Long-term stability of bone mineral density in kidney transplant recipients treated with low-dose steroids and cyclosporine: protective effect of cyclosporine?
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作者:
Ezaitouni, F
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机构:CHU Amiens, Hop Sud, Serv Nephrol, F-80054 Amiens 01, France
Ezaitouni, F
Westeel, PF
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机构:
CHU Amiens, Hop Sud, Serv Nephrol, F-80054 Amiens 01, FranceCHU Amiens, Hop Sud, Serv Nephrol, F-80054 Amiens 01, France
Westeel, PF
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Fardellone, P
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机构:CHU Amiens, Hop Sud, Serv Nephrol, F-80054 Amiens 01, France
Fardellone, P
Mazouz, H
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机构:CHU Amiens, Hop Sud, Serv Nephrol, F-80054 Amiens 01, France
Mazouz, H
Brazier, M
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机构:CHU Amiens, Hop Sud, Serv Nephrol, F-80054 Amiens 01, France
Brazier, M
El Esper, I
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机构:CHU Amiens, Hop Sud, Serv Nephrol, F-80054 Amiens 01, France
El Esper, I
Sebert, JL
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机构:CHU Amiens, Hop Sud, Serv Nephrol, F-80054 Amiens 01, France
Sebert, JL
Petit, J
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机构:CHU Amiens, Hop Sud, Serv Nephrol, F-80054 Amiens 01, France
Petit, J
Westeel, A
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机构:CHU Amiens, Hop Sud, Serv Nephrol, F-80054 Amiens 01, France
Westeel, A
Pruna, A
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机构:CHU Amiens, Hop Sud, Serv Nephrol, F-80054 Amiens 01, France
Pruna, A
Fournier, A
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机构:CHU Amiens, Hop Sud, Serv Nephrol, F-80054 Amiens 01, France
Fournier, A
机构:
[1] CHU Amiens, Hop Sud, Serv Nephrol, F-80054 Amiens 01, France
[2] CHU Amiens, Hop Sud, Serv Rhumatol, F-80054 Amiens, France
[3] CHU Amiens, Hop Sud, Serv Hormonol, F-80054 Amiens 01, France
[4] CHU Amiens, Hop Sud, Nucl Med Serv, F-80054 Amiens 01, France
[5] CHU Amiens, Hop Sud, Serv Urol, F-80054 Amiens 01, France
[6] CHU Amiens, Hop Sud, Serv Radiol, F-80054 Amiens 01, France
OBJECTIVES: Cyclosporine has been thought to have a deleterious effect on bone in transplant recipients because of high turnover osteopenia observed in humans after transplantation. However, varying confounding factors such as renal and parathyroid function, cumulative steroid doses and previous exposure to aluminium, also play a role and hinder interpretation of the cyclosporine effect on bone mineral density (BMD). PATIENTS AND METHODS: A 2-year prospective study was conducted to measure BMD starting 3 months after transplantation and bone remodeling markers from the first post-transplantation day in 52 kidney recipients with no prior exposure to aluminum. None of the patients experienced rejection and at 3 months all had good stable renal function (serum creatinine 137 mu mol/l) and mildly elevated parathyroid hormone levels (1.5 times the upper limit of normal). All patients were given the same low dose steroid treatment (10 mg/day) and at 6 months cyclosporine was decreased from 7 to 4.8 mg/kg/day. RESULTS: BMD measured by double energy X-ray absorptiometry, (DEXA) and expressed in Z score, was moderately decreased at 3 months for the vertebrae (-1.40), the femoral neck (-1.34) and the ultradistal radius (-0.95) which have predominantly cancellous bone and was significantly less decreased (p<0.05) for the lower third of the radius (-0.6) which is mainly cortical bone. BMD measurements were comparable at 6, 12 and 24 months. When measured by axial computerized tomography (ACT) BMD of the vertebrae showed a non-significant increase of Z score from -1.37 to -1.19 at 2 years. Bone remodelling markers was observed up to month 6 (from month 3 for osteocalcine and from month 1 for total and bone alkaline phosphatase and urinary pyridinoline), then returned to baseline levels at 2 years in parallel with decreased cyclosporine dosage. The increase of vertebral BMD measured by ACT at 1 year was correlated both to cyclosporine dose at 1 year and to bone alkaline phosphatase at 6 months. CONCLUSION: Our data confirm the presence of moderate osteopenia 3 months after transplantation, predominantly in trabecular bone, logically linked to the initial high doses of corticosteroids, The long-term stability of BMD measured by DEXA and the correlation of vertebral BMD increase measured by ACI with cyclosporine dose and bone alkaline phosphate suggest that cyclosporine had a beneficial immunosuppressor effect by stimulating bone remodeling and thus counterbalancing the suppressive effect of corticosteroids. (C) 1998, Masson, Paris.
