Immunosuppressive Agents and Bone Disease in Renal Transplant Patients With Hypercalcemia

Sessa, A.; Esposito, A.; Iavicoli, G.; Lettieri, E.; Dente, G.; Costa, Cristina; Bergallo, Massimiliano; Rossano, R.; Capuano, M.

doi:10.1016/j.transproceed.2010.03.069

Cited by 14 publications

(12 citation statements)

References 46 publications

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“…In patients with CKD G5D, both hypocalcemia and hypercalcemia are associated with mortality [ 28 , 29 ]. In patients after KT, hypercalcemia is common due to persistence of preexistent hyperparathyroidism, hypophosphatemia, postintervention immobilization, or progressive normalization of calcitriol level [ 30 ].…”

Section: Characteristics Of Chronic Kidney Disease-mineral and Bonmentioning

confidence: 99%

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Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review

Hsu

Chen

2020

IJMS

103

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Chronic kidney disease (CKD) is associated with the development of mineral bone disorder (MBD), osteoporosis, and fragility fractures. Among CKD patients, adynamic bone disease or low bone turnover is the most common type of renal osteodystrophy. The consequences of CKD-MBD include increased fracture risk, greater morbidity, and mortality. Thus, the goal is to prevent the occurrences of fractures by means of alleviating CKD-induced MBD and treating subsequent osteoporosis. Changes in mineral and humoral metabolism as well as bone structure develop early in the course of CKD. CKD-MBD includes abnormalities of calcium, phosphorus, PTH, and/or vitamin D; abnormalities in bone turnover, mineralization, volume, linear growth, or strength; and/or vascular or other soft tissue calcification. In patients with CKD-MBD, using either DXA or FRAX to screen fracture risk should be considered. Biomarkers such as bALP and iPTH may assist to assess bone turnover. Before initiating an antiresorptive or anabolic agent to treat osteoporosis in CKD patients, lifestyle modifications, such as exercise, calcium, and vitamin D supplementation, smoking cessation, and avoidance of excessive alcohol intake are important. Managing hyperphosphatemia and SHPT are also crucial. Understanding the complex pathogenesis of CKD-MBD is crucial in improving one’s short- and long-term outcomes. Treatment strategies for CKD-associated osteoporosis should be patient-centered to determine the type of renal osteodystrophy. This review focuses on the mechanism, evaluation and management of patients with CKD-MBD. However, further studies are needed to explore more details regarding the underlying pathophysiology and to assess the safety and efficacy of agents for treating CKD-MBD.

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Section: Characteristics Of Chronic Kidney Disease-mineral and Bonmentioning

confidence: 99%

“…In patients after KT, hypercalcemia is common due to persistence of preexistent hyperparathyroidism, hypophosphatemia, postintervention immobilization, or progressive normalization of calcitriol level [30].…”

Section: Characteristics Of Chronic Kidney Disease-mineral and Bone Disorder (Ckd-mbd)mentioning

confidence: 99%

Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review

Hsu

Chen

2020

IJMS

103

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“…Posttransplant renal osteopathy is a clinical posttransplant complication associated with morbidity and mortality due to the increased frequency of bone fractures compared with general population [128]. Osteopenia, osteoporosis, and osteonecrosis represent the most common complications related to renal transplant [129].…”

Section: Bone Diseasesmentioning

confidence: 99%

Systemic and Nonrenal Adverse Effects Occurring in Renal Transplant Patients Treated with mTOR Inhibitors

Zaza

Tomei

Ria

et al. 2013

Clinical and Developmental Immunology

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The mammalian target of rapamycin inhibitors (mTOR-I), sirolimus and everolimus, are immunosuppressive drugs largely used in renal transplantation. The main mechanism of action of these drugs is the inhibition of the mammalian target of rapamycin (mTOR), a regulatory protein kinase involved in lymphocyte proliferation. Additionally, the inhibition of the crosstalk among mTORC1, mTORC2, and PI3K confers the antineoplastic activities of these drugs. Because of their specific pharmacological characteristics and their relative lack of nephrotoxicity, these inhibitors are valid option to calcineurine inhibitors (CNIs) for maintenance immunosuppression in renal transplant recipients with chronic allograft nephropathy. However, as other immunosuppressive drugs, mTOR-I may induce the development of several adverse effects that need to be early recognized and treated to avoid severe illness in renal transplant patients. In particular, mTOR-I may induce systemic nonnephrological side effects including pulmonary toxicity, hematological disorders, dysmetabolism, lymphedema, stomatitis, cutaneous adverse effects, and fertility/gonadic toxicity. Although most of the adverse effects are dose related, it is extremely important for clinicians to early recognize them in order to reduce dosage or discontinue mTOR-I treatment avoiding the onset and development of severe clinical complications.

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“…Study of Raghu Nadhanan et al found that low dose of methotrexate can increase the risk of osteopenia [30]. But, other immunosuppressants such as Azathioprin, Chloroquine, Cyclophosphamide and Mycophenolat mofetil have no interference in bone mass density [31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Homocysteine, Folic Acid, Vitamin B6, Vitamin B12, and Biochemical Parameters of Bone Metabolism in Female Patients with Systemic Lupus Erythematosus

Handono¹

2014

J Clin Cell Immunol

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Objectives: Premature osteoporosis is one of the long term complications of Systemic Lupus Erythematosus (SLE). Recent studies showed that increased level of homocysteine was detected in SLE patients and it was associated with deterioration of bone health. The aim of this study was to determine the association between homocysteine and biochemical parameters of bone metabolism in SLE patients. Subjects and methods: Thirty-nine female patients who fulfilled American College of Rheumatology 1997 criteria for SLE under 50 years old and twelve healthy female as control group were studied. Various laboratory parameters including serum homocysteine, folic acid, vitamin B6, vitamin B12, bCTx, osteocalcin, MDA, and RANKL were measured. Results: This study found that significantly higher levels of homocysteine were found in SLE patients (p=0.010). There was also a significantly higher level of MDA and RANKL in SLE patient (p=0.042, p=0.030). Whereas, the folic acid, vitamin B6, vitamin B12, bCTX, and osteocalcin levels were not statistically different between SLE patients and control group. High homocysteine level was significantly associated with increased levels of bCTx (p=0.000, r=0.943), MDA (p=0.002, r=0.731), and RANKL (p=0.000, r=0.758). High level of homocysteine associated with decreased levels of osteocalcin (p=0.000, r=-0.771), folic acid (p=0.000, r=-0.734), vitamin B6 (p=0.046, r=-0.332). But an insignificant relationship was found between serum homocysteine and vitamin B12 (p=0.080, r=-0.284). Conclusion: Bone diminution in SLE seems to be attributable by homocysteine that influence bone formation and bone resorption process.

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Immunosuppressive Agents and Bone Disease in Renal Transplant Patients With Hypercalcemia

Cited by 14 publications

References 46 publications

Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review

Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review

Systemic and Nonrenal Adverse Effects Occurring in Renal Transplant Patients Treated with mTOR Inhibitors

Homocysteine, Folic Acid, Vitamin B6, Vitamin B12, and Biochemical Parameters of Bone Metabolism in Female Patients with Systemic Lupus Erythematosus

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