The use of pamidronate in three children with renal disease

The successful use of pamidronate, a bisphosphonate, for the treatment of h ypercalcemia and/or osteopenia is reported in three children with renal fai lure or following renal transplant. Patient 1 was an 11-year-old post renal transplant male who received a single dose of IV pamidronate (0.5 mg/kg) f or the treatment of acute hypercalcemia associated with a pathological frac ture and subsequent immobilization. Prompt resolution of the hypercalcemia was seen. He received a second course of pamidronate (0.5 mg/kg per day for 3 days) for the treatment of osteopenia and has had a subsequent 15% incre ase in lumbar spine bone mineral content (BMC). Patient 2, a 14-year-old ma le on peritoneal dialysis, presented with symptomatic hypercalcemia associa ted with tertiary hyperparathyroidism, A single dose of IV pamidronate (0.4 mg/kg) was given with prompt resolution and prolonged control of his hyper calcemia. The third patient was a 16-year-old female, also in renal failure on peritoneal dialysis. Her course had been complicated by marked osteopen ia. IV pamidronate (0.5 mg/kg per dose) was given on 3 successive days befo re and after renal transplant in an attempt to stabilize her bone mineral d ensity (BMD) around the time of renal transplantation, when additional gluc ocorticoid was necessary. Her total body BMC and BMD remained stable pre an d post transplant. The treatment was effective and well tolerated in all th ree patients. Hence pamidronate is safe and effective for the management of hypercalcemia and osteopenia in children with renal failure and/or renal t ransplant.