Reflex sympathetic dystrophy of the lower limbs after kidney transplantation

Abstract

Reflex sympathetic dystrophy syndrome (RSDS) is a rarely described complication after different types of organ transplants. Three out of 147 kidney recipients treated at our center during the last 6 years developed severe bilateral symmetrical pain in the ankles and knees, with great difficulties in walking 2-3 months after kidney transplantation. Clinical examination revealed periarticular soft tissue swelling and vasomotor changes with no effusion. Patchy osteoporotic patterns were seen radiographically in clinically affected areas. Scintigraphy showed increased epiphyseal uptake of ""' Tc with a periarticular distribution. Clinical symptoms, radiographic, and scintigraphic signs were compatible with so-called RSDS. The exact cause of the syndrome remained obscure. All patients received standard immunosuppression with cyclosporine A (CyA), azathioprine, and prednisone. Symptoms of RSDS improved when doses of CyA were reduced and blood levels declined; patients were treated with calcitonin and calcium channel blockers simultaneously. Non-steroidal antiinflammatory drugs were not effective in symptom relief. In all three cases, most probably spontaneous complete recovery was achieved over the course of 2-8 months; no one patient progressed to aseptic osteonecrosis.

Complex regional pain syndrome type I of the knee: A systematic literature review

“…In all patients who developed RSD or CRPS after renal transplantation, radiographs showed patchy osteopenia and bone scintigraphy showed increased uptake in the affected areas; the authors considered these findings as supportive in diagnosing RSD or CRPS (Grandtnerova et al., ; Puig i Mari et al., ; Molina et al., ).…”

“…The authors of three articles reported the occurrence of RSD in the lower extremities in patients after renal transplantation. A total of seven patients had severe pain in one or both of the knees and ankles; clinical examination revealed increased local temperature, trophic changes and periarticular soft tissue swelling (Grandtnerova et al., ; Puig i Mari et al., ; Molina et al., ). Table shows the number and percentage of reported eliciting factors.…”

Calcineurin inhibitor induces pain hypersensitivity by potentiating pre‐ and postsynaptic NMDA receptor activity in spinal cords

“…The pain associated with CIPS is typically symmetrical, sharp, stinging and intermittent and increases when standing or walking (Grotz et al 2001; Kida et al 2004; Collini et al 2006; Fujii et al 2006; Noda et al 2008). Although CIPS seems to affect about 5–10% of patients who undergo kidney, heart, lung, liver, pancreas, or bone marrow transplantation, it is probably much more common in transplant patients because CIPS is frequently diagnosed as reflex sympathetic dystrophy syndrome (Muñoz‐Gomez et al 1991; Grandtnerova et al 1998; Puig et al 2000; Ybarra et al 2003). Also, the concurrent use of L‐type Ca 2+ channel blockers (to treat hypertension caused by calcineurin inhibitors) may mask CIPS in many patients, because L‐type Ca 2+ channels contribute to regulating glutamatergic input from primary afferents to the spinal dorsal horn (Bao et al 1998).…”