Search
renal osteodystrophy
Etiology:
- chronic renal failure
Pathology:
1) 4 components:
a) osteitis fibrosa cystica
- secondary hyperparathyroidism
- osteoclastic overactivity
- subperiosteal resorption of bone, most prominent at phalanges
b) osteomalacia
- 1,25-dihydroxy-vitamin D deficiency
- increased osteoid formation within bone
- bone pain, bone fractures
c) adynamic bone disease*
- relatively suppressed plasma PTH due to chronic illness, ESRD or vitamin D analogs
- risk for bone fractures increased by bisphosphonates
d) osteoporosis*
e) growth retardation
2) pathophysiology
a) phosphate retention
b) stimulates parathyroid hormone (see secondary hyperparathyroidism)
c) decrease in urinary calcium
d) bone is often poorly responsive to PTH in chronic renal failure
e) 1,25 dihydroxyvitamin D deficiency leads to:
- phosphate retention
- increasing PTH (see secondary hyperparathyroidism)
Laboratory:
- serum PTH may be markedly increased
Radiology:
- lytic lesions of bone
Management:
1) renal diet: restriction of phosphate-rich foods
2) intestinal phosphate binders
a) calcium acetate
b) calcium carbonate
3) calcitriol
Related
hyperparathyroidism
osteitis fibrosa cystica; von Recklinghausen's disease of bone
osteomalacia
osteoporosis
Specific
adynamic bone disease
General
osteodystrophy
chronic kidney disease-mineral & bone disorder (CKD-MBD)
References
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 617
- Carvalho C, Alves CM, Frazao JM.
The role of bone biopsy for the diagnosis of renal osteodystrophy:
a short overview and future perspectives.
J Nephrol. 2016 Oct;29(5):617-26. Review.
PMID: 27473148
- Medical Knowledge Self Assessment Program (MKSAP) 19.
American College of Physicians, Philadelphia 2021
- Medical Knowledge Self Assessment Program (MKSAP) 19
Board Basics. An Enhancement to MKSAP19.
American College of Physicians, Philadelphia 2022
- Renal Osteodystrophy
http://kidney.niddk.nih.gov/kudiseases/pubs/renalosteodystrophy/index.htm