机构:
Hop Necker Enfants Malad, AP HP, Serv Transplantat Renale Adulte, Paris, France
Univ Paris 05, Paris, FranceHop Necker Enfants Malad, AP HP, Serv Transplantat Renale Adulte, Paris, France
Snanoudj, R.
Royal, V.
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机构:
Hop Necker Enfants Malad, AP HP, Lab Anatomopathol, Paris, FranceHop Necker Enfants Malad, AP HP, Serv Transplantat Renale Adulte, Paris, France
Royal, V.
Elie, C.
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机构:
Univ Paris 05, Paris, France
Hop Necker Enfants Malad, AP HP, Serv Biostat, Paris, FranceHop Necker Enfants Malad, AP HP, Serv Transplantat Renale Adulte, Paris, France
Elie, C.
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机构:
Rabant, M.
Girardin, C.
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机构:
Hop Necker Enfants Malad, AP HP, Serv Transplantat Renale Adulte, Paris, FranceHop Necker Enfants Malad, AP HP, Serv Transplantat Renale Adulte, Paris, France
Girardin, C.
Morelon, E.
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机构:
Hop Necker Enfants Malad, AP HP, Serv Transplantat Renale Adulte, Paris, FranceHop Necker Enfants Malad, AP HP, Serv Transplantat Renale Adulte, Paris, France
Morelon, E.
Kreis, H.
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机构:
Hop Necker Enfants Malad, AP HP, Serv Transplantat Renale Adulte, Paris, France
Univ Paris 05, Paris, FranceHop Necker Enfants Malad, AP HP, Serv Transplantat Renale Adulte, Paris, France
Kreis, H.
Fournet, J. -C.
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机构:
Univ Paris 05, Paris, France
Hop Necker Enfants Malad, AP HP, Lab Anatomopathol, Paris, FranceHop Necker Enfants Malad, AP HP, Serv Transplantat Renale Adulte, Paris, France
Fournet, J. -C.
Noel, L. -H.
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机构:
Univ Paris 05, Paris, France
Hop Necker Enfants Malad, AP HP, Lab Anatomopathol, Paris, FranceHop Necker Enfants Malad, AP HP, Serv Transplantat Renale Adulte, Paris, France
Noel, L. -H.
Legendre, C.
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机构:
Hop Necker Enfants Malad, AP HP, Serv Transplantat Renale Adulte, Paris, France
Univ Paris 05, Paris, FranceHop Necker Enfants Malad, AP HP, Serv Transplantat Renale Adulte, Paris, France
机构:
Univ Western Ontario, Div Nephrol, London, ON, Canada
Univ Western Ontario, Dept Epidemiol & Biostat, London, ON, CanadaUniv Western Ontario, Div Nephrol, London, ON, Canada
Naylor, Kyla L.
Garg, Amit X.
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机构:
Univ Western Ontario, Div Nephrol, London, ON, Canada
Univ Western Ontario, Dept Epidemiol & Biostat, London, ON, Canada
ICES, Toronto, ON, CanadaUniv Western Ontario, Div Nephrol, London, ON, Canada
Garg, Amit X.
Hodsman, Anthony B.
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机构:
Univ Western Ontario, Div Nephrol, London, ON, CanadaUniv Western Ontario, Div Nephrol, London, ON, Canada
Hodsman, Anthony B.
Rush, David N.
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机构:
Univ Manitoba, Dept Med, Winnipeg, MB, CanadaUniv Western Ontario, Div Nephrol, London, ON, Canada
Rush, David N.
Leslie, William D.
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机构:
Univ Manitoba, Dept Med, Winnipeg, MB, CanadaUniv Western Ontario, Div Nephrol, London, ON, Canada