0
Article |

Aseptic Necrosis After Renal Transplantation in Children FREE

Christel H. Uittenbogaart, MD; Alvin S. Isaacson, MD; Philip Stanley, MD; Alfred J. Pennisi, MD; Mohammad H. Malekzadeh, MD; Robert B. Ettenger, MD; Richard N. Fine, MD
[+] Author Affiliations

Reprint requests to Dialysis and Transplant Program, Childrens Hospital of Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027 (Dr Uittenbogaart).


Am J Dis Child. 1978;132(8):765-767. doi:10.1001/archpedi.1978.02120330037009.
Text Size: A A A
Published online

• Aseptic necrosis developed in 11 (6%) of 171 recipients of renal allografts who underwent transplant operations at Childrens Hospital of Los Angeles between February 1967 and August 1977. Pain was the predominant presenting symptom and preceded roentgenographic evidence of aseptic necrosis by as long as seven months. Initial symptoms occurred two months to four years posttransplant.

Limited weight bearing and reduction in the dosage of prednisone failed to prevent the progressive destruction of five femoral heads in three patients. Hip replacement led to an amelioration of the symptoms and a resumption of normal activity in each patient. Two patients with involvement of multiple osseous structures have persistent knee and elbow joint pain and effusions, and one of them has required prosthetic replacement of the proximal humerus. No therapy was required for patients with aseptic necrosis of single bones of the hand and foot.

There was no statistically significant difference in the total steroid dose received during the first posttransplant year between patients in whom aseptic necrosis developed, and those in whom it did not develop.

(Am J Dis Child 132:765-767, 1978)

REFERENCES

Briggs WA, Hampers CL, Merrill JP, et al:  Aseptic necrosis in the femur after renal transplantation . Ann Surg 175:282-289, 1972;.
Griffiths HJ, Ennis JT, Bailey G:  Skeletal changes following renal transplantation . Radiology 113:621-626, 1974;.
Chatterjee SN, Friedler RM, Berne TV, et al:  Persistent hypercalcemia after successful renal transplantation . Nephron 17:1-7, 1976;.
Bell PRF, Briggs JD, Kyle K, et al:  Renal transplantation: An analysis of 33 cases . Br Med J 4:408-413, 1972;.
Bravo JF, Herman JH, Smyth CJ:  Musculoskeletal disorders after renal homotransplantation . Ann Intern Med 66:87-104, 1967;.
Cruess RL, Blennerhassett J, MacDonald FR. et al:  Aseptic necrosis following renal transplantation . J Bone Joint Surg [Am] 50:1577-1589, 1968;.
Elmore SM:  Bone problems related to renal transplantation . Transplant Proc 4:687-688, 1972;.
Eremin J, Swaney WE, Marshall VC, et al:  Avascular necrosis in cadaveric renal allografts . J Surg 39:41-46, 1969;.
Evarts CM, Phalen GS:  Osseous avascular necrosis associated with renal transplantation . Clin Orthop 78:330-335, 1971;.
Hall MC, Elmore SM, Bright RW, et al:  Skeletal complications in a series of human renal allografts . JAMA 208:1825-1829, 1969;.
Harrington KD, Murray WR, Kountz SL, et al:  Avascular necrosis of bone after renal transplantation . J Bone Joint Surg [Am] 53:203-215, 1969;.
Murray WR:  Hip problems associated with organ transplants . Clin Orthop 90:57-69, 1973;.
Pierides AM, Simpson W, Stainsby D, et al:  Avascular necrosis of bone following renal transplantation . Q J Med 175:459-480, 1975;.
Smyth CJ, Leidholt JD:  Steroid arthropathy of the hip . Clin Orthop 90:50-56, 1973;.
Troch T, Rombouts JJ, van Ypersele de Strihou C, et al:  Epiphyseal osteonecrosis in transplanted patients: Effect of surgical treat ment . Proc EDTA 9:376-387, 1972;.
Velayos EE, Leidholt JD, Smyth CJ, et al:  Arthropathy associated with steroid therapy . Ann Intern Med 64:759-771, 1966;.
Yadav RVS, Marshall VC, Johnson W, et al:  Cadaveric renal transplantation: Long-term survival . Med J Aust 1:729-733, 1972;.
Bewick M, Stewart PH, Rudge C, et al:  Avascular necrosis of bone in patients undergoing renal allotransplantation . Clin Nephrol 5:66-72, 1976;.
Jone JP, Engleman EP, Najarian JS:  Systemic fat embolism after renal homotransplantation and treatment with corticosteroids . N Engl J Med 273:1453-1458, 1965;.
Najarian JS, Simmons RL, Tallent MB, et al:  Renal transplantation in infants and children . Ann Surg 174:583-601, 1971;.
McEnery PT, Gonzalez LL, Martin LW, et al:  Growth and development of children with renal transplants: Use of alternate-day steroid therapy . J Pediatr 83:806-814, 1973;.
Williams GM, Lee HM, Hume DM:  Renal transplants in children . Transplant Proc 1:262-266, 1969;.
Lilly JR, Giles G, Hurwitz R, et al:  Renal homotransplantation in pediatric patients . Pediatrics 47:548-557, 1971;.
Hulme B, Kenyon JR, Owen K, et al:  Renal transplantation in children: Analysis of 25 consecutive transplants in 19 recipients . Arch Dis Child 47:486-494, 1972;.
Belzer FO, Schweitzer TR, Holliday M, et al:  Renal homotransplantation in children . Am J Surg 124:270-278, 1972;.
Fine RN:  Renal transplantation in children . Adv Nephrology 5:201-227, 1975;.
Fisher DE, Bickel WH:  Corticosteroid-induced avascular necrosis . J Bone Joint Surg 53:859-873, 1971;.
Fisher DE, Bickel WH, Holley KE:  Histologic demonstration of fat emboli in aseptic necrosis associated with hypercortisonism . Mayo Clin Proc 44:252-259, 1969;.
Pennisi AJ, Fiedler J, Mickey R, et al:  Hyperlipidemia in pediatric renal allograft recipients . J Pediatr 87:249-251, 1975;.
Cole WG, Neal BW:  Corticosteroids and avascular necrosis of the femoral head in childhood . Aust Paediatr J 12:37-42, 1976;.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

