Case Report: Avascular Necrosis of Femoral Head in Kidney Trasplant

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https://storage.unitedwebnetwork.com/files/1099/19e4bff957e17d3ac8a47c898668b230.pdf

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Ada

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Chavez

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Introduction

Avascular necrosis (AVN) of the femoral head is a type of aseptic osteonecrosis, which occurs as a result of a disruption of the blood supply to the proximal femur, resulting in the death of the osteocytes. The most common causes include treatment with corticosteroids, fractures, dislocation of the hip joint, and alcohol abuse. It usually affects active people between the ages of 20 and 40.

Methods

Paciente masculino de 21 años con antecedentes de enfermedad renal desde 2016 quien se encontraba en tratamiento de hemodiálisis, recibió trasplante renal de donante vivo emparentado en 2019 quien presentó dificultad para irrigar el injerto durante el procedimiento y se le colocó un stent en la vía renal. arteria, al mes presenta colección perirrenal se lleva a drenaje de hematoma. Un mes después desarrolló infección activa por CMV, con tratamiento hospitalario prolongado. En agosto de 2019 se le realizó apendicectomía, tras lo cual la función renal se deterioró, quedando creatinina en 3mg/dl en enero de 2020, iniciando con infección urinaria de repetición con estenosis ureteral, nefrostomía con ITU de repetición, múltiples ingresos por el mismo padecimiento. Ha perdido su injerto y está nuevamente en hemodiálisis. Todo el tiempo el paciente continúa con el uso de esteroides y ICN hasta el presente, Consulta el 1 de marzo de 2022 con antecedentes de dolor en articulación coxofemoral izquierda, indica que el dolor inició hace 4 meses pero se agudizó hace 2 semanas y anteriormente realizaba actividades diarias que ahora el dolor le impide realizar e incluso le dificulta caminar. Paciente ingresado y estudios de imagen, creatinina actual en 7.4 BUN 65, Potasio 5.4 PTH 365, P 4.9, Calcio 8.9, Magnesio 1.2, Vitamina D 13

Results

It is known in the literature that avascular necrosis of the femoral head by the use of steroids is one of the nontraumatic causes of it, considering the case of this patient by the time of use of steroids in addition to associated symptoms, we consider avascular necrosis of femoral head secondary to the use of long-standing corticosteroids although the doses were not high.

Corticosteroids alter the differentiation of adipocytes, increasing the size and number of adipocytes. This process leads to intracellular accumulation of lipids. As a result, pressure within the bone cells increases, vascular endothelial cells are damaged, leading to local coagulopathy, vascular thrombosis and ischemia. A dose-dependent effect was observed in a meta-analysis where the rate of avascular necrosis increased by 3.6% for every additional 10 mg of prednisone.

We consider the case of this patient as a cause of the same although not usually described in the renal transplantation literature but associated with the use of steroids

Conclusions

It is important to recognize and prevent this pathology in patients who receive a renal transplant as part of their quality of life and functionality, as well as to give them an optimal and timely treatment to patients. More studies are needed on the subject.

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