[Hypophosphatemic osteomalacia acquired after renal transplantation: a a cause of severe osteoporosis].
Renal osteodystrophy improves after renal transplantation but, after the procedure, other forms of bone disease emerge. We report a male patient that received a renal allograft four years before, who consulted for low back pain secondary to multiple vertebral compression fractures. The patient had good renal function, a parathormone independent hyperphosphaturia, normal 25-OH cholecalciferol, increased urinary hydroxyproline, decreased osteocalcin, reduced bone density and a bone biopsy revealing osteomalacia. The diagnosis of hypophosphatemic osteomalacia was reached and treatment with phosphates and ergocalciferol was started but, despite this, the patient suffered a new fracture two years later. Two mechanisms can produce hypophosphatemia after a renal transplantation: a parathormone excess due to the previous renal failure, that disappears during the first year after the transplantation or a derangement in renal phosphate transport that can be due to a generalized proximal tubule solute transport derangement (Fanconi syndrome), parathormone hypersensitivity or to an "idiopathic" hyperphosphaturia. Despite a good treatment, bone mass is not recovered and there is a high fracture risk. Mineral metabolism must be closely monitored after a renal allograft and its alterations must be quickly treated.
González
F
F
Departamento de Medicina, Facultad de Medicina, Universidad de Chile, Hospital del Salvador, Santiago de Chile.
Gómez
C
C
Ayala
A
A
Roessler
E
E
D000328:Adult; D004872:Ergocalciferols / Q000627:therapeutic use; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D010018:Osteomalacia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D010710:Phosphates / Q000627:therapeutic use; D012720:Severity of Illness Index
D004872:Ergocalciferols; D010710:Phosphates
Osteomalacia hipofosfémica adquirida post-trasplante renal: una causa de osteoporosis grave.