Briggs WA, Hampers CL, Merrill JP, et al:  Aseptic necrosis in the femur after renal transplantation . Ann Surg 175:282-289, 1972;.
Griffiths HJ, Ennis JT, Bailey G:  Skeletal changes following renal transplantation . Radiology 113:621-626, 1974;.
Chatterjee SN, Friedler RM, Berne TV, et al:  Persistent hypercalcemia after successful renal transplantation . Nephron 17:1-7, 1976;.
Bell PRF, Briggs JD, Kyle K, et al:  Renal transplantation: An analysis of 33 cases . Br Med J 4:408-413, 1972;.
Bravo JF, Herman JH, Smyth CJ:  Musculoskeletal disorders after renal homotransplantation . Ann Intern Med 66:87-104, 1967;.
Cruess RL, Blennerhassett J, MacDonald FR. et al:  Aseptic necrosis following renal transplantation . J Bone Joint Surg [Am] 50:1577-1589, 1968;.
Elmore SM:  Bone problems related to renal transplantation . Transplant Proc 4:687-688, 1972;.
Eremin J, Swaney WE, Marshall VC, et al:  Avascular necrosis in cadaveric renal allografts . J Surg 39:41-46, 1969;.
Evarts CM, Phalen GS:  Osseous avascular necrosis associated with renal transplantation . Clin Orthop 78:330-335, 1971;.
Hall MC, Elmore SM, Bright RW, et al:  Skeletal complications in a series of human renal allografts . JAMA 208:1825-1829, 1969;.
Harrington KD, Murray WR, Kountz SL, et al:  Avascular necrosis of bone after renal transplantation . J Bone Joint Surg [Am] 53:203-215, 1969;.
Murray WR:  Hip problems associated with organ transplants . Clin Orthop 90:57-69, 1973;.
Pierides AM, Simpson W, Stainsby D, et al:  Avascular necrosis of bone following renal transplantation . Q J Med 175:459-480, 1975;.
Smyth CJ, Leidholt JD:  Steroid arthropathy of the hip . Clin Orthop 90:50-56, 1973;.
Troch T, Rombouts JJ, van Ypersele de Strihou C, et al:  Epiphyseal osteonecrosis in transplanted patients: Effect of surgical treat ment . Proc EDTA 9:376-387, 1972;.
Velayos EE, Leidholt JD, Smyth CJ, et al:  Arthropathy associated with steroid therapy . Ann Intern Med 64:759-771, 1966;.
Yadav RVS, Marshall VC, Johnson W, et al:  Cadaveric renal transplantation: Long-term survival . Med J Aust 1:729-733, 1972;.
Bewick M, Stewart PH, Rudge C, et al:  Avascular necrosis of bone in patients undergoing renal allotransplantation . Clin Nephrol 5:66-72, 1976;.
Jone JP, Engleman EP, Najarian JS:  Systemic fat embolism after renal homotransplantation and treatment with corticosteroids . N Engl J Med 273:1453-1458, 1965;.
Najarian JS, Simmons RL, Tallent MB, et al:  Renal transplantation in infants and children . Ann Surg 174:583-601, 1971;.
McEnery PT, Gonzalez LL, Martin LW, et al:  Growth and development of children with renal transplants: Use of alternate-day steroid therapy . J Pediatr 83:806-814, 1973;.
Williams GM, Lee HM, Hume DM:  Renal transplants in children . Transplant Proc 1:262-266, 1969;.
Lilly JR, Giles G, Hurwitz R, et al:  Renal homotransplantation in pediatric patients . Pediatrics 47:548-557, 1971;.
Hulme B, Kenyon JR, Owen K, et al:  Renal transplantation in children: Analysis of 25 consecutive transplants in 19 recipients . Arch Dis Child 47:486-494, 1972;.
Belzer FO, Schweitzer TR, Holliday M, et al:  Renal homotransplantation in children . Am J Surg 124:270-278, 1972;.
Fine RN:  Renal transplantation in children . Adv Nephrology 5:201-227, 1975;.
Fisher DE, Bickel WH:  Corticosteroid-induced avascular necrosis . J Bone Joint Surg 53:859-873, 1971;.
Fisher DE, Bickel WH, Holley KE:  Histologic demonstration of fat emboli in aseptic necrosis associated with hypercortisonism . Mayo Clin Proc 44:252-259, 1969;.
Pennisi AJ, Fiedler J, Mickey R, et al:  Hyperlipidemia in pediatric renal allograft recipients . J Pediatr 87:249-251, 1975;.
Cole WG, Neal BW:  Corticosteroids and avascular necrosis of the femoral head in childhood . Aust Paediatr J 12:37-42, 1976;.

Correspondence

CME
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.