Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, UK Medical Center, 800 Rose Street, Lexington, KY 40508, USA.
Nat Rev Nephrol. 2010 Jan;6(1):32-40. doi: 10.1038/nrneph.2009.192. Epub 2009 Nov 17.
In light of greatly improved long-term patient and graft survival after renal transplantation, improving other clinical outcomes such as risk of fracture and cardiovascular disease is of paramount importance. After renal transplantation, a large percentage of patients lose bone. This loss of bone results from a combination of factors that include pre-existing renal osteodystrophy, immunosuppressive therapy, and the effects of chronically reduced renal function after transplantation. In addition to low bone volume, histological abnormalities include decreased bone turnover and defective mineralization. Low bone volume and low bone turnover were recently shown to be associated with cardiovascular calcifications, highlighting specific challenges for medical therapy and the need to prevent low bone turnover in the pretransplant patient. This Review discusses changes in bone histology and mineral metabolism that are associated with renal transplantation and the effects of these changes on clinical outcomes such as fractures and cardiovascular calcifications. Therapeutic modalities are evaluated based on our understanding of bone histology.
鉴于肾移植后患者和移植物的长期生存率有了显著提高，改善骨折和心血管疾病等其他临床结局变得至关重要。肾移植后，很大一部分患者会出现骨质流失。这种骨质流失是多种因素共同作用的结果，包括原有肾性骨营养不良、免疫抑制治疗以及移植后慢性肾功能减退的影响。除了骨量减少，组织学异常还包括骨转换减少和矿化缺陷。最近的研究表明，低骨量和低骨转换与心血管钙化有关，这突出了医学治疗的具体挑战，以及需要在移植前预防低骨转换。这篇综述讨论了与肾移植相关的骨组织学和矿物质代谢变化，以及这些变化对骨折和心血管钙化等临床结局的影响。根据我们对骨组织学的理解，对治疗方式进行了评估。
