How to monitor renal function in pediatric solid organ transplant recipients

Authors

  • Guido Filler,

    1. Department of Paediatrics, Children’s Hospital at London Health Science Centre, University of Western Ontario, London, Ontario, Canada
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  • Ajay P. Sharma

    1. Department of Paediatrics, Children’s Hospital at London Health Science Centre, University of Western Ontario, London, Ontario, Canada
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Guido Filler, Professor and Chair, Department of Paediatrics, Children’s Hospital of Western Ontario, 800 Commissioners Road East, London, Ontario, Canada N6A 5W9
Tel.: +1 519 685 8377
Fax: +1 519 685 8551
E-mail: guido.filler@lhsc.on.ca

Abstract

Abstract:  The aim is to review the tools for early detection of renal dysfunction after pediatric solid organ transplantation. Currently, the most widely used marker for detection of renal dysfunction involves measurement of GFR. Inulin clearance forms the “gold standard” method for measuring GFR; however, nuclear medicine methods (51Cr EDTA and 99Tc DTPA isotope clearance studies) have replaced inulin clearance. The measurement of serum creatinine has a low sensitivity for the early detection of renal damage. The Schwartz formula using patient height and serum creatinine requires center-specific constants and has limitations associated with creatinine determination. These limitations may be overcome using a cystatin C-based GFR estimation. In diabetic nephropathy, and more recently in hemolytic uremic syndrome, microalbuminuria has been established as a useful screening tool for renal damage, while its predictive value in the transplantation setting needs to be established. All transplant recipients should be screened for hypertension. Early referral for ambulatory 24-h blood pressure monitoring and involvement of pediatric nephrologists should be considered. All pediatric solid organ transplant recipients receiving CNI should be screened regularly for high blood pressure and early evidence of renal damage using either GFR scans or cystatin C-based GFR estimations.

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