Lidia Ghezzi

Influence of CYP3A5 polymorphism on tacrolimus maintenance doses and serum levels after renal transplantation: age dependency and pharmacological interaction with steroids.

Ferraris JR, Argibay PF, Costa L, Jimenez G, Coccia PA, Ghezzi LFR, Ferraris V, Belloso WH, Redal MA, Larriba JM. Influence of CYP3A5 polymorphism on tacrolimus maintenance doses and serum levels after renal transplantation: Age dependency and pharmacological interaction with steroids. 
Pediatr Transplantation 2011: 15: 525–532.

ABPM vs. office blood pressure to define blood pressure control in treated hypertensive paediatric renal transplant recipients

Abstract:  While 24‐h ambulatory blood pressure monitoring (ABPM) is an established tool for monitoring antihypertensive therapy in adults, data in children are scarce. We retrospectively analysed whether office blood pressure (BP) is reliable for the diagnosis of BP control in 26 treated hypertensive paediatric renal transplants. Controlled office BP was defined as the mean of three replicate systolic and diastolic BP recordings less than or equal to the 95th age‐, sex‐ and height‐matched percentile on the three‐outpatient visits closest to ABPM. Controlled ABPM was defined as systolic and diastolic daytime BP ≤95th distribution adjusted height‐ and sex‐related percentile of the adapted ABPM reference. Eight recipients (30%) with controlled office BP were in fact categorized as having non‐controlled BP by ABPM criteria. Overall, when office BP and ABPM were compared using the Bland and Altman method, the 95% limits of agreement between office and daytime values ranged from −12.6 to 34.1 mmHg for systolic and −23.9 to 31.7 mmHg for diastolic BP, and the mean difference was 10.7 and 3.9 mmHg respectively. Office readings miss a substantial number of recipients who are hypertensive by ABPM criteria. Undertreatment of hypertension could be avoided if ABPM is applied as an adjunct to office readings.

Improved long-term allograft function in pediatric renal transplantation with mycophenolate mofetil

Abstract:  MMF has been shown to decrease the incidence of acute rejection in children and adults at 1 and 3 yr. Other beneficial effects of MMF have been more difficult to demonstrate. Our open‐labeled study presents a 5‐yr data for patients and graft survival, allograft function, and growth in MMF‐treated patients. The trial included 29 patients who were treated with MMF in combination with cyclosporine and methylprednisone. Patients were compared with a preceding group of 29 patients treated with AZA instead of MMF. Patient and graft survival rate 5 yr after transplantation were 97 and 90% in the MMF group vs. 93 and 83% in the AZA group (p: NS). Acute rejection was 20.6% in the MMF group vs. 58.6% in the AZA group (p < 0.01). Chronic rejection was 10.3% in the MMF group and 25% in the AZA group (p: NS). The changes in the creatinine clearance from baseline to 5 yr (Δ) were different between groups (−6.0 ± 5.1 mL/min/1.73 m2 in the MMF group vs. −22.2 ± 7.6 mL/min/1.73 m2 in the AZA group, p < 0.05). Also, the slope of 1/Scr showed a significant lower incidence of worsening renal function after the second year of renal transplantation (p < 0.0001) in the MMF group compared with the AZA group. Δ Height SDS in prepubertal patients was 0.3 ± 0.4 SDS in the MMF group vs. −0.8 ± 0.2 SDS in the AZA group (p < 0.05).

Renal physiology in newborns and old people: Similar characteristics but different mechanisms

Five characteristics of neonate renal physiology, namely glomerular hypofiltration, low renal blood flow and alterations in water, sodium and potassium management, disappear during the first year of life but reoccur during senescence. However, the underlying mechanisms are different during the two periods.

Renal Physiology in Newborns and Old People: Similar Characteristics but Different Mechanisms

Five characteristics of neonate renal physiology, namely glomerular hypofiltration, low renal blood flow and alterations in water, sodium and potassium management, disappear during the first year of life but reoccur during senescence. However, the underlying mechanisms are different during the two periods.