Articular complications of homotransplantation and chronic renal hemodialysis.

Renal homotransplantaion and chronic hemodialysis are accepted methods of treating end-stage kidney disease. However, these procedures are fraught with complications involving bones, joints, and soft tissues. Transplantation and immunosuppressive therapy problems include "connective tissue-like" reactions, infections in joints and avascular necrosis of bone. Long term hemodialysis may accentuate secondary hyperparathyroidism, renal osteodystrophy, and metastatic calcification, which can be minimized by phosphorous control or calcium loading in the dialysate. In the presence of osteomalacia, vitamin D may be helpful and parathyroidectomy is indicated if autonomy is present. In one patient undergoing long term hemodialysis, a chalky material was aspirated from the olecranon bursa. Two inorganic solid phases were identified as being present - a major phase, octacalcium phosphate (ocp) and a minor phase, calcite (CaCO3). Because of its elusive properties, the role of OCP in biological systems is poorly known and can easily escape detection. Methods of identification of OCP and its potential role in crystal deposition syndromes are discussed.