Bone mineral density after renal transplantation in children

Feber, Janusz; Cochat, Pierre; Braillon, P.; Castelo, Fernanda; Martín, Xavier; Glastre, Catherine; Chapuis, François; David, L; Meunier, Pierre J.

doi:10.1016/s0022-3476(05)82001-3

Cited by 64 publications

(39 citation statements)

References 11 publications

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“…However, more recent data indicate that following successful transplantation, the initial increase in remodelling helps to correct the consequences of uremic vintage on the bone and after the second year following transplantation, bone mineral density (BMD) actually increases [11,25,26,27,28]. Accordingly, to evaluate the effect of time since transplantation, patients were divided into two groups: those with a follow-up of less than 24 months, and those with a follow up of 24 months or longer.…”

Section: Discussionmentioning

confidence: 99%

Bone Metabolism and Arterial Stiffness After Renal Transplantation

Cseprekál

Kis²,

Dégi³

et al. 2014

Kidney Blood Press Res

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Background/Aims: To assess the relationship between bone and vascular disease and its changes over time after renal transplantation. Metabolic bone disease (MBD) is common in chronic kidney disease (CKD) and is associated with cardiovascular (CV) disease. Following transplantation (Tx), improvement in CV disease has been reported; however, data regarding changes in bone disease remain controversial. Methods: Bone turnover and arterial stiffness (pulse wave velocity (PWV)) were assessed in 47 Tx patients (38 (3-191) months after Tx). Results: Bone alkaline phosphatase (BALP), osteocalcin (OC) and beta-crosslaps were significantly higher in Tx patients, and decreased significantly after one year. There was a negative correlation between BALP, OC and steroid administered (r=-0.35;r=-0.36 respectively). PWV increased in the Tx group (1.15 SD). In patients with a follow up of <24 months, PWV was correlated with BALP and beta-crosslaps (r=0.53; r=0.69 respectively) while in the ≥24 months group, PWV was correlated with cholesterol (r=0.38). Conclusions: Increased bone turnover and arterial stiffness are present following kidney transplantation. While bone turnover decreases with time, arterial stiffness correlates initially with bone turnover, after which the influence of cholesterol becomes significant. Non-invasive estimation of bone metabolism and arterial stiffness may help to assess CKD-MBD following renal transplantation.

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Section: Discussionmentioning

confidence: 99%

Bone Metabolism and Arterial Stiffness After Renal Transplantation

Cseprekál

Kis²,

Dégi³

et al. 2014

Kidney Blood Press Res

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“…Serum and urine biochemical parameters were determined prospectively during the first year following renal transplantation. Blood for determination of total calcium, creatinine, magnesium, phosphorus, alkaline phosphatase, and intact parathyroid hormone (PTH) concentrations was collected at the time of transplantation and at 1,2,4,6,8,12,16,24,36, and 52 weeks after. Serum 25-hydroxy-vitamin D (25OHD) and 1,25-dihydroxyvitamin D [1,25(OH) 2 D] concentrations were determined at 1, 2, 4, and 8 weeks after transplantation.…”

Section: Data Collectionmentioning

confidence: 99%

“…Secondary hyperparathyroidism (HPTH) is a common complication of chronic kidney disease (CKD) and causes significant morbidity in children [1], including osteitis fibrosa, osteopenia [2,3], and impaired growth leading to short stature as a young adult. Studies of quality of life after pediatric renal transplantation reveal that one third of patients that have had functioning grafts for more than 10 years were dissatisfied with their body appearance and were concerned about short stature and poor bone health [4].…”

Section: Introductionmentioning

confidence: 99%

“…In patients with advanced CKD prior to kidney transplantation, the key factors in the pathogenesis of HPTH include hypocalcemia, decreased serum concentrations of 1,25-dihydroxy-vitamin D [1,25(OH) 2 D], and hyperphosphatemia [6]. After successful kidney transplantation, these biochemical abnormalities are corrected, but HPTH persists in many patients.…”

