Transient hyperphosphatasemia in pediatric renal transplant patients – Is there a need for concern and when?

Authors


Janusz Feber, MD, FRCPC, Division of Pediatric Nephrology, Department of Pediatrics, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada
Tel.: +1 613 737 7600 ext. 2441
Fax: +1 613 738 3254
E-mail: jfeber@cheo.on.ca

Abstract

Kutílek Š, Skálová S, Vethamuthu J, Geier P, Feber J. Transient hyperphosphatasemia in pediatric renal transplant patients – Is there a need for concern and when?
Pediatr Transplantation 2012: 16: E5–E9. © 2010 John Wiley & Sons A/S.

Abstract:  TH of infancy and early childhood is characterized by transiently increased S-ALP, predominantly its bone or liver isoforms. There are neither signs of metabolic bone disease or hepatopathy corresponding to the increased S-ALP, nor a common underlying/triggering disease. TH may also occur in children post-renal Tx, which may raise significant concerns and anxiety. We describe four patients aged 2.8–7 yr in whom the TH occurred at 11–34 (median = 28) months after Tx and lasted from 40 to 105 (median = 63) days. No obvious cause/trigger of TH could be found; the clinical status and bone turnover were not altered. In cases of TH post-Tx, we recommend the evaluation of basic biochemical indices and wrist X-ray. If these results are normal, TH is most likely the diagnosis and the S-ALP can be monitored over the next three months without further testing. In patients with persisting TH for more than three months and/or in children with pre-existing or suspected metabolic bone disease, further evaluation may be indicated. In conclusion, TH is a benign disorder in patients post-Tx. Detailed investigation including bone biopsy is only indicated in patients with persisting TH.

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