Incidence of hyperkalemic RTA in pediatric post-renal transplant patients and the role of fludrocortisone.

BACKGROUND: One of the most common forms of post-transplant tubulopathy is hyperkalemic (RTA). The true incidence of hyperkalemic RTA in pediatric patients has not yet been studied. (CNIs) remain mostly blamed. Most cases are managed with sodium bicarbonate and potassium binding resins. Few studies have addressed the role of fludrocortisone in managing such patients. This study aimed to assess the efficacy and safety of fludrocortisone in the treatment of post-transplant hyperkalemic RTA. METHOD: This is a retrospective cohort study of all pediatric (aged ≤16 years) post-kidney transplant patients who were followed up in KFSH-D, Saudi Arabia from January 2015 until September 2019. A total of 136 pediatric post-renal transplant patients were reviewed, of these, 39 patients who were commenced on fludrocortisone post-transplant treatment and were followed up for at least 6 months after fludrocortisone initiation were included in this study. RESULTS: The incidence of hyperkalemic RTA in our center was 60.6%. The medication requirements decreased significantly after fludrocortisone initiation. The median sodium bicarbonate dose decreased from 1.2 mEq/kg/day (range, 0.0-4.7) prior to fludrocortisone treatment to 0.0 mEq/kg/day (range, 0.0-4.3) at 6-month follow-up (p < .001). Similarly, the median (SPS) dose decreased from 1.2 g/kg/day (range, 0.0-4.0) before fludrocortisone treatment to 0.0 g/kg/day (range, 0.0-3.6) (p < .001) at 6-month follow-up. The initial mean potassium level 5.17 mmol/L ± 0.61SD dropped to 4.60 mmol/L ± 0.46SD at 6-month follow-up (p < .001). The initial mean serum bicarbonate level 22.31 mmol/L ± 3.67SD increased to 24.5 mmol/L ± 2.8SD at 6-month follow-up (p < .01). No effect on systolic and diastolic blood pressure was observed during follow-up. CONCLUSION: Hyperkalemic RTA incidence was high in our cohort. Fludrocortisone is safe and effective drug in the treatment of post-kidney transplant hyperkalemic RTA.

Practice of Childhood Nephrotic Syndrome Management amongPediatric Nephrologists in the GCC Countries.

Childhood nephrotic syndrome (NS) management is greatly variable among pediatric nephrologists worldwide. We aimed to evaluate if this variability exists among pediatric nephrologists in the gulf countries and whether certain training programs influence this variability. A web-based multiple-choice survey of 35 NS management questions distributed to certified pediatric nephrologists working in the Gulf countries. Amongst 92 invitees, the response rate was 67%. The majority (73%) were older than 50 years and male (58%). Sixty percent trained in North America and 41% had >10 years of experience. Sixty-three percent use a 12- week corticosteroids regimen for the initial treatment of childhood NS and only 10% never consider long-term small alternate dose corticosteroids therapy to sustain remission before commencing a corticosteroids-sparing agent for frequently relapsing or corticosteroids-dependent NS. Mycophenolate mofetil was the drug of choice for frequently relapsing and corticosteroids dependent NS in 51% and 58% of the participants, respectively, whereas calcineurin inhibitors were preferred by the vast majority (95%) of the participants for corticosteroids-resistant childhood NS. Regarding rituximab treatment, almost half of the participants (48%) give two doses of rituximab one to two weeks apart and 61% do not give another course of rituximab until the child relapse. Fellowship training site and the duration of the clinical experience did not seem to influence certain management of childhood NS. As shown in North American studies, great variability in the management of childhood NS does exist in the Gulf countries. The country of fellowship training and the experience did not seem to contribute to this variability.