Endocrine Abstracts

Introduction: Children with chronic renal failure may grow poorly and have altered bone metabolism and body composition. Post-renal transplant (Tx), improvement in these parameters may be hindered due to glucocorticoid exposure.

Aims & methods: To study changes in these parameters after Tx, anthropometry, bone mineral content (BMC) at total body (TB) and lumber spine (LS), lean mass (LM) and fat mass (FM) were analysed by DXA in 15 children (median age 12.8 years, range 4.2–16.8 years) at pre TX, and 6 and 12 months post-Tx and BMC was corrected for height (ppBMCht). Urinary DPD was measured, and serum biomarker data were collected from routine clinical tests.

Results: Height age was lower than chronological age prior to Tx (P=0.005) and had not improved 12 months post-Tx. Median TB fat increased from pre-Tx (24.4%) to 6 months post Tx (26.7%) (P<0.05), and returned to near pre-Tx levels by 12 months. Group median ppBMCht was unchanged in the year post-Tx. However, dramatic changes in ppBMCht were observed in some individuals, particularly at 6 months and at LS (range −69.4 to 44.3%), which is comprised primarily of trabecular bone. This was generally an adjustment (from high or low mineralisation states) towards median ppBMCht as renal function improved. Median urinary DPD creatinine ratio, a marker of bone modelling, increased from 14.1 at pre-Tx to 19.6 (nmol DPD/mmol creatinine), at 4-months (P=0.28), to 26.1 at 6-months (P=0.043) and to 24.4 at 12-months post-Tx (P=0.018). This increase may reflect increased bone modelling or improved DPD excretion. Change in DPD did not correlate to change in ppBMCht at either anatomical site.

Conclusion: Body composition changes after renal-Tx. Bone does not generally appear to be adversely affected, but, rather adjusts with improved renal function. Further studies should be directed towards improving our understanding of the factors that influence body composition and bone health in these patients.