Skip to main content

Advertisement

SpringerLink
Log in

Parathyroid hormone levels in long-term renal transplant children and adolescents

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Secondary hyperparathyroidism is a common complication of chronic renal failure. Kidney transplantation corrects renal insufficiency and most metabolic abnormalities but hyperparathyroidism persists in 50% of children after transplantation. The aim of this study was to investigate parathyroid hormone (PTH) course and potential risk factors for hyperparathyroidism in children after renal transplant. We collected data from 145 transplanted children (mean follow-up 4.7 years). Intact PTH level (iPTH) rapidly decreased in the first 6 months post-transplant and continued to decline in the following years. iPTH was above the normal range in 69.1% of the patients at the time of transplant and in 47% 1 year later, this improvement continuing thereafter. Hypercalcemia was present in 20.3% of the patients before transplant and in 6.3 and 4.1% of patients 6 months and 1 year after transplant, respectively. Hypophosphatemia was present in 5.5% of the patients at 6 months, and 45.5% of the patients needed phosphorus supplements during the first 6 months after transplant. Multivariate analysis indicated pre-transplant hyperparathyroidism, dialysis duration, creatinine clearance and hypophosphatemia as predictors of persistent hyperparathyroidism. In kidney transplanted children, serum iPTH normalized in the long term in the majority of cases. Thus, parathyroidectomy should be reserved for selected patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Sanchez CP (2003) Secondary hyperparathyroidism in children with chronic renal failure: pathogenesis and treatment. Paediatr Drugs 5(11):763–776

    Article  Google Scholar 

  2. Sanchez CP (2008) Mineral metabolism and bone abnormalities in children with chronic renal failure. Rev Endocr Metab Disord 9(2):131–137

    Article  CAS  Google Scholar 

  3. Matsuda-Abadini M, Portale AA, Shah A, Neuhaus J, McEnhill M, Mathias R (2006) Persistent secondary hyperparathyroidism after renal transplantation in children. Pediatr Nephrol 21:413–418

    Article  Google Scholar 

  4. Koch Nogueira PC, Rey N, Said MH, Cochat P (1997) Evolution of hyperparathyroidism after renal transplantation in children—effect of pre-emptive transplantation and duration of dialysis. Nephrol Dial Transplant 12:984–987

    Article  Google Scholar 

  5. Sanchez CP, Salusky IB, Kuizon BD, Ramirez JA, Gales B, Ettenger RB, Goodman WG (1998) Bone disease in children and adolescents undergoing successful renal transplantation. Kidney Int 53:1358–1364

    Article  CAS  Google Scholar 

  6. National Kidney Foundation (2005) K/DOQI clinical practice guidelines for bone metabolism and disease in children with chronic kidney disease. Am J Kidney Dis 46(S1):1–121

    Google Scholar 

  7. Torres A, Rodriguez AP, Concepcion MT, Garcia S, Rufino M, Martin B, Perez L, Machado M, de Bonis E, Losada M, Henandez H, Lorenzo V (1998) Parathyroid function in long-term renal transplant patients: importance of pre-transplant PTH concentration. Nephrol Dial Transplant 13(3):94–97

    Article  Google Scholar 

  8. Evenepoel P, Claes K, Kuypers D, Maes B, Bammens B, Vanrenterghem Y (2004) Natural history of parathyroid function and calcium metabolism after kidney transplantation: a single-centre study. Nephrol Dial Transplant 19:1281–1287

    Article  CAS  Google Scholar 

  9. Messa P, Sindici C, Cannella G, Miotti V, Risaliti A, Gropuzzo M, Di Loreto PL, Bresadola F, Mioni G (1998) Persistent secondary hyperparathyroidism after renal transplantation. Kidney Int 54:1704–1713

    Article  CAS  Google Scholar 

  10. Dumoulin G, Hory B, Nguyen NU, Bresson C, Fournier V, Bouhaddi M, Chalopin JM, Saint-Hillier Y, Regnard J (1997) No trend toward a spontaneous improvement of hyperparathyroidism and high bone turnover in normocalcemic long-term renal transplant recipients. Am J Kidney Dis 29(5):746–753

    Article  CAS  Google Scholar 

  11. Drueke TB (2000) Cell biology of parathyroid gland hyperplasia in chronic renal failure. J Am Soc Nephrol 11:1141–1152

    CAS  PubMed  Google Scholar 

  12. Sinha R, Saad A, Marks SD (2010) Prevalence and complications of chronic kidney disease in paediatric renal transplantation: a K/DOQI perspective. Nephrol Dial Transplant 25:1313–1320

