Flury W, Haldimann B
Schweiz Med Wochenschr. 1981 Jan 3;111(1):21-8.
53 patients were followed up for an average of 3 years after renal transplantation for evaluation of disturbances in calcium-phosphorus metabolism and skeletal diseases. Postoperative hypercalcemia and hypophosphatemia can be related to persistence of hyperparathyroidism when kidney function is restored. Hypercalcemia was observed in 43% of the patients and lasted less than one year in 80% of cases. Transient hypophosphatemia was present in 15%. These abnormalities did not cause clinical symptoms or deterioration of renal function. However, the skeletal diseases are more impressive and in the first place osteopenia. Bone densitometry revealed decreased bone mineral content in two thirds of the females and one fifth of the males. In females the bone density decreased 3.3% during an average observation period of 7 months, but remained constant in males. Renal osteodystrophy is the main cause of the initial osteopenia. The absence of remineralization or the progression of bone losses is related to the initial persistence of hyperparathyroidism and to corticosteroid treatment. According, 12.5% of the patients presented pathological fractures (spine, hip). In 3 patients (5.7%) with reduced transplant function, osteomalacia without hypophosphatemia was observed. 4 patients (7.5%) had osteonecrosis of the femoral head. There was little progression and surgery was not necessary.
53例患者肾移植后平均随访3年，以评估钙磷代谢紊乱和骨骼疾病。肾功能恢复时，术后高钙血症和低磷血症可能与甲状旁腺功能亢进持续存在有关。43%的患者出现高钙血症，80%的病例持续时间不到一年。15%的患者出现短暂性低磷血症。这些异常未引起临床症状或肾功能恶化。然而，骨骼疾病更为明显，首先是骨质减少。骨密度测定显示，三分之二的女性和五分之一的男性骨矿物质含量降低。女性在平均7个月的观察期内骨密度下降了3.3%，而男性则保持不变。肾性骨营养不良是最初骨质减少的主要原因。骨矿化未恢复或骨质流失进展与甲状旁腺功能亢进的最初持续存在以及皮质类固醇治疗有关。因此，12.5%的患者出现病理性骨折（脊柱、髋部）。3例（5.7%）移植功能减退的患者观察到无低磷血症的骨软化症。4例（7.5%）有股骨头坏死。进展很少，无需手术。
