Reversal of adynamic bone disease after successful renal transplantation.
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:547A 1997
Sixteen patients with adynamic bone disease were evaluated histomorphometrically at time of transplantation and 1 year following successful transplantation. Improvement of the adynamic lesion was observed in 8 of the 16 patients, whereas PTH decreased in all the patients. Aluminum, which was present in 8 at the time of transplantation, was absent after 1 year. The authors conclude that elevated PTH levels are not required to repair adynamic bone disease following successful transplantation.
Comment: Post transplantation bone disease and adynamic bone disease are an increasing problem in the management of ESRD. The most common cause of adynamic bone disease is aluminum toxicity, however, in the absence of aluminum, adynamic bone disease is thought to result from a relative deficiency of parathyroid hormone. It has been suggested that patients with adynamic bone disease have increased incidence of fractures following transplantation. It was not stated as to how many of the 8 patients who normalized their bone histology, initially had aluminum bone disease. The conclusion that successful transplantation corrects the adynamic bone lesion independent of parathyroid hormone and aluminum is not totally supported by the data. An alternative explanation may be that the correction of bone histology was due to the removal of aluminum following transplantation. (Stuart Sprague, D.O., Northwestern University, Chicago, IL)
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ASN 30th Annual Meeting, San Antonio
Transplant : Transplantation
CRF by problem area : Bone disease/aluminum