Osteonekrosen bei Niereninsuffizienz

Zusammenfassung

Osteonekrosen bei chronischen Nierenerkrankungen stellen insbesondere bei Dialysepatienten und nach Nierentransplantation eine schwerwiegende Komplikation dar. Diese Osteonekrosen treten gehäuft im Bereich des Femurkopfes, aber auch im Bereich von Humeruskopf, Talus, Humeruskondylen, distalen Femurkondylen, Kuboid und den Karpalknochen auf. Die Pathogenese der Erkrankung ist noch nicht abschließend geklärt, neben der Kortisoneinnahme werden verschiedene andere Risikofaktoren diskutiert. Die Diagnostik besteht neben der klinischen und laborchemischen Untersuchung aus radiologischen Verfahren. Neben den nativradiologischen Aufnahmen stellt die Kernspintomografie ein Verfahren mit einer hohen Sensitivität auch für frühe Veränderungen dar. Die therapeutischen Möglichkeiten reichen von der konservativen Therapie bis zu den gängigen operativen Verfahren zur Behandlung avaskulärer Knochennekrosen anderer Genese, wobei bei chronischen Nierenerkrankungen einige Besonderheiten gerade bei der endoprothetischen Versorgung von Hüftkopfnekrosen zu beachten sind. Der vorliegende Artikel soll einenÜberblicküber die renal bedingten Osteonekrosen bei Erwachsenen und Kindern sowieüber deren Therapie geben.

Summary

Osteonecrosis in chronic renal disease is a high risk complication for patients undergoing dialysis and after renal transplantation. Main localisation is the femoral head, followed by the humeral head, talus, humeral condyles, distal femoral condyles, cuboid and the carpal bones. So far, the pathogenesis remains unsolved, but several risk factors like cortisone intake are discussed. Besides the clinical examination and blood tests, the diagnosis is based on radiological findings. X-ray, as well as MRI are high sensitive tools detecting early changes in bone structure. Therapeutical options range from non-invasive treatment to the known surgical approaches of treating avascular bone necrosis. Some difficulties occur with endoprosthetic implantation in patients with chronic renal diseases. This review wants to provide an overview of osteonecrosis due to renal insufficiency in adults and children and the current therapeutical approaches.

Schlüsselwörter

Osteonekrosen - avaskuläre Nekrose - Hüftkopfnekrose - Niereninsuffizienz - Dialyse - Nierentransplantation

Keywords

Osteonecrosis - avascular necrosis - necrosis of the femoral head - renal insufficiency - dialysis - renal transplantation

