft and 4 their second. Twenty-five patients received their graft from live-related donors (LD): 11 mothers, 13 fathers and 1 grandmother. Eleven children received cadaveric (CD) kidneys. The underlying renal diseases were dysplastic kidneys and/or other renal malformations in 15, familial juvenile nephronophthisis in 5, polycystic kidney disease in 6, glomerulonephritisin 6, haemolytic-uraemic syndrome in 1, congenital nephrotic syndrome in 2 and unknown in 1 patient. Renal function tests were performed within 5 months of transplantation and thereafter yearly. Renal function was evaluated from the glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) determined as the clearances of inulin (Inutest, 25%, Laevosan-Gesellschaft, Wien, Austria) and para-aminohippuric acid (PAH) (aminohippurate sodium, 20%, MSD, West Point, USA) respectively. A standard clearanee technique was used, employing a continuous infusion after a prime dose [5]. Water diuresis was induced by the oral ingestion of 20 mi water/kg body weight (bw) during the 1st h and then 5 ml/kg bw every 30 min. This enabled the patients to empW their bladders by spontaneous micturition every 30 min. Four urine samples were collected and midway through each collection period a blood sample was drawn. The clearance values presented are the mean values of the four clearance periods. Investigations in the youngest children (
