Serum bone alkaline phosphatase is superior to plasma levels of bone matrix proteins for assessment of bone metabolism in patients receiving renal transplants

Withold, Wolfgang; Friedrich, Wolfgang; Degenhardt, Stefan

doi:10.1016/s0009-8981(97)06519-4

Cited by 17 publications

(9 citation statements)

References 11 publications

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“…ALP represents a group of enzymes produced by bone (isoenzyme ALP‐1 or bone ALP), liver (iso‐ enzyme ALP‐2) and certain other cells in the body (isoenzyme ALP‐3). Measurement of bone ALP may be superior to assay of bone matrix proteins (such as osteocalcin and osteonectin) in estimating mineralization rates in patients undergoing renal transplantation7. In patients receiving dialysis, levels of ALP correlate directly with risk of hospitalization and death independent of calcium, phosphorus and parathyroid hormone levels2.…”

Section: Discussionmentioning

confidence: 99%

Alkaline phosphatase predicts calcium requirements after total parathyroidectomy in patients receiving dialysis

Goh

Yudisthra

Hisham³

2010

Journal of British Surgery

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Section: Discussionmentioning

confidence: 99%

Alkaline phosphatase predicts calcium requirements after total parathyroidectomy in patients receiving dialysis

Goh

Yudisthra

Hisham³

2010

Journal of British Surgery

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“…Thus, we assume that changes in AP levels reflect altered bone metabolism. Given that increases in bone‐specific AP levels post‐transplant reflect osteoblast activity, cinacalcet may have led to a burst of increased bone formation and normalization of the bone trophic effects of PTH (28). Therefore, we suspect that cinacalcet therapy in this clinical situation may lead to improved bone mineralization.…”

Section: Discussionmentioning

confidence: 99%

Early and Severe Hyperparathyroidism Associated with Hypercalcemia After Renal Transplant Treated with Cinacalcet

Leca

Laftavi

Gundroo

et al. 2006

American Journal of Transplantation

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Bone disease is a common clinical problem following renal transplantation. In renal transplant recipients, multiple underlying factors determine the extent of bone loss and the subsequent risk of fractures. In addition to the well-recognized risk to bone disease posed by steroids, calcineurin inhibitors and preexisting bone disease, persistent hyperparathyroidism (HPT) contributes to post-transplant bone loss. HPT is usually treated with vitamin D supplements combined with calcium. Patients whose HPT is associated with hypercalcemia pose a difficult therapeutic dilemma which often requires parathyroidectomy. Cinacalcet, a calcium mimetic agent, offers a unique pharmacologic approach to the treatment of patients with posttransplant hypercalcemia and HPT. In this paper, we describe the clinical course and biochemical changes in 10 renal transplant recipients with hypercalcemia and severe HPT early after renal transplantation treated with cinacalcet. Cinacalcet therapy corrected hypercalcemia and decreased parathyroid hormone (PTH) levels in all cases. A transient rise in the level of alkaline phosphatase was noted following initiation of cinacalcet therapy. In this patient population, correction of HPT was not permanent as discontinuing cinacalcet therapy led to a rapid rise in PTH level.

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“…Treatment options for hyperparathyroidism are summarized below. Serum bone-specific alkaline phosphatase is significantly correlated with calcitriol and adequately reflects increased bone formation after renal transplantation 65. Higher levels of alkaline phosphatase, but not PTH in the months prior to kidney transplantation may herald poor post-transplant outcomes (Miklos Z. Molnar and colleagues, personal communication).…”

Section: Pth and Alkaline Phosphatasementioning

confidence: 99%

Management of mineral and bone disorder after kidney transplantation

Kalantar-Zadeh¹,

Molnar²,

Kövesdy³

et al. 2012

Current Opinion in Nephrology and Hypertension

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Purpose of review Mineral and bone disorders (MBD), inherent complications of moderate and advanced chronic kidney disease (CKD), occur frequently in kidney transplant recipients. However, much confusion exists about clinical application of diagnostic tools and preventive or treatment strategies to correct bone loss or mineral disarrays in transplanted patients. We have reviewed the recent evidence about prevalence and consequences of MBD in kidney transplant recipients and examined diagnostic, preventive and therapeutic options to this end. Recent findings Low turnover bone disease occurs more frequently after kidney transplantation according to bone biopsy studies. The risk of fracture is high, especially in the first several months after kidney transplantation. Alterations in minerals (calcium, phosphorus and magnesium) and biomarkers of bone metabolism (PTH, alkaline phosphatase, vitamin D and FGF-23) are observed with varying impact on post-transplant outcomes. Calcineurin inhibitors are linked to osteoporosis, whereas steroid therapy may lead to both osteoporosis and varying degrees of osteonecrosis. Sirolimus and everolimus might have a bearing on osteoblasts proliferation and differentiation or decreasing osteoclast mediated bone resorption. Selected pharmacologic interventions for treatment of MBD in transplant patients include steroid withdrawal, the use of bisphosphonates, vitamin D derivatives, calcimimetics, teriparatide, calcitonin and denosumab. Summary MBD following kidney transplantation is common and characterized by loss of bone volume and mineralization abnormalities often leading to low turnover bone disease. Although there are no well-established therapeutic approaches for management of MBD in renal transplant recipients, clinicians should continue individualizing therapy as needed.

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Serum bone alkaline phosphatase is superior to plasma levels of bone matrix proteins for assessment of bone metabolism in patients receiving renal transplants

Cited by 17 publications

References 11 publications

Alkaline phosphatase predicts calcium requirements after total parathyroidectomy in patients receiving dialysis

Alkaline phosphatase predicts calcium requirements after total parathyroidectomy in patients receiving dialysis

Early and Severe Hyperparathyroidism Associated with Hypercalcemia After Renal Transplant Treated with Cinacalcet

Management of mineral and bone disorder after kidney transplantation

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