Hypertension and obesity after pediatric kidney transplantation: management based on pathophysiology: a mini review

Abstract

Hypertension after pediatric renal transplant is a common and important risk factor for graft loss and patient survival. The mechanism of post kidney transplant hypertension is complex and multifactorial. Control of blood pressure in renal transplant patients is important but often times blood pressures remain uncontrolled. The management of hypertension and obesity in pediatric kidney transplant patients is based on the pathophysiology. Compared to the general pediatric hypertensive population, special attention needs to be focused on the additional impact of immunosuppressive medications side effects and interactions, recurrent disease, and donor and recipient comorbidities such as obesity on blood pressure control with thoughtful consideration of the risk of graft failure. In general, there is a need for prospective studies in pediatric kidney transplant patients to understand the pathophysiology of hypertension and obesity and the appropriate approach to achieve a balance between the primary need to avoid rejection and the need to lower blood pressure and prevent obesity.

Keywords: Hypertension; obesity; pediatric kidney transplant.

Figure 1

Causes of hypertension in pediatric patients with renal transplant (Modified from hypertension after kidney transplantation: A pathophysiologic approach by Thomas, et al.[54]) *CNIS - Calcinurin inhibitors *CSA - Cyclosporin *TAC - Tacrolimus *HTN-Hypertention *CKD-Chronic Kidney Disease *UTI-urinary tract infection *Gc-Glucocorticoids *Na-Sodium *RAAS-Renin-angiotensin aldosterone system *ENac-Sodium Channel *SCD-Standard Criteria Donor *ECD-Extended Criteria Donor