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Making life easier for kidney patients

Less invasive test finds problems earlier

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AFTER having his tummy poked and prodded in front of the media and sitting through his parents' umpteenth interview, you'd think a four-year-old boy might get restless.

Then again, Kaden Morris has had a lot of practice being patient -- starting in the first 30 months of his life, when he spent 12 hours a day hooked up to a dialysis machine, waiting for his body to grow big enough to accept a donor kidney from his dad.

"I'm going to be on the TV," the sociable youngster chirped to reporters crowded into an examining room at the Manitoba Institute of Child Health on Wednesday. Hopping onto the table, he lay back on a huge, colourful pillow and allowed Dr. Tom Blydt-Hansen to gently probe the site of his March 2008 transplant surgery.

Kaden, who was diagnosed with renal failure 24 hours after birth, is among the seven or so children who receive kidney transplants every year in Manitoba.

He's lucky. While between 10 and 20 per cent of pediatric transplant recipients will experience at least one rejection episode within the first year, Kaden's body accepted his father's gift without complications.

Currently, detecting organ rejection requires a biopsy -- inserting a needle directly into the kidney to remove a piece of it. Biopsies are usually done within a month following surgery, then every three months thereafter during the first year. After that, it's once a year, a milestone Kaden's family is glad they've passed.

"The biopsies are stressful for him and for us," said his dad, Keith. "It takes a whole day. We come in early in the morning and he has to be sedated. Then after, we have to see if he can pass urine without any blood clots. When he wakes up, he's irritable.

Blydt-Hansen hopes to change that. The physician and his team of scientists are developing a less invasive test that would use a patient's urine to detect early signs of rejection. The technique is called Nuclear Magnetic Resonance (NMR) spectroscopy and uses a magnetic field to measure levels of metabolites -- simple sugars, amino acids and waste products that are present in urine. The premise of the research is that organ rejection causes changes in the amounts of these metabolites. If doctors can distinguish patterns, they'll be able to detect rejection early and begin treatment to save the transplant organ, Blydt-Hansen explained.

"If you have an injury going on in the kidney, it takes a long time for it to manifest as kidney malfunction," said the head of pediatric nephrology at the University of Manitoba's faculty of medicine. "We'd use this to screen weekly for changes that suggest rejection. If I can pick it up early, I can reverse it."

Blydt-Hansen stressed that the NMR project, which began in 2002, is still in the research stage. Kaden is among 40 or so patients from the pediatric kidney transplant program being monitored by Blydt-Hansen.


Kidney trouble

700 -- Manitoba children admitted to hospital every year with kidney disease

48 -- Children with chronic kidney failure who may need a transplant

5 to 8 -- Number of pediatric kidney transplants per year

10 to 20 -- Percentage of kids who will experience at least one rejection episode in the first year after a kidney transplant

-- Manitoba Institute of Child Health

Republished from the Winnipeg Free Press print edition September 10, 2009 A6

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