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[[Renal osteodystrophy case study one|Case #1]]
[[Renal osteodystrophy case study one|Case #1]]


==Overview==
==Related Chapters==
 
'''Renal osteodystrophy''' is a [[bone]] pathology, characterized by defective mineralization, that results from [[renal disease]].  <i>renal</i> - refers to [[kidney]], <i>osteo</i> - refers to [[bone]], and <i>dystrophy</i> - 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 and nociception|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, Ca<sub>5</sub>(PO<sub>4</sub>)<sub>3</sub>(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]]
*[[osteoporosis]]
*[[osteopenia]]  
*[[osteopenia]]  
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*[[Calcium pyrophosphate deposition disease|hydroxyapatite crystal deposition disease]]
*[[Calcium pyrophosphate deposition disease|hydroxyapatite crystal deposition disease]]
*hypervitaminosis
*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<ref name=bonomini>{{cite journal |author=Bonomini V, Mioli V, Albertazzi A, Scolari P |title=Daily-dialysis programme: indications and results |journal=Nephrol. Dial. Transplant. |volume=13 |issue=11 |pages=2774-7; discussion 2777-8 |year=1998 |pmid=9829478 |doi=}}</ref>
*[[renal transplantation]]
==Prognosis==
Recovery from renal osteodystrophy has been observed post renal transplantation.  Renal osteodystrophy is a [[chronic (medicine)|chronic]] (persistent) condition with a conventional hemodialysis schedule.<ref name=bonomini/>
==References==
{{reflist|2}}


==External links==
==External links==

Revision as of 16:16, 28 September 2012

Renal osteodystrophy
ICD-10 N25.0
ICD-9 588.0
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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

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Natural History, Complications and Prognosis

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