Purpose: Kidney transplant recipients are prone to metabolic bone diseases and consequent fractures. This study aimed to evaluate the incidence of incipient vertebral fractures, osteopenia, osteoporosis, and the clinical factors associated with incipient vertebral fractures in a group of kidney transplant patients. Methods: Two hundred sixty-four patients (F/M:124/140, 45.3±13 years) who had undergone kidney transplantation between 2008 and 2018 and who were followed up at least one year in third care centers were included in this multicenter retrospective study. Bone mineral densitometry was performed using dual-energy X-ray absorptiometry. Vertebral fractures were assessed semi-quantitatively using conventional thoracolumbar lateral radiography in 202 of the patients. Results: Vertebral fractures were observed in 56.4% (n=114) of the study group. Severe vertebral fractures were observed in 30.7% (n=62) of the patients in vertebral X-ray evaluation. The frequency of osteoporosis was 20.0% (53 of 264 patients), and osteopenia was 35.6% (94 of 264 patients). BMD levels were in the normal range in 40.3% (n=46) of the subjects with vertebral fractures. It was in the osteoporotic range in 20.1% (n=23) and the osteopenic range in 40.3% (n=46). Serum calcium, parathormone vitamin, and creatinine levels were similar between the patients with and without vertebral fractures. Femoral neck BMD was negatively correlated with age (r: −0.21, p<0.001) and positively correlated with body mass index (r:0.29, p<0.001). Vertebral fractures were associated with age, duration of hemodialysis, BMI, femoral neck Z score (R2: 37.8%, p=0.027). Conclusion: BMD was in the normal or osteopenic range in 79.8% in our cohort of renal transplant patients with incipient vertebral fractures. As incipient vertebral fractures can be observed in patients with normal BMD levels in kidney transplant recipients, conventional X-ray screening for vertebral fractures may be beneficial for a proper therapy decision of metabolic bone disease in kidney transplant recipients.

Introduction: Human Immunodeficiency virus is a chronic infection that attacks the immune system of the human body, particularly CD4 T lymphocytes. Combined antiretroviral therapies are highly effective in virological suppression of human immunodeficiency virus infection. It has been shown that some retroviral therapies have a higher nephrotoxicity potential. As a result of renal injury, serum creatinine increases, and the estimated glomerular filtration rate is reduced. The aim of our study was to assess changes in kidney function during a 24-month period in HIV-positive patients who were begun on combined antiretroviral therapy. Material-method: A total of 127 HIV positive patients were enrolled. The patients were divided into five groups; patients who received no therapy were designated as Group 1; those that received Dolutegravir/Abacavir/Lamivudine combination as Group 2; those that received Elvitegravir/Cobicistat/Emtricitabine/Tenofovir Alafenamide Fumarate combination as Group 3; those that received Emtricitabine/Tenofovir Disoproxil Fumarate/Dolutegravir combination as Group 4; and those that received Emtricitabine/Tenofovir Disoproxil Fumarate/Raltegravir combination as Group 5. We compared the effects of these drugs on estimated glomerular filtration rate during a 24-month follow-up period. Results: At the 24th month of therapy, a significant difference was observed between the eGFR levels of the study groups (p:<0.001). eGFR level was significantly higher in Group 4 compared to Groups 1, 2, and 3 (p:0.009, p:<0.001, p:<0.001, respectively) while it was significantly lower in Group 5 than groups 1, 2, and 3 (p:0.005, p:<0.001, p:<0.001, respectively). No significant eGFR difference was found between Group 4 and Group 5 (p>0.05). Serum creatinine level was significantly higher in Groups 4 and 5 compared to the other groups (p<0.001). Conclusion: The use of TDF-containing regimens causes renal dysfunction. Therefore, we recommend close monitoring of renal function, especially in patients treated with TDF.