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Post-Renal Transplantation Bone Health in Children Evaluated by Means of Quantitative Ultrasound and Densitometry
A L González-Jorge1, S Enciso1, A Reyes2
1Laboratorio de Nefrología y Metabolismo Mineral Óseo, Hospital Infantil de México Federico Gómez, México DF, México.
Insights
Bone mineral disease can persist after kidney transplants in children. Quantitative ultrasound (QUS) and dual-energy X-ray absorptiometry (DXA) show varying bone health results, indicating different bone areas impact assessments.
Area of Science:
- Pediatric Nephrology
- Pediatric Endocrinology
- Bone Metabolism
Background:
- Bone mineral disease is common in children with end-stage renal disease and may persist post-transplant.
- Immunosuppressants used after renal transplantation can negatively impact bone health.
- Evaluating bone health in pediatric transplant recipients is crucial.
Purpose of the Study:
- To assess bone health in children after renal transplantation using quantitative ultrasound (QUS) and dual-energy X-ray absorptiometry (DXA).
- To compare the diagnostic capabilities of QUS and DXA in evaluating bone mineral density in this population.
Main Methods:
- A descriptive study involving children over 3 months post-renal transplantation with stable graft function.
- Measurements included radial QUS and DXA of the lumbar spine and total body less head (TBLH) on the same day.
Main Results:
- Out of 35 children, significant bone density abnormalities were detected by DXA (TBLH Z-score < -2 in 28.5%, lumbar spine Z-score < -2 in 11.4%) and QUS (radial Z-score < -2 in 17.1%).
- A positive correlation was found between TBLH and radial QUS Z-scores (r=0.317, P=.016) and between lumbar spine and radial QUS Z-scores (r=0.452, P=.014).
- Only 2 subjects had Z-scores < -2 by both QUS and DXA, suggesting discordance in findings.
Conclusions:
- QUS and DXA show a good correlation but can yield differing results for bone health assessment in pediatric renal transplant recipients.
- Discrepancies may arise from the evaluation of different bone areas (e.g., radial bone vs. TBLH).
- Further research is needed to reconcile these findings and optimize bone health monitoring in this cohort.
Background:
Patients with end-stage renal disease develop bone mineral disease, which is not always resolved after a successful renal transplantation; moreover, some of the immunosuppressants used to prevent graft rejection may affect bone health. The aim of this study was to evaluate bone health in post-renal transplantation children with the use of quantitative ultrasound (QUS) and dual-energy X-ray absorptiometry (DXA).
Methods:
A descriptive study was performed in children >3 months after renal transplantation and with stable function of graft. Radial QUS and DXA (lumbar spine and total body less head (TBLH) were performed on the same day.
Results:
A total of 35 patients were included. Mean age was 13.9 ± 3.9 years. Ten subjects had total bone density score <2 (28.5%), 4 a lumbar spine (L1-L4) Z-score of <2 (11.4%) as well as TBLH <2, and 6 subjects had a radial QUS Z-score of <2 (17.1%), and only 2 of them had concomitant Z-score <2 with the use of DXA. There was a positive non-significant correlation between TBLH and radial QUS Z-scores (Pearson r = 0.317; P = .016) and a positive significant correlation of DXA lumbar spine and radial QUS Z-scores (Pearson r = 0.452; P = .014).
Conclusions:
Despite a good correlation between TBLH and QUS Z-scores, there are subjects that can be considered normal by QUS and have osteopenia by TBLH DXA and vice versa; this could be due to the different bone areas evaluated.
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