Bone Alterations in Children and Young Adults With Renal Transplant Assessed by Phalangeal Quantitative Ultrasound

Mussa, Alessandro; Porta, Francesco; Gianoglio, Bruno; Gaido, Maurizio; Nicolosi, Mario Guido; De Terlizzi, Francesca; de Sanctis, Carlo; Coppo, Rosanna

doi:10.1053/j.ajkd.2007.06.002

« Previous Next »American Journal of Kidney Diseases
Volume 50, Issue 3 , Pages 441-449, September 2007

Bone Alterations in Children and Young Adults With Renal Transplant Assessed by Phalangeal Quantitative Ultrasound

Alessandro Mussa, MD
- Department of Pediatric Endocrinology, Regina Margherita Children’s Hospital, Torino, Italy
- Address correspondence to Alessandro Mussa, MD, Department of Pediatric Endocrinology, Regina Margherita Children’s Hospital, Piazza Polonia 94, 10126, Torino, Italy.
Francesco Porta, MD
- Department of Pediatrics, University of Torino, Torino, Italy
Bruno Gianoglio, MD
- Department of Pediatric Nephrology, Regina Margherita Children’s Hospital, Torino, Italy
Maurizio Gaido, MD
- Department of Pediatric Nephrology, Regina Margherita Children’s Hospital, Torino, Italy
Mario Guido Nicolosi, MD
- Department of Gynecology and Obstetrics, S. Anna Hospital, Torino, Italy
Francesca De Terlizzi, PhD
- Igea Biophysics Laboratory, Carpi, Modena, Italy.
Carlo de Sanctis, MD
- Department of Pediatric Endocrinology, Regina Margherita Children’s Hospital, Torino, Italy
Rosanna Coppo, MD
- Department of Pediatric Nephrology, Regina Margherita Children’s Hospital, Torino, Italy

Received 8 January 2007; accepted 4 June 2007. published online 07 August 2007.

Background

Bone alterations in young renal transplant recipients were investigated in several studies with conflicting results. Quantitative ultrasound of the phalanges is a recently developed noninvasive procedure to assess skeletal status.

Study Design

Cross-sectional study at a single transplant center with values compared with previously studied healthy controls.

Settings & Participants

40 children and young adult recipients of renal grafts (15 females, 25 males; age, 20.0 ± 8.4 years) studied 7.1 ± 3.8 years after kidney transplantation.

Predictor

Clinical, biochemical, and therapeutic features, including calcium, phosphate, and intact parathormone levels; and cumulative dosages of glucocorticoids and cyclosporine administered since transplantation.

Outcome & Measurement

Phalangeal quantitative ultrasound, including amplitude-dependent speed of sound (AD-SoS) and bone transmission time (BTT), mainly dependent on mineral density and cortical thickness, respectively. Age- and sex-matched healthy controls were used to provide age-related z scores; sex- and height-matched healthy subjects, to provide z scores related to statural age.

Results

Mean z scores of AD-SoS and BTT were −0.05 ± 1.59 and −0.54 ± 1.17, respectively (P > 0.05 and P < 0.001, respectively). Multivariate analysis showed that AD-SoS z score was associated significantly with body mass index, intact parathormone level, cumulative glucocorticoids administered in the first posttransplantation year, and cyclosporine administered since transplantation (model r² = 0.79; P < 0.001); BTT z score was associated significantly with glucocorticoid dosage in the first posttransplantation year and age (model r² = 0.55; P < 0.001).

Limitations

Absence of other measures of bone structure and longitudinal measures and comparison to a noncurrent control group.

Conclusions

Children and young adults may have decreased cortical thickness with maintained overall mineral density after renal transplantation. The findings of phalangeal quantitative ultrasound parallel observations using other imaging techniques. Phalangeal quantitative ultrasound may be a useful method to assess bone alternations after renal transplantation.

Index Words: Bone, bone density, kidney transplantation, quantitative ultrasound, renal osteodystrophy