Avascular necrosis of bone after renal transplantation
D. E. Potter, H. K. Genant and O. Salvatierra
Avascular necrosis (AN) of bone developed in 11 of 100 children who
received renal transplants from 1964 to 1977. Bones involved were femoral
heads, 14; femoral condyles, 12; tall, two; and carpal naviculars, two.
Seven children with symptomatic AN of the femoral heads were treated with
limited weight bearing; three subsequently required arthroplasty, and
degenerative joint disease developed in one. The AN at other joints healed
clinically but not roentgenographically. Although the prevalence of AN
decreased after 1967 coincident with a decrease in prednisone dose,
children with AN received the same cumulative prednisone dose as children
in a control group. Serum phosphorus levels were different in the AN and
control groups, but other indexes of hyperparathyroidism were similar. The
relative contributions of prednisone therapy and hyperparathyroidism to the
development of AN could not be delineated.
