Musculoskeletal Complications After Renal Transplantation: Pathogenesis and Treatment

Julian, Bruce A.; Quarles, L. Darryl; Niemann, Kurt M. W.

doi:10.1016/s0272-6386(12)70118-x

Cited by 129 publications

(57 citation statements)

References 111 publications

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“…At variance, it did not appreciably change during nonparicalcitol therapy. Thus, at 6 months, BMD values were significantly higher on paricalcitol than nonparicalcitol therapy (1.05460.225 versus 1.01060.185 g/cm 2 , respectively; P=0.04). At 6 months, L4 vertebra ) compared with baseline (1.01660.2082 g/cm 2 ).…”

Section: Bmdmentioning

confidence: 89%

“…CKD mineral and bone disorders (MBDs) may even worsen post-transplant, despite restoring near-normal renal function. 1,2 Bone mineral density (BMD) rapidly decreases in the early post-transplant period, and bone demineralization may eventually progress over years, albeit at a lower rate. This result largely explains why, in recipients of kidney transplants, the incidence of fractures is 4-fold higher than in the general population and even exceeds the incidence observed in patients on hemodialysis.…”

mentioning

confidence: 99%

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Paricalcitol for Secondary Hyperparathyroidism in Renal Transplantation

Trillini

Cortinovis

Ruggenenti

et al. 2015

Journal of the American Society of Nephrology

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Secondary hyperparathyroidism contributes to post-transplant CKD mineral and bone disorder. Paricalcitol, a selective vitamin D receptor activator, decreased serum parathyroid hormone levels and proteinuria in patients with secondary hyperparathyroidism. This single-center, prospective, randomized, crossover, open-label study compared the effect of 6-month treatment with paricalcitol (1 mg/d for 3 months and then uptitrated to 2 mg/d if tolerated) or nonparicalcitol therapy on serum parathyroid hormone levels (primary outcome), mineral metabolism, and proteinuria in 43 consenting recipients of renal transplants with secondary hyperparathyroidism. Participants were randomized 1:1 according to a computer-generated sequence. Compared with baseline, median (interquartile range) serum parathyroid hormone levels significantly declined on paricalcitol from 115.6 (94.8-152.0) to 63.3 (52.0-79.7) pg/ml (P,0.001) but not on nonparicalcitol therapy. At 6 months, levels significantly differed between treatments (P,0.001 by analysis of covariance). Serum bone-specific alkaline phosphatase and osteocalcin decreased on paricalcitol therapy only and significantly differed between treatments at 6 months (P,0.001 for all comparisons). At 6 months, urinary deoxypyridinoline-to-creatinine ratio and 24-hour proteinuria level decreased only on paricalcitol (P,0.05). L3 and L4 vertebral mineral bone density, assessed by dual-energy x-ray absorption, significantly improved with paricalcitol at 6 months (P,0.05 for both densities). Paricalcitol was well tolerated. Overall, 6-month paricalcitol supplementation reduced parathyroid hormone levels and proteinuria, attenuated bone remodeling and mineral loss, and reduced eGFR in renal transplant recipients with secondary hyperparathyroidism. Longterm studies are needed to monitor directly measured GFR, ensure that the bone remodeling and mineral effects are sustained, and determine if the reduction in proteinuria improves renal and cardiovascular outcomes.

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Section: Bmdmentioning

confidence: 89%

mentioning

confidence: 99%

Paricalcitol for Secondary Hyperparathyroidism in Renal Transplantation

Trillini

Cortinovis

Ruggenenti

et al. 2015

Journal of the American Society of Nephrology

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“…AVN is a major postoperative complication that develops within 12 weeks (Kubo et al 1997, Fujioka et al 2001 with a reported incidence of 3-40% (Harrington et al 1971, Gustafsson et al 1976, Ibels et al 1978, Anderson and Nielsen 1981, Bradford et al 1983, Julian et al 1992, Tang et al 2000. It has been shown that the total dose in a 1-year period or average daily dose of steroids is related to the risk of development of AVN (Harrington et al 1971, Pierides et al 1975, Chatterjee et al 1976, Patton and Plaff 1988, Tang et al 2000.…”

mentioning

confidence: 99%

Degree of corticosteroid treatment within the first 2 months of renal transplantation has a strong influence on the incidence of osteonecrosis of the femoral head

Shibatani¹,

Fujioka²,

Arai³

et al. 2008

Acta Orthopaedica

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Degree of corticosteroid treatment within the first 2 months of renal transplantation has a strong influence on the incidence of osteonecrosis of the femoral head, Acta Orthopaedica, 79:5, 631-636, DOI: 10.1080 Background and purpose It has been suggested that avascular osteonecrosis (AVN) of the femoral head develops early after renal transplantation. We evaluated the relationship between risk of AVN and dose of steroids administered in different time periods.Methods Development of AVN was determined using MRI at 3-6 weeks, 9-12 weeks, 24 weeks, and 12 months after transplantation in 150 patients (96 males). We investigated possible associations between acute rejection reactions, the dose of cyclosporine, tacrolimus use, total steroid dose by the second, fourth, sixth, or eighth weeks after transplantation, and incidence of AVN.Results There was no statistically significant difference between incidence of AVN and presence or absence of an acute rejection reaction. We found a statistically significant association between AVN incidence and the total dose of steroids administered during the first 2 months after transplantation, and there was a doseresponse relationship. No other statistically significant associations were found.Interpretation Our findings confirm that the total dose of steroids given within the first 2 months after renal transplantation has a great influence on the incidence of AVN.

