Transient hyperphosphatasaemia in a 4-year-old boy after successful kidney transplantation

Schwab, Michelle; Schmidt‐Gayk, H.; Ruder, H.

doi:10.1093/ndt/12.8.1745

Cited by 6 publications

(10 citation statements)

References 1 publication

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“…Fortunately, the clinical course of TH is usually time limited, as was observed in all our patients, in whom the S‐ALP returned to normal within four months after detection. This is in line with other reports on renal transplant patients in whom the spontaneous recovery was observed within three months except for one patient in whom the TH lasted for 204 days (Table 2) (10–12, 15). It seems therefore reasonable to limit the initial investigations to basic bone metabolism work‐up and await the evolution of the S‐ALP over 3–4 months before embarking on more sophisticated and invasive tests.…”

Section: Discussionsupporting

confidence: 92%

“…TH has been thus far described in 36 transplant patients (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18): in six children (10)(11)(12)15) (Table 2) and three adults (18) after renal Tx, 25 children after liver Tx (7-9, 14-17) and in two children after cardiac Tx (13). Based on the literature review (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), the prevalence of TH in post-transplant patients ranges from 1% to 4%. The TH can occur at any time post-Tx; in renal Tx patients, the range of TH occurrence was 1-36 months ( Table 2) (10)(11)(12)15), and this was also observed in our patients ( Table 1).…”

Section: Patientmentioning

confidence: 99%

“…TH may also occur in patients post-solid organ Tx (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Similarly to the classic TH in nontransplanted children, the occurrence of TH in transplant recipients causes significant anxiety to the attending physician and raises similar questions -is there a need for a detailed work-up and when?…”

mentioning

confidence: 99%

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Transient hyperphosphatasemia in pediatric renal transplant patients – Is there a need for concern and when?

Kutı́lek¹,

Skálová

Vethamuthu

et al. 2010

Pediatric Transplantation

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TH of infancy and early childhood is characterized by transiently increased S-ALP, predominantly its bone or liver isoforms. There are neither signs of metabolic bone disease or hepatopathy corresponding to the increased S-ALP, nor a common underlying/triggering disease. TH may also occur in children post-renal Tx, which may raise significant concerns and anxiety. We describe four patients aged 2.8-7 yr in whom the TH occurred at 11-34 (median = 28) months after Tx and lasted from 40 to 105 (median = 63) days. No obvious cause/trigger of TH could be found; the clinical status and bone turnover were not altered. In cases of TH post-Tx, we recommend the evaluation of basic biochemical indices and wrist X-ray. If these results are normal, TH is most likely the diagnosis and the S-ALP can be monitored over the next three months without further testing. In patients with persisting TH for more than three months and/or in children with pre-existing or suspected metabolic bone disease, further evaluation may be indicated. In conclusion, TH is a benign disorder in patients post-Tx. Detailed investigation including bone biopsy is only indicated in patients with persisting TH.

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Section: Discussionsupporting

confidence: 92%

Section: Patientmentioning

confidence: 99%

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Transient hyperphosphatasemia in pediatric renal transplant patients – Is there a need for concern and when?

Kutı́lek¹,

Skálová

Vethamuthu

et al. 2010

Pediatric Transplantation

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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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“…None of these studies appears to have controlled for dietary collagen intake, which can influence urinary hydroxyproline levels 29. Among children who developed TH after liver or kidney transplantation, PTH levels were normal in 5 of 6 children,30 and normal urine hydroxyproline/creatinine ratio was reported in one 5 year old boy 31. In our study, the similar mean levels of calcium, magnesium, phosphorus and PTH across AP groups did not support increased bone resorption among children with TH.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Transient Hyperphosphatasemia Among Healthy Infants and Toddlers

Huh¹,

Feldman

Cox³

et al. 2009

Pediatrics

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Objective To describe the prevalence and clinical characteristics of transient hyperphosphatasemia (TH) in a cohort of healthy infants and toddlers. Patients and Methods We performed a secondary data analysis of children enrolled in a study examining the epidemiology of vitamin D deficiency among healthy infants and toddlers. Children aged 8 to 24 months were enrolled at well-child visits conducted from 2005 - 2007 in an urban primary care pediatric clinic. Children with a chronic disease or using medications known to affect bone metabolism were excluded. At enrollment, we collected data regarding child age, gender, height, and weight; and maternal race/ethnicity. We measured serum levels of alkaline phosphatase, 25-hydroxyvitamin D, parathyroid hormone (PTH), calcium, magnesium and phosphorus. We divided participants into three categories, based on serum AP levels at enrollment: normal (AP 110 to 400 U/L), intermediate (AP >400 to 1000 U/L), and TH (AP >1000 U/L). We used the Fisher exact test and analysis of variance to evaluate differences in clinical characteristics among the three groups. Results Nine of 316 children (2.8%) had an AP > 1000 U/L (mean 2165 U/L, range 1006 to 4293 U/L). Sixteen children (5.1%) had an intermediate serum AP (mean 544 U/L, range 423 to 835 U/L). Mean weight-for-age z-score, length-for-age z-score and weight-for-length z-scores were similar across all three AP groups. Compared to the 291 children without TH, children in the intermediate AP and TH groups had similar mean serum levels of 25-hydroxyvitamin D, PTH, calcium, magnesium, and phosphorus. Conclusions TH appears to be a relatively common condition among healthy infants and toddlers. TH was not associated with anthropometric measures, vitamin D status, PTH, or serum minerals. Recognition of this benign condition is important to avoid unnecessary investigations.

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Transient hyperphosphatasaemia in a 4-year-old boy after successful kidney transplantation

Cited by 6 publications

References 1 publication

Transient hyperphosphatasemia in pediatric renal transplant patients – Is there a need for concern and when?

Transient hyperphosphatasemia in pediatric renal transplant patients – Is there a need for concern and when?

Normal Bone Turnover in Transient Hyperphosphatasemia

Prevalence of Transient Hyperphosphatasemia Among Healthy Infants and Toddlers

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