Department of Renal Medicine, Westmead Hospital, Sydney, Australia.
Skeletal Biology Program, Garvan Institute of Medical Research, Sydney, Australia.
Transplantation. 2023 Oct 1;107(10):2107-2119. doi: 10.1097/TP.0000000000004538. Epub 2023 Feb 15.
Most patients with end-stage kidney disease undergoing kidney transplantation are affected by the chronic kidney disease-mineral and bone disorder. This entity encompasses laboratory abnormalities, calcification of soft tissues, and the bone abnormalities of renal osteodystrophy that together result in an increased risk of fracture, cardiovascular events, and mortality. Although many biochemical disturbances associated with end-stage kidney disease improve in the first year after transplantation, hyperparathyroidism commonly persists, and residual changes of renal osteodystrophy are slow to resolve. When superimposed on common, traditional risk factors, post-transplant glucocorticoid treatment, the possibility of tubular disturbances and post-transplant chronic kidney disease, rates of incident fracture remain high. This review examines hormonal and biochemical changes before and after kidney transplantation, fracture risk assessment tools and imaging modalities, a staged approach to management and concerns associated with antiresorptive and anabolic therapies. A multidisciplinary approach is proposed as the best means to improve patient-level outcomes.
大多数接受肾移植的终末期肾病患者都受到慢性肾脏病-矿物质和骨异常的影响。该实体包括实验室异常、软组织钙化和肾性骨营养不良的骨异常，这些共同导致骨折、心血管事件和死亡率增加。尽管许多与终末期肾病相关的生化紊乱在移植后第一年得到改善，但甲状旁腺功能亢进症通常持续存在，肾性骨营养不良的残留变化缓慢解决。当叠加常见的传统危险因素、移植后糖皮质激素治疗、管状紊乱和移植后慢性肾脏病的可能性时，骨折发生率仍然很高。这篇综述检查了肾移植前后的激素和生化变化、骨折风险评估工具和成像方式、分阶段管理方法以及与抗吸收和合成代谢治疗相关的问题。提出了多学科方法作为改善患者水平结局的最佳手段。
