Management of mineral and bone disorder after kidney transplantation

Kamyar Kalantar-Zadeh, Miklos Z. Molnar, Csaba Kovesdy, Istvan Mucsi, Suphamai Bunnapradist

Research output: Contribution to journalReview article

31 Citations (Scopus)

Abstract

Purpose of review: Mineral and bone disorders (MBDs), inherent complications of moderate and advanced chronic kidney disease, occur frequently in kidney transplant recipients. However, much confusion exists about the 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. Recent findings: 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 (parathyroid hormone, alkaline phosphatase, vitamin D and FGF-23) are observed with varying impact on posttransplant 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 osteoblast proliferation and differentiation or decreasing osteoclast-mediated bone resorption. Selected pharmacologic interventions for the treatment of MBD in transplant patients include steroid withdrawal, and the use of bisphosphonates, vitamin D derivatives, calcimimetics, teriparatide, calcitonin and denosumab. Summary: 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.

Original languageEnglish (US)
Pages (from-to)389-403
Number of pages15
JournalCurrent opinion in nephrology and hypertension
Volume21
Issue number4
DOIs
StatePublished - Jul 1 2012

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Kidney Transplantation
Minerals
Bone and Bones
Bone Diseases
Kidney
Vitamin D
Osteoporosis
Therapeutics
Steroids
Teriparatide
Physiologic Calcification
Osteonecrosis
Diphosphonates
Calcitonin
Osteoclasts
Sirolimus
Bone Resorption
Parathyroid Hormone
Osteoblasts
Chronic Renal Insufficiency

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Nephrology

Cite this

Management of mineral and bone disorder after kidney transplantation. / Kalantar-Zadeh, Kamyar; Molnar, Miklos Z.; Kovesdy, Csaba; Mucsi, Istvan; Bunnapradist, Suphamai.

In: Current opinion in nephrology and hypertension, Vol. 21, No. 4, 01.07.2012, p. 389-403.

Research output: Contribution to journalReview article

Kalantar-Zadeh, Kamyar ; Molnar, Miklos Z. ; Kovesdy, Csaba ; Mucsi, Istvan ; Bunnapradist, Suphamai. / Management of mineral and bone disorder after kidney transplantation. In: Current opinion in nephrology and hypertension. 2012 ; Vol. 21, No. 4. pp. 389-403.
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