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.

Background The seroprevalence of SARS-CoV-2 infection has been studied in immunocompetent children. However, data in the pediatric kidney transplant population (PKT) are lacking. Methods Using two commercial immunoassays that measured IgG antibodies against SARS-CoV-2 spike protein and IgG against the nucleocapsid (N) protein, we screened 72 PKT recipients who attended the outpatient clinic for routine blood work. The majority of patients with positive serology underwent an additional serology test at least once during subsequent clinical follow-up. Patients were confirmed to have SARS-CoV-2 infection if they had two positive tests. Results Eight patients out of the 72 screened (11.1%) had positive results for SARS-CoV-2 IgG antibodies in both serological tests. Of those who tested positive, 4 had positive SARS-CoV-2 PCR results before screening. All patients were asymptomatic or had a history of mild symptoms. All tested patients had persistently positive antibodies at a median follow-up time of 75 days (IQR, 44.5, 86.5 days). One patient had a positive PCR test at 75 days and a positive serology test at 120 days post infection. Conclusion The seroprevalence of SARS-CoV-2 was relatively high (11.1%) in our population. Although all patients were asymptomatic or mildly symptomatic, they mounted a strong humoral immune response that persisted for a few months despite being on triple immunosuppressants. These findings have positive implications regarding vaccination efficacy in this group.

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