vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2017-4-130-140vtio-837Research ArticleОбзор литературыLiterature ReviewsСовременные подходы к коррекции минеральных и костных нарушений у реципиентов почечного трансплантатаModern approaches to correction mineral and bone disorders in kidney transplant recipientsВетчинниковаО. Н.VetchinnikovaO. N.

Москва.

Moscow.

olg-vetchinnikova@yandex.ruГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского».РоссияM.F. Vladimirsky Moscow Regional Clinical and Research InstituteRussian Federation201701022018194130140Copyright © Ветчинникова О.Н., 20182018Ветчинникова О.Н.Vetchinnikova O.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/837

Синдром минерально-костных нарушений у пациентов с хронической болезнью почек, перенесших трансплантацию почки, включает гипофосфатемию, гиперкальциемию, гиповитаминоз D, гиперпаратиреоз и снижение минерализации кости (вторичный остеопороз). Современная стратегия профилактики и лечения посттрансплантационных нарушений минерального обмена и костного метаболизма опирается на принципы индивидуального подхода с учетом оценки факторов риска и минимизации причин, вызвавших эти нарушения. Попытка восполнения недостатка фосфора обычно неэффективна и даже опасна возникновением осложнений. Рассмотрены разнообразные способы коррекции симптоматической гиперкальциемии и гиперкальциемии, обусловленной посттрансплантационным гиперпаратиреозом. Представлены современные подходы к профилактике и лечению посттрансплантационного остеопороза. Анализируются эффективность и показания к использованию иммуносупрессивной терапии с минимизацией глюкокортикостероидов в раннем послеоперационном периоде, витамина D и активаторов рецептора витамина D, медикаментозной и хирургической коррекции ГПТ, бисфосфонатов и других лекарственных средств.

The syndrome of mineral and bone disorders in patients with chronic kidney disease after kidney transplantation include hypophosphatemia, hypercalcemia, hypovitaminosis D, and decreased bone mineralization (secondary osteoporosis). The modern strategy of prevention and treatment of post-transplantation mineral and bone disorders is based on the principles of individual approach, taking into account the assessment of risk factors and minimizing the factors that caused these disorders. An attempt to compensate for phosphorus defi ciency is usually ineffective and even dangerous due to complications. This review analyzes different correction´s methods of symptomatic hypercalcemia and hypercalcemia after kidney transplantation secondary to hyperparathyroidism. Also in this review presented modern approaches to the prevention and treatment of posttransplant osteoporosis. Also it shows the effects and indications for use steroid sparing/withdrawal, vitamin D and vitamin D receptor activator, drug and surgical correction of hyperparathyroidism, bisphosphonates and other medications.

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The authors declare that there are no conflicts of interest present.