The Decreased Incidence of Aseptic Necrosis in Renal Transplant Recipients—a Case Control Study

Ps, Parfrey; Farge, Dominique; Na, Parfrey; Ja, Hanley; Rd, Guttman

doi:10.1097/00007890-198602000-00010

Cited by 43 publications

(15 citation statements)

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“…In our group aseptic necrosis occurred only in patients who had received a transplant before the time when cyclosporine was used and when higher doses of steroids had to be administered. It appears from these data that the bone necrosis was due to the steroid effect on bone rather than to hyperparathyroidism, as has been suggested by other studies [23][24][25].…”

Section: Discussionsupporting

confidence: 77%

Continuing loss of vertebral mineral density in renal transplant recipients

et al. 1994

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This cross-sectional study examined bone abnormalities by digital radiography, bone densitometry and biochemical tests in 44 clinically asymptomatic renal transplant recipients 6-195 months after renal transplantation. Abnormal radiographs were obtained in 40 of the 44 patients. Dual-energy X-ray absorptiometry (DXA) performed at the lumbar spine (L2-L4)/showed a negative Z score in all patients, ranging from -1 to -1.9 in 28 patients and less than -2.0 in 16 patients. The severity of osteopenia increased with the length of time after transplantation and there was a significant correlation with parathyroid hormone values in patients with normal and low glomerular filtration rates. Our data suggest that decreased bone density values (Z score less than -2) are present in about one-third of patients with renal transplants. Bone loss appears to continue after transplantation. Steroid therapy and immunotherapy are probably the cause of this bone loss. Bone mineral measurements alone are helpful in identifying asymptomatic patients with low bone mass after transplantation.

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Section: Discussionsupporting

confidence: 77%

Continuing loss of vertebral mineral density in renal transplant recipients

et al. 1994

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“…Morbidity associated with persisting HPT after transplantation includes worsening of osteoporosis, development of renal calculi 42 and possibly soft tissue calcification. Although avascular necrosis is seen after renal transplantation, a case–control study by Parfrey and co‐workers 43 did not demonstrate an association between pre‐ or post‐transplant HPT and avascular necrosis.…”

Section: Physiologymentioning

confidence: 95%

Pathogenesis and management of hyperparathyroidism in end‐stage renal disease and after renal transplantation

Elder

2001

Nephrology

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SUMMARY: Secondary hyperparathyroidism is an adaptive response to progressive loss of renal function so as to maintain calcium and phosphate homeostasis, 1,25‐dihydroxyvitamin D3 levels and normal bone turnover, despite skeletal resistance to parathyroid hormone. As feedback regulation fails, complications of parathyroid overactivity develop, and by the commencement of dialysis abnormal bone histology is present in almost all patients, with hyperparathyroid changes most commonly found. Post transplantation, persisting hyperparathyroidism predisposes to osteoporosis. The risk of bone disease is reduced by early, carefully targeted dietary measures and suppressive therapy with calcitriol and calcium‐based phosphate binders, while newer therapies include bisphosphonates and calcimimetics. Timely surgical intervention is necessary in some patients.

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“…In reported series, the interval between transplantation and the onset of symptoms of femoral head AVN, such as hip pain, varies between 5 and 126 months, with a mean of 9-19 months [3,[21][22][23][24]. In our study, only eight of the 23 hips (35%) with femoral head AVN were asymptomatic at the time of diagnosis.…”

Section: Discussionmentioning

confidence: 55%

Incidence and radio-uptake patterns of femoral head avascular osteonecrosis at 1 year after renal transplantation: a prospective study with planar bone scintigraphy

Lee

Lee²,

Huh³

et al. 2006

Nuclear Medicine Communications

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a Objectives We prospectively investigated the incidence of femoral head avascular osteonecrosis (AVN) and radio-uptake patterns of femoral heads on bone scintigraphy at 1 year after renal transplantation.Methods A total of 237 subjects (473 femoral heads) were included. A bone scintigraphy was performed at 12 ± 1.1 months after renal transplantation, and 17 hips were painful at the time of bone scintigraphy. We graded the radioactivity in each femoral head as normal (grade 0), mildly increased (grade I), and definitely increased (grade II). Typical photon defects in the upper lateral femoral heads were evaluated separately. AVN was confirmed with clinical follow-up of more than 1 year and MRI and/or plain radiography findings.Results Femoral head AVN was detected in 15 of the 237 patients and 23 of the 473 femoral heads. When grade I and II activities were used as positive criteria, bone scintigraphy had a sensitivity of 91.3% (100% with pain) and specificity of 74.0% (100% with pain) for AVN diagnosis. When only grade II activity was considered positive, the rates were 56.5% (80.0% with pain) and 99.5% (100% with pain), respectively. The presence of a typical photon defect had a low sensitivity of 47.8%, although the specificity was high (99.1%).Conclusions The incidence of femoral head AVN was low among a prospective cohort of renal transplantation recipients at the time of 1 year after engraftment. Planar bone scintigraphy is sufficient to diagnose AVN in symptomatic patients at risk for femoral head AVN using grade I and II activities as positive criteria. Nucl Med

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The Decreased Incidence of Aseptic Necrosis in Renal Transplant Recipients—a Case Control Study

Cited by 43 publications

References 0 publications

Continuing loss of vertebral mineral density in renal transplant recipients

Continuing loss of vertebral mineral density in renal transplant recipients

Pathogenesis and management of hyperparathyroidism in end‐stage renal disease and after renal transplantation

Incidence and radio-uptake patterns of femoral head avascular osteonecrosis at 1 year after renal transplantation: a prospective study with planar bone scintigraphy

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