Musculoskeletal Disorders After Renal Homotransplantation

Abstract

Of 60 patients receiving renal homotransplants whose duration of survival (mean 491 days) permitted accurate analysis, one or more clinical manifestations denoting connective tissue disorder independent of muscle weakness, dermtologic lesions, osteoporosis or neuropathy were observed in 38%. Avascular bone necrosis appeared in 5 patients; synovitis, in 5; arthralgia, in 13; diffuse musculoskeletal pain, in 10. Anti-gamma globulin activity principally directed against human globulin was detected between the 2nd and 28th week post-transplant of 93% of cases regardless of the presence or absence of rheumatic problems. Antibodies to DMA and RNA were detected in 40% and 28% respectively of the sera examined. Serial lupus erythematosus preparations were negative. Tanned-cell hemagglutination and agar diffusion systems employing antigen preparations from a variety of tissues failed to detect antibody. Quantitative plasma lipid determinations demonstrated fluctuating abnormalities in free and esterified cholesterol, phospholipid, triglyceride, non-esterified fatty aicd and total lipid levels. Analysis of synovial fluid consistently revealed the presence of both intracellular and extracellular, refractile, over lipid staining particles. These studies suggest the potential importance of aberrations in lipid metabolism secondary to corticosteroid therapy as a factor in pathogenesis.