Background: Post renal transplantation, tubulopathies may occur as an effect of transplantation itself or secondary to the use of immunosuppressive regimes. This often requires administration of large doses of sodium bicarbonate and sodium chloride, resulting in poor compliance. Adult studies have shown the advantages of fludrocortisone in the treatment of severe tubulopathies post renal transplant. There is limited data in children. We report our experience from a tertiary paediatric centre.
Objective and hypotheses: To evaluate the efficacy of fludrocortisone as a treatment for tubulopathy post renal transplantation in children.
Method: Retrospective review using data collected from a renal database from December 2014 to January 2016.
Results: A total of 24 post transplant patients were identified as being on sodium supplements, of which 6 patients were started on fludrocortisone post transplantation. The median patient age was 7.3(4.99.9) years. Patients received fludrocortisone 18.5(252) months after transplantation and were followed up for 12.5(620) months. Following treatment with fludrocortisone, all patients stopped sodium bicarbonate supplements and all patients had a reduction in the total daily doses of sodium chloride. Serum potassium levels were significantly lower on treatment, 5.3 vs 4.5 mmol/l, P=0.04. There was no significant increase in systolic blood pressure, 98.5 vs 103.5 mmHg, P=0.40. Renal function was unchanged, serum creatinine 57.0 vs 54.5 μmol/l, P=0.12. No side-effects of treatment with fludrocortisone were reported in this cohort (Table 1).
|Fludrocortisone (μg)||NaHO3 (g)||NaCl (g)|
|Patient||Diagnosis||Initial dose||Max dose||Pre-fludro||With fludro||Pre-fludro||With fludro|
|1||Congenital renal hypoplasia||100||200|||||||||
|2||Congenital nephrotic syndrome||50||75||3.0||0||1.8||1.8|
|3||Prune belly syndrome||25||100||1.9||0||2.7||1.8|
|4||Posterior urethral valves||25||150||2.0||0||1.8||0.9|
|5||Congenital renal hypoplasia||50||150||5.0||0||0.9||4.0|
|6||Prune belly syndrome||25||150||6.7||0||4.0||0|
Conclusion: Fludrocortisone is an effective treatment for tubulopathies in children post renal transplantation. It reduces the requirement for sodium bicarbonate and sodium chloride supplementation without a significant effect on renal function or blood pressure. The hypokalaemic properties of fludrocortisone are an added benefit as some patients in this cohort were also on potassium restricted diets. This study adds to the limited evidence in the literature regarding the benefit of fludrocortisone.
10 - 12 Sep 2016
European Society for Paediatric Endocrinology