[Disorders of bone metabolism after renal transplantation]

Kidney transplantation restores renal function (glomerular filtration and production of vitamin D), thereby improving renal bone disease observed during the dialysis period. But the degree of improvement is often incomplete. Some of bone disorders related to pre-transplant renal osteodystrophy can persist after transplantation. Furthermore, immunosuppressive drug regimens effect bone remodeling in kidney transplant recipients. Post-transplant bone and mineral disorders can be classified, according to their pathogenesis and appearance time, into two groups of entities: (i) bone disorders related to pre-transplant renal osteodystrophy that persist after renal transplantation and (ii) disorders arising de novo. The first group includes: secondary hyperparathyroidism, aluminium bone disease, and dialysis-related amyloid bone disease. Post-transplant bone disorders comprise a painful legs syndrome, avascular bone necrosis, and osteopenia. Glucocorticosteroids still play a significant role in the pathogenesis of bone disease in renal transplant recipients. Due to disturbances in bone remodeling that commonly occur after renal transplantation, it is important to monitor bone metabolism in these patients.