Department of Nephrology, Galway University Hospital, H91 YR71 Galway, Ireland.
Department of Rheumatology, Galway University Hospital, H91 YR71 Galway, Ireland.
Int J Mol Sci. 2024 Feb 3;25(3):1859. doi: 10.3390/ijms25031859.
Kidney transplantation is the preferred gold standard modality of treatment for kidney failure. Bone disease after kidney transplantation is highly prevalent in patients living with a kidney transplant and is associated with high rates of hip fractures. Fractures are associated with increased healthcare costs, morbidity and mortality. Post-transplant bone disease (PTBD) includes renal osteodystrophy, osteoporosis, osteonecrosis and bone fractures. PTBD is complex as it encompasses pre-existing chronic kidney disease-mineral bone disease and compounding factors after transplantation, including the use of immunosuppression and the development of de novo bone disease. After transplantation, the persistence of secondary and tertiary hyperparathyroidism, renal osteodystrophy, relative vitamin D deficiency and high levels of fibroblast growth factor-23 contribute to post-transplant bone disease. Risk assessment includes identifying both general risk factors and kidney-specific risk factors. Diagnosis is complex as the gold standard bone biopsy with double-tetracycline labelling to diagnose the PTBD subtype is not always readily available. Therefore, alternative diagnostic tools may be used to aid its diagnosis. Both non-pharmacological and pharmacological therapy can be employed to treat PTBD. In this review, we will discuss pathophysiology, risk assessment, diagnosis and management strategies to manage PTBD after kidney transplantation.
肾移植是治疗肾衰竭的首选黄金标准治疗方法。移植肾后骨病在肾移植受者中非常普遍，并且与髋部骨折的高发生率相关。骨折与增加的医疗保健成本、发病率和死亡率相关。移植后骨病（PTBD）包括肾性骨营养不良、骨质疏松症、骨坏死和骨折。PTBD 很复杂，因为它包含了移植前存在的慢性肾脏病-矿物质骨病以及移植后发生的复杂因素，包括免疫抑制的使用和新发性骨病的发展。移植后，继发性和 tertiary 甲状旁腺功能亢进症、肾性骨营养不良、相对维生素 D 缺乏症和成纤维细胞生长因子-23 水平升高都会导致移植后骨病。风险评估包括确定一般风险因素和肾脏特异性风险因素。诊断很复杂，因为并非总是能够获得黄金标准的双四环素标记骨活检来诊断 PTBD 亚型。因此，可以使用替代诊断工具来帮助诊断。可以采用非药物和药物治疗来治疗肾移植后的 PTBD。在这篇综述中，我们将讨论移植肾后 PTBD 的发病机制、风险评估、诊断和管理策略。