Section: Introductionmentioning

confidence: 99%

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Persistent secondary hyperparathyroidism after renal transplantation in children

et al. 2005

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Secondary hyperparathyroidism (HPTH) is a frequent complication of chronic kidney disease (CKD). Renal transplantation corrects the biochemical abnormalities that cause HPTH; however, HPTH persists in some patients. The factors that contribute to the persistence of HPTH after transplantation in children are poorly understood. We examined 57 children who underwent renal transplantation and determined whether baseline clinical and biochemical parameters could predict the persistence of HPTH at 1 year post-transplantation, using multivariate logistic regression. At the time of transplantation, serum parathyroid hormone (PTH) levels were >300 pg/ml in 60%, 150-300 pg/ml in 17%, and <150 pg/ml in 23% of recipients. HPTH (PTH >73 pg/ml) persisted in 78% of patients at 6 months and in 56% at 1 year after transplant. Older age at transplantation was the strongest predictor of HPTH at 1 year (OR=1.17, P<0.05). After adjustment for age, other baseline clinical or laboratory parameters were not predictive of HPTH at 1 year. The relationship between older age and persistent HPTH may be explained by longer duration of CKD. Given the potential morbidities associated with persistent HPTH, the role of interventions that would prevent or reverse persistent HPTH post-transplantation requires further investigation.

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“…Feber et al found significant demineralization in 62% of children [40]. Moderate-to-severe osteopenia in children following transplantation has also been reported by other authors [19,41].…”

Section: Discussionmentioning

confidence: 54%

Complications of pediatric live-donor kidney transplantation: a single center’s experience in Egypt

2008

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Our objective was to study the complications of chronic renal failure (CRF) among pediatric live-donor kidney transplant recipients. Between March 1976 and December 2005, 1,785 live-donor kidney transplantations were carried out at our center. Of the recipients, 292 were 20 years old or younger (mean age 12.8 years, ranging from 4 years to 20 years). Clinical and laboratory parameters of these 292 patients were analyzed retrospectively. They were 182 boys and 110 girls. Patients who had received transplants before 1988 were treated with prednisolone and azathioprine as combined therapy. From 1988 to 1998, a triple regimen comprising prednisolone, azathioprine and cyclosporine A (CsA) was administered. Tacrolimus and mycophenolate mofetil (MMF) were introduced as primary therapy in 1998. Growth, anemia, infections, and surgical, cardiac, neurologic, bone and other medical complications were assessed. Triple-drug immunosuppression (prednisone + CsA + azathioprine) was used in 68.2% of transplants. Acute rejection rate was 47.6%; chronic rejection rate was 31%. Hypertension (62%) was the commonest complication. Anemia was diagnosed in 61%. A substantial proportion of patients (48%) were short, with height standard deviation scores (SDSs) of less than -1.88. The overall infection rate was high, and the majority (54%) was bacterial. Malignancy was diagnosed in eight (3%) patients. The incidence of urological complications was 14%, and that of vascular complications was 1%. Cardiac complications included left ventricular hypertrophy (LVH) in 47.9% of patients, left atrial enlargement (31.5%) and left ventricular dilatation and systolic dysfunction (13.7% for each). Neuropathic changes were found in 19% of our cases, with the distal muscles of lower limbs more affected. Other complications included avascular bone necrosis in 8% (all of them in the hip joint) and bone loss in 60% of patients. We concluded that, despite the long-term success of pediatric renal transplantation in a developing country, there is a risk of significant morbidity.

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Bone mineral density after renal transplantation in children

Cited by 64 publications

References 11 publications

Bone Metabolism and Arterial Stiffness After Renal Transplantation

Bone Metabolism and Arterial Stiffness After Renal Transplantation

Persistent secondary hyperparathyroidism after renal transplantation in children

Complications of pediatric live-donor kidney transplantation: a single center’s experience in Egypt

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