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.
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Acknowledgments
The authors would like to acknowledge Amélie Ferdinand, MD, for her help in the initial data collection.
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Justine Bacchetta and Odile Basmaison contributed equally to the manuscript
Preliminary clinical data have been presented as an abstract at the 2012 European Society for Paediatric Nephrology (Krakow) conference and at the 2013 International Pediatric Nephrology Association (Shanghai) conference.
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Bacchetta, J., Basmaison, O., Leclerc, AL. et al. Fludrocortisone as a new tool for managing tubulopathy after pediatric renal transplantation: a series of cases. Pediatr Nephrol 29, 2061–2064 (2014). https://doi.org/10.1007/s00467-014-2842-3
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DOI: https://doi.org/10.1007/s00467-014-2842-3