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Evolution of bone disease after kidney transplantation: A prospective histomorphometric analysis of trabecular and cortical bone
Author(s) -
Carvalho Catarina,
Magalhães Juliana,
Pereira Luciano,
SimõesSilva Liliana,
CastroFerreira Inês,
Frazão João Miguel
Publication year - 2016
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/nep.12570
Subject(s) - medicine , biopsy , cortical bone , transplantation , bone biopsy , bone remodeling , urology , bone disease , kidney disease , bone histomorphometry , bone mineral , osteoblast , trabecular bone , pathology , surgery , osteoporosis , chemistry , biochemistry , in vitro
Aim Post‐transplant bone disease results from multiple factors, including previous bone and mineral metabolism disturbances and effects from transplant‐related medications. Bone biopsy remains the gold‐standard diagnostic tool. Methods We aimed to prospectively evaluate trabecular and cortical bone by histomorphometry after kidney transplantation. Seven patients, willing to perform follow‐up bone biopsy, were included in the study. Dual‐ X ‐ray absorptiometry and trans‐iliac bone biopsy were performed within the first 2 months after renal transplantation and repeated after 2–5 years of follow‐up. Results Follow‐up biopsy revealed a significant decrease in osteoblast surface/bone surface (0.91 ± 0.81 to 0.47 ± 0.12%, P = 0.036), osteoblasts number/bone surface (0.45 (0.23, 0.94) to 0.00/mm 2 , P = 0.018) and erosion surface/bone surface (3.75 ± 2.02 to 2.22 ± 1.38%, P = 0.044). A decrease in trabecular number (3.55 (1.81, 2.89) to 1.55/mm (1.24, 2.06), P = 0.018) and increase in trabecular separation (351.65 ± 135.04 to 541.79 ± 151.91 μm, P = 0.024) in follow‐up biopsy suggest loss in bone quantity. We found no significant differences in cortical analysis, except a reduction in external cortical osteonal eroded surface (5.76 (2.94, 13.97) to 3.29% (0.00, 6.67), P = 0.043). Correlations between bone histomorphometric and dual‐ X ‐ray absorptiometry parameters gave inconsistent results. Conclusions The results show a reduction in bone activity, suggesting increased risk of adynamic bone and loss of bone volume. Cortical bone seems less affected by post‐transplant biological changes in the first years after kidney transplantation.