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“…Böbrek nakli sonrasında puls steroid ve ATG tedavisi alan hastalarda, almayan hastalara göre kemik kitlesinde daha fazla azalma olduğu bazı çalışmalarda gösterilmiştir (3,17). Bizim çalışmamızda puls steroid ve ATG alan hastalarda, almayan hastalara göre kemik kitlesinde azalma istatistiksel olarak anlamlı bulunmamıştır.…”

Section: Gereç Ve Yöntemlerunclassified

“…Böbrek nakli sonrasındaki ilerleyen süreçte (5 yıldan sonraki uzun süre), böbrek işlevlerindeki kayıpla birlikte tıpkı nakilden önceki kemiğin histolojik yapısındaki anormallikler gelişir. Böbrek naklinden sonra kalıcı hiperparatiroidi gelişebilir (17,19,20). Bazı raporlarda kalıcı hiperparatiroidinin %30-50 olduğu bildirilmiştir (21).…”

Section: Gereç Ve Yöntemlerunclassified

Risk Factors for Osteoporosis in Renal Transplant Recipients

Karataş¹,

Erdem²,

Kaya³

et al. 2012

Turk Neph Dial Transpl

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Öz amaÇ: Çalışmamızın amacı, böbrek nakli yaptığımız işlevsel grefti olan hastalarda osteoporoz sıklığını ve risk etmenlerini belirlemektir. gErEÇ ve YÖntEMlEr: 1997-2010 yılları arasında böbrek nakli yapılan, nakil sonrası kemik mineral yoğunluğu (KMY) ölçümü olan 92 hasta ile çalışmamız yapıldı.BulgulAr: 92 hastamızın 57'si (%62) erkek, 35'i (%38) kadın idi. Hastaların yaş ortalaması 36 yıldı (19-62 yıl). Femur ve/veya lomber vertebra KMY sonuçlarına göre; 39 (%42,4) hasta normal, 39 (%42,4) hastada osteopeni ve 14 (%15,2) hastada osteoporoz vardı. KMY sonuçları ile yaşın, cinsiyetin, vücut kitle indeksinin, paratiroidektomi durumunun, toplam steroid ve bağışıklığı baskılayıcı ilaç dozunun, KMY ölçümü sırasındaki serum kreatinin, kalsiyum, fosfor, alkalen fosfataz düzeylerinin arasında anlamlı ilişki yoktu (p>0,05).SOnuÇ: Bizim çalışmamızda, risk faktörlerin hiçbirisi ile KMY arasında anlamlı bir ilişki saptanmadı. Bu bulgular; tek başına KMY ölçümünün böbrek naklinden sonra gelişmesi olası kemik hastalığını izlemede iyi bir gösterge olmadığını göstermektedir. Bu konuda pratik yeni yöntemlere gereksinim vardır.AnAhtAr SÖzCüKlEr: Kronik böbrek hastalığı, Böbrek nakli, Kemik mineral yoğunluğu abstract OBJECtIVE: The aim of our study was to determine the frequency and risk factors of osteoporosis in patients who had undergone renal transplantation in our clinic and had a functional graft. MAtErIAl and MEthODS:This study included 92 patients who had undergone renal transplantation between 1997 and 2010 and whose bone mineral density was measured after transplantation. rESultS: Our study included 92 patients. 57 patients (62%) were male and 35 (38%) were female. The mean age of the patients was 36 years (range: 19-62 years). According to the bone mineral density in the femur and/or lumbar vertebrae, 39 (42.4%) patients were normal, 39 (42.4%) had osteopenia and 14 (15.2%) had osteoporosis. There was no statistical relationship between the patients' age, gender, body mass index, history of parathyroidectomy, total steroid and immunosuppressive drug dose, creatininecalcium-phosphorus-alkaline phosphatase level at the time of the bone mineral density measurement and bone mineral density (p>0,05). COnCluSIOn:We did not find any relationship between the above risk factors and bone mineral density. These findings show that bone mineral density is not a good parameter in the follow-up of bone disease after renal transplantation.

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Musculoskeletal Complications After Renal Transplantation: Pathogenesis and Treatment

Cited by 129 publications

References 111 publications

Paricalcitol for Secondary Hyperparathyroidism in Renal Transplantation

Paricalcitol for Secondary Hyperparathyroidism in Renal Transplantation

Degree of corticosteroid treatment within the first 2 months of renal transplantation has a strong influence on the incidence of osteonecrosis of the femoral head

Risk Factors for Osteoporosis in Renal Transplant Recipients

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