Hormonal abnormalities in renal transplantation

It is generally maintained that the variety of endocrine disorders which occur in uraemia and persist in dialysis (above all hormones whose production and/or metabolic clearance are pertinent functions of the kidney) usually abate after successful renal transplantation. However, a retrospective analysis of long-term results in 71 out of 275 cases serially studied by regular checks, indicates that this event occurs in no more than 2/3 of successfully transplanted patients. In the other patients various endocrine abnormalities may be documented: some seem apparently 'inherited' from uraemia (hyperparathyroidism, sexual dysfunction, growth retardation); some are mainly related to steroids (hyperinsulinism), and some have a de novo origin (erythrocytosis, reno-vascular hypertension). These endocrine abnormalities may occur with a normal or reduced graft function, have a baseline or stimulated expression, a clinical or subclinical course, and a reversible or irreversible outcome. A proper grasp of these events in renal transplantation is of clinical significance particularly for the long-term patient and graft prognosis.