Title:
Change of bone lesion in hemodialysis patients with renal osteopathy after renal transplantation

Tadahiko Tokumoto¹ ;Tadahiko Tokumoto¹ ;Tadahiko Tokumoto¹ ;Tadahiko Tokumoto¹ ;Tadahiko Tokumoto² ;Tadahiko Tokumoto¹

Tokyo Women's Medical University' ne '' Tokyo Women's Medical University' ne ''

E-mail address corresponding author:
as4t-tkmt@asahi-net.or.jp

Background:
Bone lesion in hemodialysis (HD) patients with renal osteopathy is important as one of the serious complications of chronic renal failure (CRF). Conventionally, We expect if CRF is improved after renal transplantation (RTx), dialysis osteopathy is also recover to normal in bone lesion. Nevertheless, it is controversial whether bone lesion is really improved after RTx. In this study, we evaluated whether dialysis osteopathy was improved after RTx.

Methods:
Ten cases that underwent living related RTx at Toda central general hospital for one year from January, 2004 were enrolled in this study. Bone biopsy was also performed at Tx. Mean age was 38.9 years old, with 8 males and 2 females. The periods of HD were an average of 40.1 months. The immunosuppression was basically triple drug therapy such as FK, MMF and Steroid. The parameter of Ca, P, whole PTH (w-PTH) and metabolic bone marker and bone density (DXA) were examined with relation to dialysis osteopathy in before Tx, 1, 3, 6, 12 months. We measured the metabolic bone marker useing urinary deoxypyridinoline (DPD), urinary beta - crosslaps (CTX), alkaline phosphatase (ALP), bone-specific alkaline phosphatase (BAP), intact baton-osteocalcin (i-BGP), and type 1 procollagen -N- propeptide (P1NP). Bone density (DXA) was measured in before TX, 6, 12 months. In addition, bone biopsy was performed in RTx after having made osteal labeling twice in principle before bone biopsy.

Results:
All cases are survival and the renal grafts are functioning well in all cases. 7 cases (70%) were diagnosed as renal osteodystrophy, and 3 cases (30%) were diagnosed as aplastic osteopathy. by bone biopsy before RTx. The mean level of Ca and P were 9.6mg/ml and 6.2mg/dl, respectively. The mean level of w-PTH was 86.8, 59.0, 58.8, 59.2pg/ml in before RTx, 1, 3, 6 months, respectively. The mean level of ALP was 24.7, 51.7, 78.5, 100.4 U/l in before RTx, 1, 3, 6 months, respectively. The mean level of BAP was 222.6, 406.3, 496.6, 554 U/l in before RTx, 1, 3, 6 months, respectively. The mean level of i-BGP was 28.3, 10.6, 9.1, 16.7 ng/ml in before RTx, 1, 3, 6 months, respectively. The mean level of P1NP was 44.6, 164.5ng/ml in before RTx, 3 months, respectively. The mean level of DPD was 25.4, 45.1, 37.0, 47.3nmol/L in before RTx, 1, 3, 6 months, respectively. The mean level of CTX was 946, 3589, 3,222.9, 3123.6ug/L in before RTx, 1, 3, six months. The total density and %age match of DXA before RTx were an average of 374.4mg/ccm and 86.7%, respectively. However, The final data of total density and %age match of DXA after RTx decreased to average 362.8mg/ccm (289.2-482.9) and an average of 79.5% (65.6-95), respectively.

Conclusion:
Metabolic bone marker seemed to be improved, however, metabolic bone disease did not seemed to recover within one year after RTx. The further examination by metabolic bone marker and bone biopsy will be needed in future.

Subject:
Complications

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