Transplantation 1990 Jan;49(1):81-5

The impairment of true glomerular filtration rate in long-term cyclosporine-treated pediatric allograft recipients

McDiarmid SV, Ettenger RB, Hawkins RA, Senguttvan P, Busuttil RW, Vargas J,
Berquist WE, Ament ME
Division of Pediatric Gastroenterology, UCLA School of Medicine 90024
Abstract
We performed indium-111-DTPA plasma clearance studies in 61 pediatric kidney and
liver recipients treated with cyclosporine to compare true glomerular filtration
rate with calculated GFR (cGFR). The mean true GFR of 61.9 +/- 36.6 ml/min/1.73
m2 indicated renal impairment. The mean cGFR of 85.2 +/- 22.4 ml/min/1.73 m2 was
significantly higher (P less than 0.001), and overestimated GFR by 38%. cGFR
alone did not accurately reflect the degree of renal dysfunction. A group of 48
pediatric orthotopic liver transplant recipients was studied in more detail: 73%
of these patients had a true GFR less than 70 ml/min/1.73 m2, while 85% had a
true GFR below 90 ml/min/1.73 m2, the lower limit for normal GFR in children.
The mean true GFR for patients treated more than 24 months with CsA was lower (P
= 0.02) than patients treated with CsA for 12 to 24 months. OLT patients with
normal true GFR (greater than 90 ml/min/1.73 m2) had significantly lower plasma
CsA levels, and 50% of patients with a true GFR less than or equal to 50
ml/min/1.73 m2 had hypertension. There was no effect on true GFR of age, liver
function, azathioprine use, or peritransplant treatment with other nephrotoxic
drugs. We conclude that true GFR is significantly impaired in long-term
CsA-treated allograft pediatric recipients. Calculations of GFR underestimate
the degree of renal dysfunction. As patients treated greater than 24 months had
the lowest true GFRs, the fall in GFR may be progressive