Management of mineral and bone disorder after kidney transplantation.
Management of mineral and bone disorder after kidney transplantation.
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DOI：
10.1097/mnh.0b013e3283546ee0
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发表时间：
2012-07
影响因子：
3.2
通讯作者：
Bunnapradist S
中科院分区：
文献类型：
--
作者：
Kalantar-Zadeh K;Molnar MZ;Kovesdy CP;Mucsi I;Bunnapradist S
矿物质和骨疾病（MBD），中度和晚期慢性肾脏病（CKD）的固有并发症，经常发生在肾移植受者。然而，在临床上应用诊断工具和预防或治疗策略来纠正移植患者的骨丢失或矿物质紊乱方面存在许多困惑。我们已经审查了最近的证据，在肾移植受者的MBD的患病率和后果，并检查诊断，预防和治疗方案，以达到这一目的。根据骨活检研究，肾移植后低转换性骨病发生率更高。骨折的风险很高，特别是在肾移植后的头几个月。观察到矿物质（钙，磷和镁）和骨代谢生物标志物（PTH，碱性磷酸酶，维生素D和FGF-23）的变化对移植后结果有不同的影响。钙调磷酸酶抑制剂与骨质疏松症有关，而类固醇治疗可能导致骨质疏松症和不同程度的骨坏死。西罗莫司和依维莫司可能与成骨细胞增殖和分化或减少破骨细胞介导的骨吸收有关。用于治疗移植患者MBD的选定药理学干预包括停用类固醇、使用双膦酸盐、维生素D衍生物、拟钙剂、特立帕肽、降钙素和地舒单抗。肾移植后的MBD是常见的，其特征是骨量丢失和矿化异常，通常导致低转换性骨病。虽然目前还没有成熟的治疗方法来治疗肾移植受者的MBD，但临床医生应根据需要继续进行个体化治疗。
Mineral and bone disorders (MBD), inherent complications of moderate and advanced chronic kidney disease (CKD), occur frequently in kidney transplant recipients. However, much confusion exists about clinical application of diagnostic tools and preventive or treatment strategies to correct bone loss or mineral disarrays in transplanted patients. We have reviewed the recent evidence about prevalence and consequences of MBD in kidney transplant recipients and examined diagnostic, preventive and therapeutic options to this end. Low turnover bone disease occurs more frequently after kidney transplantation according to bone biopsy studies. The risk of fracture is high, especially in the first several months after kidney transplantation. Alterations in minerals (calcium, phosphorus and magnesium) and biomarkers of bone metabolism (PTH, alkaline phosphatase, vitamin D and FGF-23) are observed with varying impact on post-transplant outcomes. Calcineurin inhibitors are linked to osteoporosis, whereas steroid therapy may lead to both osteoporosis and varying degrees of osteonecrosis. Sirolimus and everolimus might have a bearing on osteoblasts proliferation and differentiation or decreasing osteoclast mediated bone resorption. Selected pharmacologic interventions for treatment of MBD in transplant patients include steroid withdrawal, the use of bisphosphonates, vitamin D derivatives, calcimimetics, teriparatide, calcitonin and denosumab. MBD following kidney transplantation is common and characterized by loss of bone volume and mineralization abnormalities often leading to low turnover bone disease. Although there are no well-established therapeutic approaches for management of MBD in renal transplant recipients, clinicians should continue individualizing therapy as needed.