Avascular necrosis of bone as a complication of renal transplantation

Habermann, Edward T.; Cristofaro, Robert L.

doi:10.1016/0049-0172(76)90021-4

Cited by 11 publications

(5 citation statements)

References 17 publications

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“…The cause of osteonecrosis in Crohn's disease is not known. Corticosteroids have been implicated in the past because of a relationship apparently established for some other clinical disorders, including renal transplant recipients (14,15) and systemic lupus erythematosis patients (16)(17)(18)(19). A firm causal relationship has not been established for most disorders, including Crohn's disease.…”

Section: Discussionmentioning

confidence: 99%

Prevalence Rates and an Evaluation of Reported Risk Factors for Osteonecrosis (Avascular Necrosis) in Crohn’s Disease

Freeman

Freeman²

2000

Canadian Journal of Gastroenterology

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Avascular necrosis (osteonecrosis) occurs in Crohn's disease, but the rate of this particular complication is not known. Over 20 years, 877 patients with Crohn's disease, 492 women (56.1%) and 385 men (43.9%), were evaluated with patient follow-up data available for a mean of 7.8 years. In this group, four men were seen with osteonecrosis. No woman was affected. All patients had typical radiological, magnetic resonance imaging or pathological changes of osteonecrosis involving the femoral heads, while two also had superimposed avascular necrosis involving the humeral heads. Patient ages ranged from 19 to 36 years at the time of diagnosis of their Crohn's disease, and all were white. In one patient, disease was confined to the colon, while three patients had disease involving the terminal ileum and colon. Disease behaviour in two patients was classified as penetrating because of concomitant ischiorectal abscesses, while one patient developed a metastatic colon carcinoma. Ankylosing spondylitis was present in two patients, but no other extraintestinal manifestations developed. Two patients received corticosteroids as well as parenteral nutrition during the course of their disease. Two patients did not receive corticosteroids or parenteral nutrition. Of 877 patients with Crohn's disease, 484 (55. 1%) received corticosteroids during the course of the disease, 196 (22.4%) received at least one course of parenteral nutrition, and 125 (14.3%) received both corticosteroids and parenteral nutrition. A total of 311 patients (35.5%) had at least one small intestinal resection. The overall rate of avascular necrosis in Crohn's disease was less than 0.5% but for men with Crohn's disease was about 1%. In this series, risk of osteonecrosis could not be attributed to corticosteroid use, parenteral nutrition or both forms of therapy administered together. Small intestinal resection with loss of small intestinal absorptive area was not a risk factor for the development of osteonecrosis. Avascular necrosis (or osteonecrosis) is a very rare extraintestinal osseous complication that may occur in Crohn's disease, independent of previously reported risk factors, including corticosteroids or parenteral nutrition with lipid emulsions.

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Section: Discussionmentioning

confidence: 99%

Prevalence Rates and an Evaluation of Reported Risk Factors for Osteonecrosis (Avascular Necrosis) in Crohn’s Disease

Freeman

Freeman²

2000

Canadian Journal of Gastroenterology

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“…Other reports relate knee synovitis in renal transplant recipients to aseptic necrosis of the femoral condyle (5,(22)(23)(24). In these instances the synovial fluid has been clear ($22) or tinged with blood (21).…”

Section: Discussionmentioning

confidence: 99%

“…tion (5,6), "non-specific" synovitis has 'also been reported (1)(2)(3)(4)7). In view of the solely retrospective nature of the published reports on the subject and the scarcity of data on synovial fluid from such patients, a prospective study was made of joint disease in patients receiving renal transplants.…”

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confidence: 91%

Joint effusions after kidney transplantation

Macfarlane

Filo

Brandt

1979

Arthritis & Rheumatism

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Thirty-seven consecutive renal transplant recipients were studied prospectively for joint disease. Six developed arthralgias while corticosteroid doses were being lowered. Eleven patients (30%) developed knee effusions at a mean interval of 10 days following transplantation. Synovial fluids were colorless or very pale yellow, with few leukocytes (mean, 28/mm3). These benign transudative effusions did not correlate with immunologic abnormalities, transplant rejection, crystal deposition, or avascular necrosis and may have been due to high dose oral corticosteroid therapy.Musculoskeletal complaints have been noted in up to 30% of patients receiving kidney transplants (1-4). Although aseptic necrosis has received the most atten-

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“…However, a possible association with corticosteroids was first described in 1957 (65), followed by English language reports (66)(67)(68)(69). Later, a more definite association was described following renal transplantation, with a recorded prevalence of up to 20% (70,71), and in patients with systemic lupus erythematosus (prevalence of up to 40%) (72)(73)(74)(75). Although osteonecrosis was seen in other conditions treated with corticosteroids, its prevalence was so low that a strong statistical relationship could not be defined, except possibly in patients with malignant lymphoma (76)(77)(78)(79).…”

Section: Corticosteroids and Osteonecrosismentioning

confidence: 99%

Osteomyelitis and Osteonecrosis in Inflammatory Bowel Disease

Freeman¹

1997

Canadian Journal of Gastroenterology

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Osteomyelitis and osteonecrosis are skeletal disorders seen in patients with inflammatory bowel disease (IBD). Osteomyelitis usually occurs in the pelvic bones, especially in complicated Crohn's disease, presumably by direct extension from a pelvic inflammatory mass, abscess or fistulous tract. Diagnosis of osteomyelitis may be difficult and can lead to spinal extension of the septic process with a resultant neurological deficit, including paraplegia. Osteonecrosis or avascular necrosis has been reported in patients with either ulcerative colitis or Crohn's disease, often, but not exclusively, during or following steroid treatment. The disease is often multifocal, but its natural history is unknown, especially if diagnosed early with modern imaging methods, such as magnetic resonance. In IBD patients, the relationship between osteonecrosis and steroid use is unknown. An adverse steroid effect on bones, especially the femoral heads, may develop in some patients with IBD but, to date, this hypothesis remains unproven. Critical evaluation of published data reveals no consistent association between osteonecrosis and steroid treatment in IBD patients.

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Avascular necrosis of bone as a complication of renal transplantation

Cited by 11 publications

References 17 publications

Prevalence Rates and an Evaluation of Reported Risk Factors for Osteonecrosis (Avascular Necrosis) in Crohn’s Disease

Prevalence Rates and an Evaluation of Reported Risk Factors for Osteonecrosis (Avascular Necrosis) in Crohn’s Disease

Joint effusions after kidney transplantation

Osteomyelitis and Osteonecrosis in Inflammatory Bowel Disease

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