Pediatric Nephrology

, Volume 20, Issue 5, pp 652–656 | Cite as

Hypocitraturia as a risk factor for nephrocalcinosis after kidney transplantation

  • Ludwig Stapenhorst
  • Robert Sassen
  • Bodo Beck
  • Norbert Laube
  • Albrecht Hesse
  • Bernd Hoppe
Original Article


Calcium-oxalate crystal deposition in kidney transplant biopsy specimen led us to investigate the impact of calcineurin inhibitor treatment on urinary excretion of lithogenic and stone inhibitory substances in 53 children after successful kidney transplantation (KTx) receiving cyclosporine A (CsA) or tacrolimus. We compared the values obtained with those of 12 patients with recurrent nephrotic syndrome under CsA and of 6 patients with Rasmussen encephalitis (RE) under tacrolimus therapy. Renal ultrasound examinations were repeatedly performed. Hypocitraturia was found in 69% of patients, with KTx patients having a significantly lower urinary citrate excretion than those receiving calcineurin inhibitors for other reasons. Secondly, we found hyperoxaluria in 35% of patients, again especially in those after KTx. No significant difference in urinary substances was seen comparing CsA with tacrolimus treatment. Urolithiasis was found in one and calcium-oxalate crystal deposition in biopsy specimen of three KTx patients. Calcineurin inhibitor treatment can lead to significant hypocitraturia, especially in patients after KTx receiving the highest dose of medication. Hyperoxaluria is primarily the result of a removal of significant body oxalate stores, deposited during dialysis, but may not be suspected as a specific side effect of calcineurin inhibitor therapy. Both findings can increase the risk for urolithiasis or nephrocalcinosis.


Calcineurin inhibitors Hypocitraturia Hyperoxaluria Nephrolithiasis Nephrocalcinosis Kidney transplantation 



Parts of this study were presented at the IPNA conference 2001 in Seattle. We thank Prof. E. Leumann for his editorial comments, Prof. Dr. Gabriele Benz-Bohm for performing the ultrasound examinations and Mrs. B. Baer for her laboratory assistance.


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Copyright information

© IPNA 2005

Authors and Affiliations

  • Ludwig Stapenhorst
    • 1
  • Robert Sassen
    • 2
  • Bodo Beck
    • 1
  • Norbert Laube
    • 3
  • Albrecht Hesse
    • 3
  • Bernd Hoppe
    • 1
  1. 1.Division of Pediatric Nephrology, Department of PediatricsUniversity Children’s HospitalCologneGermany
  2. 2.Department of EpileptologyUniversity HospitalBonnGermany
  3. 3.Division of Experimental Urology, Department of UrologyUniversity of BonnBonnGermany

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