    Article  Google Scholar 

  13. Valta H, Makitie O, Ronnholm K, Jalanko H (2009) Bone health in children and adolescents after renal transplantation. J Bone Miner Res 24(10):1699–1708

    Article  CAS  Google Scholar 

  14. Sprague SM, Belozeroff V, Danese MD, Martin LP, Olgaard K (2007) Abnormal bone mineral metabolism in kidney transplant patients—a review. Am J Nephrol 28(2):246–253

    Article  Google Scholar 

  15. Weisinger JR, Carlini RG, Rojas E, Bellorin-Font E (2006) Bone disease after renal transplantation. Clin J Am Nephrol 1:1300–1313

    Article  CAS  Google Scholar 

  16. Oh J, Wunsch R, Turzer M, Bahner M, Raggi P, Querfeld U, Mehls O, Schaefer F (2002) Advanced coronary and carotid arteriopathy in young adults with childhood-onset chronic renal failure. Circulation 106:100–105

    Article  Google Scholar 

  17. Evenepoel P, Claes K, Kuypers DR, Debruyne F, Vanrenterghem Y (2007) Parathyroidectomy after successful kidney transplant: a single-centre study. Nephrol Dial Transplant 22(6):1730–1737

    Article  Google Scholar 

  18. Evenepoel P, Claes K, Maes B, Vanrenterghem Y (2005) Impact of parathyroidectomy on renal graft function, blood pressure and serum lipids in kidney transplant receipients: a single-centre study. Nephrol Dial Transplant 20:1714–1720

    Article  CAS  Google Scholar 

  19. Schwarz A, Rustien G, Merkel S, Radermacher J, Haller H (2007) Decreased renal transplant function after parathyroidectomy. Nephrol Dial Transplant 22(2):584–591

    Article  Google Scholar 

  20. Shaefer B, Schlosser K, Wuhl E, Schall P, Klaus G, Shaefer F, Schmitt CP (2010) Long-term control of parathyroid hormone and calcium-phosphate metabolism after parathyroidectomy in children with chronic kidney disease. Nephrol Dial Transplant 25(8):2590–2595

    Article  Google Scholar 

  21. Srinivas TR, Schold JD, Womer KL, Kaplan B, Howard RJ, Bucci CM, Meier-Kriesche HU (2006) Improvement in hypercalcemia with cinacalcet after kidney transplantation. Clin J Am Soc Nephrol 1:323–326

    Article  CAS  Google Scholar 

  22. Serra AL, Wuhrmann C, Wuthrich RP (2008) Phosphatemic effect of cinacalcet in kidney transplant recipients with persistent hyperparathyroidism. Am J Kidney Dis 52(6):1151–1157

    Article  CAS  Google Scholar 

  23. Borchhardt KA, Diarra D, Sulzbacher I, Benesch T, Haas M, Sunder-Plassmann G (2010) Cinacalcet decreases bone formation rate in hypercalcemic hyperparathyroidism after kidney transplantation. Am J Nephrol 31(6):482–489

    Google Scholar 

  24. Falk P, Vethe NT, Asberg A, Midtvedt K, Bergan S, Egge Reubsaet JL, Holdaas H (2008) Cinacalcet’s effect on the pharmacokinetics of tacrolimus, cyclosporine and mycophenolate in renal transplant recipients. Nephrol Dial Transplant 23:1048–1053

    Article  Google Scholar 

  25. Bellorin-Font E, Rojas E, Carlini RG, Suniaga O, Weisenger JR (2003) Bone remodeling after renal transplantation. Kidney Int 63(S85):125–128

    Article  Google Scholar 

  26. Seeherunvong W, Wolf M (2011) Tertiary excess of fibroblast growth factor 23 and hypophosphatemia following kidney transplantation. Pediatr Transplant 15(1):37–46

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Nephrology and Urology Department, Bambino Gesù Children’s Hospital and Research Institute (IRCCS), Piazza S. Onofrio 4, 00165, Rome, Italy

    Isabella Guzzo, Giacomo Di Zazzo, Chiara Laurenzi, Lucilla Ravà, Germana Giannone, Stefano Picca & Luca Dello Strologo

Authors
  1. Isabella Guzzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giacomo Di Zazzo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chiara Laurenzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lucilla Ravà
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Germana Giannone
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Stefano Picca
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Luca Dello Strologo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Isabella Guzzo.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Guzzo, I., Di Zazzo, G., Laurenzi, C. et al. Parathyroid hormone levels in long-term renal transplant children and adolescents. Pediatr Nephrol 26, 2051–2057 (2011). https://doi.org/10.1007/s00467-011-1896-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00467-011-1896-8

Keywords

Search

Navigation