engleski

MEetabolic bone disease in after renal transplantation in patients with Balkan endemic nephropathy

Metabolic bone disease is common in renal transplant recipients and frequently manifests with pain, fracture, osteonecrosis or avascular necrosis. These complications significantly impair quality of life and increase mortality and need for hospitalizations. In the present study we evaluated bone status of renal transplant recipients with Balkan endemic nephropathy (BEN). There were 10 female and 9 male patients with BEN age at transplantation ranging from 47 to 68 years (mean 57 years), previously treated with hemodialysis for 1-14 (mean 5.5) years. Bone pain was present in 12 patients, 3 patients developed nephrolithiasis, and one patient had bone fracture. Intact PTH ranged from 3.52 to 17.8 (mean 7.47) pmol/L, mean BALP was 32.6 mg/L, mean vitamin D concentration was 55.6 mg/L. Mean octeocalcin value was 12.78 mg/L, and crosslaps 1.31 mg/L. Parathyroidectomy after transplantation was performed in 2 patients because of severe hypercalcemia, while three patients received pamindronate. Renal transplant recipients with other primary renal diseases and the mean age of 54 years had mean BALP 45.78 mg/L, iPTH 6.38 pmol/L, vit D 65.7 mg/L, crosslaps 1.18 mg/L and osteocalcin 15.65 mg/L. On bone densitometry at 6 months after transplantation femoral T score was -2, 11 (range 0.97 – 2, 8), antecubital -3, 7 (range 0, 65 – 4, 5) and vertebral -2, 01 (range 0, 87 – 4, 3). No further significant bone loss was observed after the first year, and bone mineral density remained relatively stable but low. Our results demonstrate that patients with BEN suffer from significant bone loss after renal transplantation. High serum calcium, relatively low PTH and low BAlP suggest adynamic bone disease. However, low osteocalcin and increased crosslaps indicate increased bone resorption, which is higher then in renal transplant recipients with other primary renal diseases.

renal transplantation; metabolic bone disease; endemic nephropathy

DOI: 10.1111/j.1432-2277.2009.00958.x