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Avascular necrosis of bone is a disabling complication of renal transplantation. Its reported incidence after transplantation varies from 3% to 41%, but the, incidence has dramatically decteased since 1970s introducing the law-doseprednisolone and vit-D supply. Many hypothesis have been offered to explain the reason why the corticosteroids predispose to avacular necrosis of bone but the exact mechanism remains obscured. And other factors, such as the time on dialysis before transplantation, 1iver function, and secondary hyperparathyroidism have also been considered risk factors. This study was undertaken to determine the prevalence and clinical features of avascular necrosis in 64 renal transplant patients(recipients) at Hanyang university hospital from Jan. 1979 to May 1986, to assess the role of the following putative risk factors; 1) Steroid therapy. 2) Duration of dialysis before transplantation. 3) Secondary hyperparathyroidism. 4) Liver dysfunction. and to stress the importance of its early diagnosis. The results; 1) The incidence of avascular necrosis of bone was 21.8% and there is no statistically significant difference between high dose steroid group and low dose steroid group(p>0.05). 2) Avascular bone necrosis was developed mean 14mo. after renal transplantation and the received cummulative dose of prednisolone was 7.12±0.58 gm. 3) The total dose of prednisolone administered at one month and four months after transplant was significantly higher in patients who developed avascular necrosis(p $lt; 0.01). 4) Hip joints were most commonly involved(11cases), and 7 of them, bilateral. And affected side of hip was not related to side of transplantation. 5) Patients who were diagnosed in its early stage (stage 1,2) was 5cases and in late stage was 9cases. Of theses, 2cases was markedly improved with analgesics and rest of joints, but others gradually progressed. 6) Our results showed that the development of avascular necrosis after transplantation is not related to parathyroid function, liver function and duration of dialysis before transplantation.
$quot;Renal osteodystrophy$quot;, a term introduced over 51 years ago, is still used to describe any bone disease occuring in a patient with renal disease. In actually, a very wide spectrum of bone disease can occur in renal failure patients, ranging from states of makedly impaired bone formation and mineralization (such as low-turnover bone disease, osteomalacia) to states of markedly increased bone turnover (hyperparathyroidism). We had experienced one case of renal osteodystrophy and secondary hyperaparathyroidism, especially combined with advanced renal failure, who was admitted to Hayang University Hospital due to severe bone pain on both lowe extremites. Skull X-ray showed decreased bone density with so called $quot;salt and pepper$quot; appearance. Subperiosteal bone resorptions along the ribs and the proximal medial tibial metaphysis were noted on chest PA and both knee X-rays. Serum calcium level was 8.9mg/ dl, serum phosphorous level was 5.6mg/dl, serum alkaline phosphatase was 1872IU/L, serum parathyroid hormone level was 6.54ng/dl(normal; 0.22-0.66ng/dl). Dual photon bone densitometry showed marked decreased total body bone density. Renal osteodystrophy(osteitis fibrosa) was confirmed by bone biopsy stained with Haematoxylin & Eosin and double tetracycline labelling, and secondary hyperparathyroidism was confirmed by parathroid gland biopsies. She was treated with CaCO3, Al(OH)3, Cholecalcitriol after parathyroidectomy.
1. With glass microelectrode technique specific for calcium ion, measurements were made for serum ionized calcium. The calibration curve was linear for pCa(2-4) and the tests were reproducible. 2. For five persons each with normal health and with uremia, serum creatinine above 10㎎/㎗, ionized calcium, total calcium, total protein, albumin, and inorganic phosphate were measured in the sera. The results are as following: 1) There were significant differences in serum phosphate and ionized calcium levels between healthy group and uremic patients. The differences were not significant in total calcium, total protein, and albumin contents. 2) The values of ionized calcium, total calcium, total protein and albumin were scattered, but individually some with uremia had lower values. 3. Preliminary tests for ionized calcium assay gave the experience that the ways of collecting and storing samples would alter the data significantly. 4. It is, therefore, felt that further studies on simplification of the sample handing before the measurement of ionized calcium is desirable.