The learning objectives in this pictorial essay are: 1) To review the pathophysiology of the bone and soft-tissue changes after renal transplantation. 2) To describe the imaging features of the most common musculoskeletal abnormalities in renal transplant patients.

Renal osteodystrophy (ROD) is the constellation of skeletal abnormalities found in chronic renal insufficiency, which can exacerbate with long-term dialysis and renal transplantation.[1],[2] ROD in transplanted patients has its own pathophysiologic particularities, since multiple biochemical and hormonal factors regulate mineral metabolism and bone turnover (table 1): the grade of previous ROD is highly variable and the postoperative impact factors include renal function, disturbances of mineral metabolism, PTH status, hypophosphataemia and immunosuppressive drugs.[2],[3] The spectrum of skeletal abnormalities existent in ROD is related to the state...

The pre-existing bone disease may persist after renal transplantation and is characterized by findings of secondaryhyperparathyroidism, namely bone reabsorption, periosteal reaction and brown tumours (osteitis fibrosa cystica-figure1).[1] In 95% of patients, skeletal features ofhyperparathyroidismare foremost identified in the hands.[5]Bone reabsorption can be categorized by location in subperiosteal, intracortical, trabecular, endosteal, subchondral and subligamentous.[1],[5] Subperiosteal reabsorption presents as a lacelike irregularity of the cortical margins.[1],[5]It has a virtually pathognomonic predilection for the radial aspects of the middle phalanges of the middle and index fingers in the...

Although renal transplantation virtually re-establishes exocrine and endocrine renal function in end-stage renal patients, musculoskeletal disease remains an important cause of morbidity and mortality. Recognizing the constellation of radiographic features is crucial to an early diagnosis and follow-up ofthe renal osteodystrophy.

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