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Post-renal transplant urolithiasis in children: an increasingly diagnosed complication: a retrospective cohort study
  1. Sophia Ma1,2,
  2. Amir Taher1,
  3. Benjamin Zhu1,
  4. Anne Maria Durkan1,3
  1. 1 Nephrology, Children’s Hospital at Westmead, Westmead, New South Wales, Australia
  2. 2 Medicine, University of New South Wales, Sydney, New South Wales, Australia
  3. 3 Paediatrics, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Anne Maria Durkan, Paediatrics, University of Sydney, Sydney, NSW 2145, Australia; Anne.durkan{at}health.nsw.gov.au

Abstract

Objective Urolithiasis in renal transplant (RTx) recipients is a potential cause of allograft loss if obstruction is untreated. It is not clear if paediatric transplant recipients are following the global trend for increased prevalence of urolithiasis over time.

Design/Setting/Patients A retrospective chart review was undertaken to evaluate the frequency, risk factors and characteristics of post-RTx urolithiasis over two decades (1995–2016), in a tertiary Australian paediatric hospital.

Results Stones were diagnosed in 8 of 142 (5.6%) recipients, 6 of whom were transplanted in the latter decade. All patients were male, with a median age 4.9 years and median weight 11.8 kg. Presentation was with haematuria (n=4), pain (n=2), dysuria (n=2), stone passage (n=1) and asymptomatic (n=1). Time to presentation was bimodal; three stones were identified in the initial 3 months post RTx and the remainder after 31–53 months. Two stones were in association with retained suture material and two patients had recurrent urinary tract infections. The average stone size was 8.4 mm. Five stones were analysed; all contained calcium oxalate, three were mixed, including one with uric acid. Five (83.3%) children had hypercalciuria but none had hypercalcaemia. Cystolithotripsy was the the most common treatment (n=5), in combination with citrate supplementation. No graft was lost due to stones.

Conclusions Calculi occur with increasing frequency after renal transplantation. Clinicians need a high index of suspicion as symptoms may be atypical in this population. The cause for the increased frequency of stones in transplant recipients is not clear but is in keeping with the increase seen in the general paediatric population.

  • calculi
  • renal transplantation
  • paediatrics
  • risk factors
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Footnotes

  • Contributors SM: data collection and manuscript writing; AT: data collection and manuscript review; BZ: data collection; AMD: study design, data collection and manuscript review.

  • Funding SM received a University of Sydney scholarship to undertake this project.

  • Competing interests None declared.

  • Ethics approval The study was approved by the human research ethics committee (HREC) of The Sydney Children’s Hospitals Network, Australia (HREC reference LNR/15/SCHN/441).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data.

  • Patient consent for publication Not required.

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