Renal osteodystrophy: Difference between revisions
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{{ | {{Renal osteodystrophy}} | ||
{{ | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' | ||
'''Associate Editor-In-Chief:''' {{CZ}} | {{CMG}}'''; Associate Editor-In-Chief:''' {{CZ}} | ||
{{SK}}: Chronic kidney disease-mineral and bone disorder (CKD-MBD) | |||
==[[Renal osteodystrophy overview|Overview]]== | |||
==[[Renal osteodystrophy historical perspective|Historical Perspective]]== | |||
==[[Renal osteodystrophy classification|Classification]]== | |||
==[[Renal osteodystrophy pathophysiology|Pathophysiology]]== | |||
==[[Renal osteodystrophy differential diagnosis|Differentiating Renal osteodystrophy from other Diseases]]== | |||
==[[Renal osteodystrophy natural history, complications and prognosis|Natural History, Complications and Prognosis]]== | |||
==Diagnosis== | |||
[[Renal osteodystrophy diagnostic criteria|Diagnostic Criteria]] | [[Renal osteodystrophy history and symptoms|History and Symptoms]] | [[Renal osteodystrophy physical examination|Physical Examination]] | [[Renal osteodystrophy laboratory findings|Laboratory Findings]] | [[Renal osteodystrophy x ray|X ray]] | [[Renal osteodystrophy CT|CT]] | [[Renal osteodystrophy MRI|MRI]] | [[Renal osteodystrophy ultrasound|Ultrasound]] | [[Renal osteodystrophy other imaging findings|Other Imaging Findings]] | [[Renal osteodystrophy other diagnostic studies|Other Diagnostic Studies]] | |||
==Treatment== | |||
[[Renal osteodystrophy medical therapy|Medical Therapy]] | [[Renal osteodystrophy surgery|Surgery]] | [[Renal osteodystrophy cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Renal osteodystrophy future or investigational therapies|Future or Investigational Therapies]] | |||
==Case Studies== | |||
[[Renal osteodystrophy case study one|Case #1]] | |||
==Overview== | ==Overview== | ||
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{{Nephrology}} | {{Nephrology}} | ||
[[Category:Organ failure]] | [[Category:Organ failure]] | ||
Revision as of 16:04, 28 September 2012
| Renal osteodystrophy | |
| ICD-10 | N25.0 |
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| ICD-9 | 588.0 |
| eMedicine | radio/500 |
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Renal osteodystrophy Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Renal osteodystrophy On the Web |
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American Roentgen Ray Society Images of Renal osteodystrophy |
For patient information click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Synonyms and keywords:: Chronic kidney disease-mineral and bone disorder (CKD-MBD)
Overview
Historical Perspective
Classification
Pathophysiology
Differentiating Renal osteodystrophy from other Diseases
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria | History and Symptoms | Physical Examination | Laboratory Findings | X ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies
Treatment
Medical Therapy | Surgery | Cost-Effectiveness of Therapy | Future or Investigational Therapies
Case Studies
Overview
Renal osteodystrophy is a bone pathology, characterized by defective mineralization, that results from renal disease. renal - refers to kidney, osteo - refers to bone, and dystrophy - means degenerative disorder (like dystrophy in muscular dystrophy).
There are different forms of renal osteodystrophy. Renal osteodystrophy that is characterized by high bone turnover, and renal osteodystrophy that is characterized by low bone turnover.
Signs and symptoms
- Silent (no symptoms).
- Bone pain.
- Joint pain.
- Bone deformation.
- Fractures.
Diagnosis
Usually diagnosed after treatment for end-stage renal disease (ESRD) begins.
- Blood tests - calcium (is decreased), phosphate (is elevated), calcitriol (vitamin D) (is decreased), PTH (is elevated).
Can be recognized on X-ray (but may be difficult to differentiate from other conditions). Features on X-ray:
- Calcification of cartilage (chondrocalcinosis) - typically at the knees and pubic symphysis.
- Bone loss - "patchy" appearance (osteopenia)
- Fractures
Pathogenesis
The mineral content of bone is calcium hydroxyapatite, Ca5(PO4)3(OH). When calcium is being actively resorbed from bone, the phosphate also enters the blood stream. The kidney is the primary means of excreting excess phosphate. Renal osteodystrophy results from an abnormally elevated serum phosphate (hyperphosphatemia) and low serum calcium (hypocalcemia), both of which are due to decreased excretion of phosphate by the damaged kidney, low vitamin D levels or tertiary hyperparathyroidism (a dysfunction of the parathyroid gland due to constant stimulation).
Differential diagnosis
- osteoporosis
- osteopenia
- osteomalacia
- hyperparathyroidism
- multiple myeloma
- soft tissue calcification including collagen vascular disease
- hydroxyapatite crystal deposition disease
- hypervitaminosis
Treatment
- calcium supplementation
- dietary phosphate restriction
- vitamin D
- phosphate binders calcium carbonate (Tums), calcium acetate (PhosLo), sevelamer hydrochloride (Renagel), or lanthanum carbonate (Fosrenol)
- cinacalcet - a calcimimetic
- frequent hemodialysis (five times a week) is thought to be of benefit[1]
- renal transplantation
Prognosis
Recovery from renal osteodystrophy has been observed post renal transplantation. Renal osteodystrophy is a chronic (persistent) condition with a conventional hemodialysis schedule.[1]