Reply to Tutar et al.

Yazigi, A.; Abou-Charaf, L Charaf

doi:10.1080/08035259950168649

Cited by 2 publications

(2 citation statements)

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“…None of the studies where increased urinary hydroxyproline was observed appear to have controlled for dietary collagen intake, which can influence urinary hydroxyproline levels (14). In addition, normal values of PTH have been reported in the following groups of children with THI: healthy ones (14,15), those with acute but mild illness (diarrhoea, respiratory tract infections) (15), and in patients after liver or kidney transplantation (16,17,18,19,20). Similarly, in our patients, the levels of OC, CTx, Ca, P and PTH were within normal ranges and not related to ALP dynamics, thus ruling out increased bone turnover.…”

Section: Discussionmentioning

confidence: 99%

Normal Bone Turnover in Transient Hyperphosphatasemia

Kutı́lek

Cervickova²,

Bebova³

et al. 2012

Jcrpe

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Transient hyperphosphatasemia of infancy and early childhood (THI) is characterized by a temporary isolated elevation of serum alkaline phosphatase activity (ALP), predominantly its bone or liver isoform, in either sick or healthy children under 5 years of age. Return to normal ALP levels usually occurs within four months. Spontaneous rise of ALP might concern the physician, especially when treating seriously ill children. However, THI is considered a benign biochemical disorder with no clinical consequences. Some existing reports support the hypothesis that THI is a result of increased bone turnover. We present evidence of normal bone turnover in two children with THI. In a one-year-old girl and a boy of the same age, high ALP levels (31 and 109 μkat/L, respectively) were accidentally detected. The children had no signs of metabolic bone disease or of liver disease. The high ALP levels returned to normal in two months, thus fulfilling the diagnosis of THI. In both patients, serum parathyroid hormone and bone turnover markers, serum CrossLaps, and serum osteocalcin were neither elevated, nor did these markers follow the ALP dynamics, thus reflecting normal bone turnover in THI. Children with THI should be spared from extensive investigations and unnecessary vitamin D treatment. Conflict of interest:None declared.

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Section: Discussionmentioning

confidence: 99%

Normal Bone Turnover in Transient Hyperphosphatasemia

Kutı́lek

Cervickova²,

Bebova³

et al. 2012

Jcrpe

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“…There have been multiple case reports of TH in solid organ transplant recipients, including kidney transplant patients; yet, the incidence of TH in this specialized population has not been described [ 4 , 6 , 9 - 10 , 13 ]. In this study, the overall incidence of TH at a large academic medical center was 6.5%, similar to the incidence found in other solid organ transplant recipients and higher than the incidence of TH that has been previously described in healthy children [ 15 - 16 ].…”

Section: Discussionmentioning

confidence: 99%

Transient Hyperphosphatasemia Following Pediatric Kidney Transplant

Cole¹,

Anslow²,

Fadakar³

et al. 2021

Cureus

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IntroductionTransient hyperphosphatasemia (TH) is a rare benign condition of elevated serum alkaline phosphatase (AP) levels seen in healthy children. TH has been reported to occur in pediatric solid organ transplants, including kidney transplant patients. Little is known about TH in pediatric kidney transplant patients. ObjectiveTo evaluate the incidence and natural history of TH in pediatric kidney transplant patients. MethodsA retrospective chart review of patients < 18 years of age who underwent kidney transplantation at the University of Pittsburgh Medical Center (UPMC) Children's Hospital of Pittsburgh between 2008 and 2019 was performed to identify patients with TH, defined as an AP level greater than 1,000 IU/L. Exclusion criteria included repeat kidney transplants or kidney transplant as part of a multiorgan transplant. ResultsOne hundred seventy-six patients underwent a solitary kidney transplant, of which 87 were less than 12 years of age. Eleven patients (6.5%) were found to have TH, all of whom were < 12 years of age (12.8%) (median age: 5 years; range: 1 -11 years). The median AP level prior to transplant was 183 IU/L (range: 104 -309 IU/L) and the median peak AP was > 2,300 IU/L (range: 1,227 -4,912 IU/L). The median time from a kidney transplant to the diagnosis of TH was 0.6 years (range: 0.3 to 7.7 years). The median length of time that TH persisted was 0.5 years (range: 0.2 to 0.9 years). The median estimated glomerular filtration rate (GFR) at the time of diagnosis of TH was 84 mL/min/1.73m 2 per the bedside Schwartz equation (range: 45 to 152 mL/min/1.73m 2 ). One patient had variable AP levels over nine months prior to resolution; the other 10 patients had a solitary peak of AP prior to resolution. No patient required treatment of elevated AP levels and the TH resolved spontaneously without intervention. No patients had significant abnormalities of markers of metabolic bone disease or were on active vitamin D, calcium, or phosphorus supplements. Two patients reported bone pain, and one patient was found to have avascular necrosis of the hip. ConclusionsTH is a relatively common finding following a pediatric kidney transplant in pre-pubertal children less than 12 years of age. It primarily occurs in the first year following a kidney transplant and usually resolves without recurrence within one year of onset.

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Reply to Tutar et al.

Cited by 2 publications

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Normal Bone Turnover in Transient Hyperphosphatasemia

Normal Bone Turnover in Transient Hyperphosphatasemia

Transient Hyperphosphatasemia Following Pediatric Kidney Transplant

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