Nefrología Vol. 29 Issue Year 2009
Este artículo no dispone de la versión en español
Nefrologia (English Version) 2009;29 Supl 1:31-7 | doi: 10.3265/Nefrologia.2009.29.S.1.5635.en.full

CHANGES IN BONE AND MINERAL METABOLISM IN KIDNEY TRANSPLANT PATIENTS WITH CHRONIC KIDNEY DISEASE

Alteraciones del metabolismo óseo mineral en la enfermedad renal crónica del paciente trasplantado renal


a Servicio de Nefrolog??a, Hospital La Paz, Madrid, Madrid, Espa??a,
b Servicio de Nefrolog??a, Hospital Reina Sof??a, C??rdoba, C??rdoba, Espa??a,
c Servicio de Nefrolog??a, Hospital Universitario La Fe, Valencia, Valencia, Espa??a,
Resumen

Definición: Recientemente, la Fundación KDIGO (Kidney Disease: Improving Global Outcomes) ha propuesto nuevas definiciones para referirse a las alteraciones del metabolismo óseo-mineral de los pacientes con enfermedad renal crónica (ERC), relegando el término tradicional de «osteodistrofia renal» (ODR). Recomiendan:
- El término de ODR para definir exclusivamente las alteraciones de la morfología y la arquitectura ósea propias de la ERC.
- Y el término de alteración óseo-mineral asociada a la ERC para describir las alteraciones bioquímicas, esqueléticas y calcificaciones extraesqueléticas que ocurren como consecuencia de las alteraciones del metabolismo mineral en la ERC.

Fisiopatología: Las diferentes alteraciones metabólicas son secundarias a la pérdida progresiva de masa renal y función renal, que conlleva una retención de fósforo y descenso de los niveles de calcitriol que son responsables de la resistencia esquelética a la acción de la PTH
Manifestaciones clínicas: Las manifestaciones clínicas principales de las alteraciones del metabolismo óseo mineral postrasplante son la osteoporosis y la osteopenia, que producen un incremento de las fracturas, osteonecrosis y dolor óseo. Métodos diagnósticos: Parámetros bioquímicos (calcio, fósforo, PTH y 25 hidroxivitamina D), radiología ósea, densitometría y biopsia ósea (evidencia B).
Alternativas terapéuticas: Para el tratamiento y la prevención de la osteopenia-osteoporosis en pacientes trasplantados se recomienda basarse en los datos de evidencia clínica disponibles de otras poblaciones de estudio, como la de los pacientes con ERC. Además del tratamiento específico, hay que tener en cuenta las medidas preventivas para reducir el riesgo de fracturas. El tratamiento específico incluye medidas para la prevención de pérdida de masa ósea (metabolitos activos de la vitamina D, activadores selectivos de los receptores de la vitamida D y bifosfonatos) y el tratamiento del hiperparatiroidismo persistente (calcimiméticos) (evidencia B).

Abstract

Description: Recently, the Foundation has proposed new definitions KDIGO to refer to the alterations of bone - mineral metabolism in patients with chronic renal disease (CRD), relegating the traditional term of renal osteodystrophy ODR). Recommend:
- The term ODR exclusively to define alterations in bone morphology and architecture characteristic of the ERC.
- And the term of bone-mineral alteration associated with the CRD to describe biochemical changes, and skeletal calcifications that occur as a result of alterations in mineral metabolism in the CRD.
Pathophysiology: The different metabolic abnormalities are secondary to the progressive loss of renal mass and renal function that leads to retention of phosphorus and a decrease in the levels of calcitriol which are responsible for the skeletal resistance to the action of PTH.
Clinical features: The main clinical manifestations of abnormal bone mineral metabolism are posttransplantation osteoporosis and osteopenia producing an increase in fractures, osteonecrosis, and bone pain.
Diagnostic methods: Biochemical parameters (calcium, phosphorus, PTH, 25 hydroxyvitamin D), X-ray bone densitometry and bone biopsy. (Evidence B)
Therapeutic alternatives: It is recommended for the treatment and prevention of osteopenia - osteoporosis in transplant patients based on data from clinical evidence available from other study populations, such as in patients with chronic kidney disease. In addition to specific treatment, we must take into account the preventive measures to reduce the risk of fractures. Treatment includes specific measures for the prevention of bone loss (active metabolite of vitamin D analogues and bisphosphonates) and the treatment of persistent hyperparathyroidism (calcimiméticos). (Evidence B).

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