Renal osteodystrophy

Renal osteodystrophy or chronic kidney disease-mineral and bone disorder^[1] is a bone pathology, characterized by bone mineralization deficiency, that is a direct result of the electrolyte and endocrine derangements that accompany chronic kidney disease. Renal osteodystrophy can be further divided into metabolic states associated with either high or low bone turnover.

Signs and symptoms

Renal osteodystrophy may exhibit no symptoms; if it does show symptoms, they include:

• Bone pain
• Joint pain
• Bone deformation
• Bone fracture

Diagnosis

Renal osteodystrophy is usually diagnosed after treatment for end-stage renal disease begins. Blood tests will indicate decreased calcium and calcitriol and increased phosphate and parathyroid hormone. X-rays will also show bone features of renal osteodystropy (chondrocalcinosis at the knees and pubic symphysis, osteopenia and bone fractures) but may be difficult to differentiate from other conditions.

Pathogenesis

Renal osteodystrophy is thought to be the result of hyperparathyroidism secondary to hyperphosphatemia combined with hypocalcaemia, both of which are due to decreased excretion of phosphate by the damaged kidney. Low activated vitamin D₃ levels are a result of the damaged kidneys' inability to convert vitamin D₃ into its active form, calcitriol, and result in further hypocalcaemia.

Differential diagnosis

To confirm diagnosis, renal osteodystrophy must be distinguished from:

• osteoporosis (Alk Phos and PO₄ usually normal)
• osteopenia
• osteomalacia
• hyperparathyroidism
• multiple myeloma
• soft tissue calcification
• chondrocalcinosis
• hypervitaminosis

Treatment

Treatment for renal osteodystrophy includes:

• calcium and vitamin D supplementation
• restriction of dietary phosphate
• phosphate binders such as calcium carbonate, calcium acetate, sevelamer hydrochloride, or lanthanum carbonate
• cinacalcet
• renal transplantation
• hemodialysis five times a week is thought to be of benefit^[2]

Prognosis

Recovery from renal osteodystrophy has been observed post renal transplantation. Renal osteodystrophy is a chronic condition with a conventional hemodialysis schedule.^[2]

References

External links

• Renal Osteodystrophy - NKUDIC, NIH