• Literatur

• 1 McHenry CR, Wilhelm SM, Ricanati E. Refractory renal hyperparathyroidism: clinical features and outcome of surgical therapy. Am Surg 2001; 67: 310-316 discussion 316–317.
• 2 Fournier A, Oprisiu R, Hottelart C. et al. Renal osteodystrophy in dialysis patients: diagnosis and treatment. Artif Organs 1998; 22: 530-557.
• 3 Spaulding CM, Young G. Osteitis fibrosa cystica and chronic renal failure. J Am Podiatr Med Assoc 1997; 87: 238-240.
• 4 Sundaram M, Dessner D, Ballal S. Solitary, spontaneous cervical and large bone fractures in aluminum osteodystrophy. Skeletal Radiol 1991; 20: 91-94.
• 5 Jevtic V. Imaging of renal osteodystrophy. Eur J Radiol 2003; 46: 85-95.
• 6 Adams JE. Renal bone disease: radiological investigation. Kidney Int Suppl 1999; 73: S38-S41.
• 7 Kubo T, Yamazoe S, Sugano N. et al. Initial MRI findings of non-traumatic osteonecrosis of the femoral head in renal allograft recipients. Magn Reson Imaging 1997; 15: 1017-1023.
• 8 Fink B, Degenhardt S, Paselk C. et al. Early detection of avascular necrosis of the femoral head following renal transplantation. Arch Orthop Trauma Surg 1997; 116: 151-156.
• 9 Adams JE. Dialysis bone disease. Semin Dial 2002; 15: 277-289.
• 10 Yamada S, Eriguchi R, Toyonaga J. et al. Kienbock 's disease: unusual cause of acute onset wrist pain in a dialysis patient. Intern Med 2011; 50: 467-469.
• 11 Edmunds I, Harvey FJ. Bilateral Kienbock's disease in a patient on haemodialysis. Aust N Z J Surg 1998; 68: 304.
• 12 Langevitz P, Buskila D, Stewart J. et al. Osteonecrosis in patients receiving dialysis: report of two cases and review of the Literature. J Rheumatol 1990; 17: 402-406.
• 13 Han D, Kim S, Chang J. Avascular necrosis following renal transplantation. Transplant Proc 1998; 30: 3034-3035.
• 14 Resnick D. Abnormalities of bone and soft tissue following renal transplantation. Semin Roentgenol 1978; 13: 329-340.
• 15 Potter DE, Genant HK, Salvatierra O. Avascular necrosis of bone after renal transplantation. Am J Dis Child 1978; 132: 1125-1129.
• 16 Parfrey PS, Farge D, Parfrey NA. et al. Guttman RD. The decreased incidence of aseptic necrosis in renal transplant recipients—a case control study. Transplantation 1986; 41: 182-187.
• 17 Lopez-Ben R, Mikuls TR, Moore DS. et al. Incidence of hip osteonecrosis among renal transplantation recipients: a prospective study. Clin Radiol 2004; 59: 431-438.
• 18 Torres A, Lorenzo V, Salido E. Calcium metabolism and skeletal problems after transplantation. J Am Soc Nephrol 2002; 13: 551-558.
• 19 Hedri H, Cherif M, Zouaghi K. et al. Avascular osteonecrosis after renal transplantation. Transplant Proc 2007; 39: 1036-1038.
• 20 Landmann J, Renner N, Gachter A. et al. Cyclosporin A and osteonecrosis of the femoral head. J Bone Joint Surg Am 1987; 69: 1226-1228.
• 21 Tang S, Chan TM, Lui SL. et al. Risk factors for avascular bone necrosis after renal transplantation. Transplant Proc 2000; 32: 1873-1875.
• 22 Lausten GS, Lemser T, Jensen PK, Egfjord M. Necrosis of the femoral head after kidney transplantation. Clin Transplant 1998; 12: 572-574.
• 23 Celik A, Tekis D, Saglam F. et al. Association of corticosteroids and factor V, prothrombin, and MTHFR gene mutations with avascular osteonecrosis in renal allograft recipients. Transplant Proc 2006; 38: 512-516.
• 24 Abbott KC, Oglesby RJ, Agodoa LY. Hospitalized avascular necrosis after renal transplantation in the United States. Kidney Int 2002; 62: 2250-2256.
• 25 Inoue S, Horii M, Asano T. et al. Risk factors for nontraumatic osteonecrosis of the femoral head after renal transplantation. J Orthop Sci 2003; 8: 751-756.
• 26 Takao M, Sakai T, Nishii T. et al. Incidence and predictors of osteonecrosis among cyclosporin-or tacrolimus-treated renal allograft recipients. Rheumatol Int 2011; 31: 165-170.
• 27 Andresen J, Nielsen HE. Osteonecrosis in renal transplant recipients. Early radiological detection and course. Acta Orthop Scand 1981; 52: 475-479.
• 28 Griffiths HJ, Ennis JT, Bailey G. Skeletal changes following renal transplantation. Radiology 1974; 113: 621-626.
• 29 Churchill MA, Spencer JD. End-stage avascular necrosis of bone in renal transplant patients. The natural history. J Bone Joint Surg Br 1991; 73: 618-620.
• 30 Weinstein RS, Nicholas RW, Manolagas SC. Apoptosis of osteocytes in glucocorticoid-induced osteonecrosis of the hip. J Clin Endocrinol Metab 2000; 85: 2907-2912.
• 31 Fryer JP, Granger DK, Leventhal JR. et al. Steroidrelated complications in the cyclosporine era. Clin Transplant 1994; 8: 224-229.
• 32 Murzic WJ, McCollum DE. Hip arthroplasty for osteonecrosis after renal transplantation. Clin Orthop Relat Res 1994; 299: 212-219.
• 33 Radford PJ, Doran A, Greatorex RA, Rushton N. Total hip replacement in the renal transplant recipient. J Bone Joint Surg Br 1989; 71: 456-459.
• 34 Grevitt MP, Spencer JD. Avascular necrosis of the hip treated by hemiarthroplasty. Results in renal transplant recipients. J Arthroplasty 1995; 10: 205-211.
