Korean Journal of Nephrology 1991;10(4):593-613.

신이식후 골대사지표의 변화

방동수 , 이태원 , 김정원 , 안재형 , 임천규 , 김명재 , 김영훈

Abstract

Renal osteodystrophy is a common and troublesome complication of chronic renal failure. Renal transplanta- tion may improve the renal osteodystrophy by abolish- ing the pathophysiologic effects of renal failure on mineral metabolism and bone. The immunosuppressive agents such as steroid, however, may induce the osteoporosis. So, the outcome of the renal transplanta- tion on the renal osteodystrophy is somewhat interest- ing. To evaluate the effects of the renal transplantation on renal osteodystrophy, bone minral denisty (BMD) and total bone calcium (TBC) were measured by dual energy X-ray absorptiometry and the changes of the biochemi- cal indices of bone metabolism were evaluated before and after renal transplantation in 12 renal allograft recipients who were immunosuppressed with the medicanion of low dose prednisolone, cyclosporin A, and azathioprine. The results were as follows; 1) After 12 months of renal transplantation, seven of twelve patients maintained good renal function (S-Cr< 1.5 mg/dl) and the rest showed mild renal insufficiency. The degree of the elevation of serum calcium and the reduction of serum parathyroid hormone were more marked in patients with good renal function compared to those with mild renal insufficiency. 2) The level of serum phosphorus was significantly reduced after one and twelve months of renal transplan- tation, and no patients showed hypophosphatemia. 3) The level of serum calcium was gradually in- creased after renal transplantation and the level of calcium at twelve months of renal transplantation was significantly higher than that at pretransplantation and that at one month after transplantation. Two patients showed mild hypercalcemia. 4) After twelve months of renal transplantation, the level of serum parathyroid hormone became normal in seven patients and the remainder showed mild hyperpar- athyoidism. In patients with normal PTH level, the level of serum creatinine was significantly lower and that of serum calcium was significantly higher than those in mild hyperparathyroidism. 5) Bone mineral density (BMD) increased by 0.9% and 0.6% after one and twelve months of renal trans- plantation respectively. The total bone calcium (TBC) increased by 0.5% and 0.8% after one and twelve months of renal transplantation respectively. However, this small increase of BMD and TBC was statistically insignificant. In conclusion, BMD and TBC slightly, not statistically significantly, increased with the improvement of renal function and the level of serum calcium, phosphorus and parathyroid hormone after twelve months in renal trans- planted patients on low dose steroid immunosuppressive regimens.