Osteoscintigraphic Changes in Kidney-Transplanted Patients

Abstract

Technetium-99m-polyphosphate bone scintigraphy was performed in 105 kidney-transplanted patients. The pathological scintigraphic changes were classified as either (1) generalized, symmetrical or (2) focal accumulations of the tracer in the bones. 40 of the patients had normal scintigrams. 18 patients had generalized symmetrical scintigraphic changes alone, while focal scintigraphic changes were found in 14 patients without generalized changes and 33 patients had generalized as well as focal changes. The severity of the scintigraphic findings correlated to the results of the transplantation, i.e. the total dose of prednisone, the number of rejection episodes and the creatinine clearance at the time of scintigraphy. Compared to patients on hemodialysis a less frequent appearance of generalized scintigraphic changes was found in kidney-transplanted patients, suggesting that the frequency of renal osteodystrophy decreases after a successful transplantation. The more frequent appearance of focal changes after a kidney transplantation suggests that a bone disease of a different etiology now is superimposed. As both types of scintigraphic changes showed highly significant correlations to the total dose of prednisone, it is concluded that glucocorticoid treatment is an important etiological factor in the development of focal bone lesions and may contribute to the maintenance of generalized skeletal lesions after a kidney transplantation.

Necrosis of the femoral head after renal transplantation

“…The present investigation indicates that pulsed high postoperative steroids are major risk factors in the development of necrosis of the femoral head following renal transplantation (Heerfordt et al 1978, Stem and Watts 1979, Moms et al 1982, Haajanen et al 1985.…”

Osteonecrosis in Renal Transplant Recipients:Early Radiological Detection and Course

“…An early sign in the present investigation is a lucent subcortical area (the crescent sign) (Griffiths et al 1974), presenting as a fracture line in the immediate subchondral bone, parallel to the articular surface. Heerfordt et al (Heerfordt et al 1978) demonstrated generalized and/or focal scintigraphic changes in renal transplant patients, 15 femoral heads showing an increased uptake. In 12 of the cases radiographic osteonecrosis was evident at the time of scintigraphy, but in the remaining 3 cases the scintigraphic signs of osteonecrosis preceded the radiographic appearance by a few months.…”

Metabolism of Prednisone in Kidney Transplanted Patients with Necrosis of the Femoral Head

“…Only a few of these patients developed osteonecrosis later than 4 years after transplantation. Although some studies have shown a relationship between prednisone and the development of posttransplant osteonecrosis (Elmstedt 1982;Harrington et al 1971;Heerfordt et al 1978;Ibels et al 1978), no definite correlation between the cumulated dose of prednisone and the risk of developing osteonecrosis has been found in others (Bewick et a/. 1976;Farge et al 1985;Feletti et al 1984;Haajanen et al 1985;Lausten et al 1989;Stern &Watts 1979).…”

“…1976;Elmstedt 1981;Haajanen eta/. 1985; Harrington e t a / . Heerfordt et al 1978;Ibels et a/. 1978).…”