Vitamin D, parathyroid hormone, and bone mineral density status in kidney transplant recipients.

INTRODUCTION: Bone disease and bone fractures are common among kidney transplant recipients. The aim of this study was to investigate the prevalence of vitamin D deficiency, hyperparathyroidism, and osteoporosis kidney transplant patients. MATERIALS AND METHODS: A total of 113 kidney transplant recipients (58 women and 55 men) were selected consecutively from the transplant clinic between January and April 2010. A serum sample from each patient was analyzed for creatinine, calcium, phosphorus, 25-hydroxyvitamin D, and intact parathyroid hormone levels. Bone mineral density was measured by the dual energy x-ray absorptiometry method and classified according to the classification of the World Health Organization. Risk factors of bone mineral density outcomes were evaluated in univariable and multivariable analyses. RESULTS: Forty-five percent of the patients had vitamin D deficiency and 76.2% had hyperparathyroidism. There was a significant correlation between vitamin D deficiency and high serum parathyroid hormone (P = .04) and serum creatinine levels (P = .001). However, there were no significant associations of serum calcium and phosphorus with vitamin D or parathyroid hormone levels. The osteoporosis and osteopenia were reported in 12.4% and 52.2% of the recipients in the lumbar spine and 45.1% and 36.3% of the patients in the femoral neck, respectively. Multivariable analyses showed that there were significant correlations between patients' age and body mass index and femoral neck osteoporosis. Risk factors for lumbar spine osteoporosis were end-stage renal disease duration, serum calcium, and body mass index. CONCLUSIONS: Vitamin D deficiency, hyperparathyroidism, and osteoporosis are very common in our kidney transplant recipients. Early diagnosis and treatment of these abnormalities should be included in the posttransplant follow-up of patients in order to prevent severe bone diseases and bone fractures.

High frequency of clinically significant infections and cytomegalovirus disease in kidney transplant recipients with serum mannose-binding lectin deficiency.

INTRODUCTION: Mannose-binding lectin (MBL) constitutes defense against infections when adaptive immune response is compromised. Elevation in serum MBL levels has been shown in patients with kidney failure. We compared serum MBL levels before and after kidney transplant and evaluated association of MBL deficiency with infectious complications in kidney transplant recipients. MATERIALS AND METHODS: This study was performed in 71 kidney transplant recipients and 48 healthy controls. In 36 recipients (group 1), serum MBL levels were tested before and on days 7 and 14 after transplantation. They were followed up for 6 months. In 35 recipients (group 2), serum MBL was measured during their posttransplant follow-up visits. In both groups, frequencies of clinically significant infections and acute rejection were compared between those with low MBL (< 500 ng/mL) and normal/high MBL (> or = 500 ng/mL). RESULTS: Serum MBL levels (1744 +/- 905 ng/mL) were not higher in group 1 before transplantation than in controls. One and 2 weeks after transplantation, MBL levels decreased to 1699 +/- 1030 ng/mL and 1562 +/- 1020 ng/mL, respectively. Five patients who had low serum MBL levels experienced more frequent episodes of infections (P = .008) and CMV disease (P < .001). Ten patients in group 2 with low MBL levels had more frequent episodes of CMV disease (P = .01). CONCLUSIONS: These findings suggest a potential role for MBL in defense against developing posttransplant CMV disease and that low serum MBL levels in kidney transplant recipients be considered an indicator of the need for CMV prophylaxis.