• 35 Devlin VJ, Einhorn TA, Gordon SL. et al. Total hip arthroplasty after renal transplantation. Longterm follow-up study and assessment of metabolic bone status. J Arthroplasty 1988; 3: 205-213.
• 36 Isono SS, Woolson ST, Schurman DJ. Total joint arthroplasty for steroid-induced osteonecrosis in cardiac transplant patients. Clin Orthop Relat Res 1987; 217: 201-208.
• 37 Asano T, Takahashi KA, Fujioka M. et al. Genetic analysis of steroid-induced osteonecrosis of the femoral head. J Orthop Sci 2003; 8: 329-333.
• 38 Lai KA, Shen WJ, Yang CY. et al. The use of alendronate to prevent early collapse of the femoral head in patients with nontraumatic osteonecrosis. A randomized clinical study. J Bone Joint Surg Am 2005; 87: 2155-2159.
• 39 Morris CD, Einhorn TA. Bisphosphonates in orthopaedic surgery. J Bone Joint Surg Am 2005; 87: 1609-1618.
• 40 Demirors H, Kaya A, Akpinar S. et al. Effect of long-term steroid use on prognosis for patients with surgically treated avascular necrosis of the hip. Transplant Proc 2002; 34: 2114-2118.
• 41 Veenstra DL, Best JH, Hornberger J. et al. Incidence and long-term cost of steroid-related side effects after renal transplantation. Am J Kidney Dis 1999; 33: 829-839.
• 42 Bradbury G, Benjamin J, Thompson J. et al. Avascular necrosis of bone after cardiac transplantation. Prevalence and relationship to administration and dosage of steroids. J Bone Joint Surg Am 1994; 76: 1385-1388.
• 43 Tsao AK, Roberson JR, Christie MJ. et al. Biomechanical and clinical evaluations of a porous tantalum implant for the treatment of early-stage osteonecrosis. J Bone Joint Surg Am 2005; 87 (Suppl. 02) 22-27.
• 44 Kim SY, Kim YG, Kim PT. et al. Vascularized compared with nonvascularized fibular grafts for large osteonecrotic lesions of the femoral head. J Bone Joint Surg Am 2005; 87: 2012-2018.
• 45 Beaule PE, Amstutz HC. Management of Ficat stage III and IV osteonecrosis of the hip. J Am Acad Orthop Surg 2004; 12: 96-105.
• 46 Nowicki P, Chaudhary H. Total hip replacement in renal transplant patients. J Bone Joint Surg Br 2007; 89: 1561-1566.
• 47 Goffin E, Baertz G, Rombouts JJ. Long-term survivorship analysis of cemented total hip replacement (THR) after avascular necrosis of the femoral head in renal transplant recipients. Nephrol Dial Transplant 2006; 21: 784-788.
• 48 Naito M, Ogata K, Shiota E. et al. Hip arthroplasty in haemodialysis patients. J Bone Joint Surg Br 1994; 76: 428-431.
• 49 Toomey HE, Toomey SD. Hip arthroplasty in chronic dialysis patients. J Arthroplasty 1998; 13: 647-652.
• 50 Nagoya S, Nagao M, Takada J. et al. Efficacy of cementless total hip arthroplasty in patients on longterm hemodialysis. J Arthroplasty 2005; 20: 66-71.
• 51 Sakalkale DP, Hozack WJ, Rothman RH. Total hip arthroplasty in patients on long-term renal dialysis. J Arthroplasty 1999; 14: 571-575.
• 52 Shrader MW, Schall D, Parvizi J. et al. Total hip arthroplasty in patients with renal failure: a comparison between transplant and dialysis patients. J Arthroplasty 2006; 21: 324-329.
• 53 Catterall A, Roberts GC, Wynne-Davies R. Association of Perthes' disease with congenital anomalies of genitourinary tract and inguinal region. Lancet 1971; 1: 996-997.
• 54 Mehls O, Ritz E, Kreusser W, Krempien B. Renal osteodystrophy in uraemic children. Clin Endocrinol Metab 1980; 9: 151-176.
• 55 Uittenbogaart CH, Isaacson AS, Stanley P. et al. Aseptic necrosis after renal transplantation in children. Am J Dis Child 1978; 132: 765-767.
• 56 Boechat MI, Winters WD, Hogg RJ. et al. Avascular necrosis of the femoral head in children with chronic renal disease. Radiology 2001; 218: 411-413.
• 57 Fisher RL. An epidemiological study of Legg-Perthes disease. J Bone Joint Surg Am 1972; 54: 769-778.
• 58 Molloy MK, MacMahon B. Incidence of Legg-Perthes disease (osteochondritis deformans). N Engl J Med 1966; 275: 988-990.
• 59 Kopecky KK, Braunstein EM, Brandt KD. et al. Apparent avascular necrosis of the hip: appearance and spontaneous resolution of MR findings in renal allograft recipients. Radiology 1991; 179: 523-527.
• 60 Rayner PH, Schwalbe SL, Hall DJ. An assessment of endocrine function in boys with Perthes' disease. Clin Orthop Relat Res 1986; 209: 124-128.
• 61 Burwell RG. Perthes' disease: growth and aetiology. Arch Dis Child 1988; 63: 1408-1412.
• 62 Burwell RG, Vernon CL, Dangerfield PH. et al. Raised somatomedin activity in the serum of young boys with Perthes' disease revealed by bioassay. A disease of growth transition?. Clin Orthop Relat Res 1986; 209: 129-138.
• 63 Tanaka H, Tamura K, Takano K. et al. Serum somatomedin A in Perthes' disease. Acta Orthop Scand 1984; 55: 135-140.
• 64 Oppermann HC, Mehls O, Willich E, Twittenhoff WD. [Osteonecroses in children with chronic renal diseases before and after kidney transplantation (author's transl)]. Radiologe 1981; 21: 175-182.