Kawarazaki Hiroo, Shibagaki Yugo, Kido Ryo, Nakajima Ichiro, Fuchinoue Shohei, Ando Katsuyuki, Fujita Toshiro, Fukagawa Masafumi, Teraoka Satoshi, Fukumoto Seiji
Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki City, Japan.
Clin Nephrol. 2012 Jul;78(1):10-6. doi: 10.5414/cn107348.
While kidney transplantation (KTx) reverses many disorders associated with end-stage renal disease (ESRD), patients who have received KTx often have chronic kidney disease and bone and mineral disorder (CKD-MBD). However, it is unknown how bone metabolism changes by KTx.
Living donor-KTx recipients (n = 34) at Tokyo Women's Medical University were prospectively recruited and the levels of bone-specific alkaline phosphatase (BAP) and serum cross-linked N-telopeptides of Type 1 collagen (NTX) were measured before, 6 and 12 months after transplantation.
Before KTx, serum BAP was within the reference range in more than half of patients while NTX was high in most patients. Serum NTX was higher in patients with longer dialysis durations compared to that with shorter durations before KTx. However, there was no difference in serum BAP between these patients. After KTx, BAP increased while NTX decreased along with the decline of PTH. In addition, the numbers of patients who showed high BAP and NTX were comparable after KTx.
These results suggest that bone formation is suppressed and uncoupled with bone resorption in patients with ESRD and this uncoupling is restored by KTx. Further studies are necessary to clarify the mechanism of bone uncoupling in patients with ESRD.
虽然肾移植（KTx）可逆转许多与终末期肾病（ESRD）相关的病症，但接受KTx的患者常患有慢性肾脏病和骨与矿物质紊乱（CKD-MBD）。然而，尚不清楚KTx如何改变骨代谢。
前瞻性招募了东京女子医科大学的活体供肾KTx受者（n = 34），并在移植前、移植后6个月和12个月测量了骨特异性碱性磷酸酶（BAP）和血清I型胶原交联N-端肽（NTX）水平。
在KTx前，超过半数患者的血清BAP在参考范围内，而大多数患者的NTX较高。与KTx前透析时间较短的患者相比，透析时间较长的患者血清NTX更高。然而，这些患者之间的血清BAP无差异。KTx后，随着甲状旁腺激素（PTH）下降，BAP升高而NTX降低。此外，KTx后BAP和NTX升高的患者数量相当。
这些结果表明，ESRD患者的骨形成受到抑制且与骨吸收解偶联，而KTx可恢复这种解偶联。有必要进一步研究以阐明ESRD患者骨解偶联的机制。
