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Diabetic Nephropathy
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
There may be abnormalities of calcium, parathyroid hormone (PTH), phosphate, and vitamin D metabolism. Renal osteodystrophy is also possible. Reduced renal production of the active vitamin D hormone calcitriol adds to hypocalcemia. Reduced renal excretion of phosphate causes hyperphosphatemia. Secondary hyperparathyroidism is often seen, developing in kidney failure prior to abnormal calcium or phosphate concentrations manifesting. Therefore, it is important to monitor PTH in patients with moderate CKS prior to hyperphosphatemia occurring. Renal osteodystrophy is abnormal bone mineralization. It occurs because of a deficiency of calcitriol, hyperparathyroidism, excessive serum phosphate, or low to normal serum calcium. There is usually increased bone turnover because of osteitis fibrosa, a hyperparathyroid bone disease. There may be decreased bone turnover, however, caused by an adynamic disease from increased suppression of the parathyroid glands, or osteomalacia. If there is a calcitriol deficiency, this may result in osteomalacia or osteopenia.
Comparing Populations
Published in Gary L. Rosner, Purushottam W. Laud, Wesley O. Johnson, Bayesian Thinking in Biostatistics, 2021
Gary L. Rosner, Purushottam W. Laud, Wesley O. Johnson
Renal osteodystrophy is a bone disease that occurs when the kidneys fail to maintain proper levels of calcium and phosphorus in the blood. Monitoring patients with loss of kidney function for lower than normal bone turnover aids in managing the disease. A commercially available diagnostic assay, DiaSorin, was believed to have the potential to determine which patients have low versus normal bone turnover. A cross-section of 34 kidney patients from the bone registry at the University of Kentucky were identified as low or normal turnover by other means and then given the commercial assay to determine whether it could correctly identify them. From boxplots, a normal sampling model appears to be untenable, due to observable skewness; however, boxplots and quantile plots of the log-transformed data appear to be reasonably normal (see Figure 5.2).
Thyroid and Parathyroid Imaging
Published in George H. Gass, Harold M. Kaplan, Handbook of Endocrinology, 2020
Brahm Shapiro, Milton D. Gross
The classical skeletal radiographic signs of hyperparathyroidism are now seldom seen in modern industrial countries.127 Full-blown ostitis fibrosa cystica with erosive brown tumors, pathological fractures, pseudofractures, marked generalized osteopenia, and deformity of the softened bones is now rare. Characteristic subtle subperiosteal resorption of bone in the lateral areas of the phalanges is more frequent and is best depicted on magnification radiographs of the hands. As the population ages and the number of patients with end-stage renal disease and on dialysis increases, so the effects of renal osteodystrophy are observed more often. These include osteopenia, Looser’s zones, brown tumors, abnormal sclerosis, and so-called “rugger jersey spine.”127
Incidence of bone fractures among patients on maintenance hemodialysis
Published in Renal Failure, 2023
Abdullah Kashgary, Feryal Omar A. Attiah, Nada AbuBakr AlKhateeb, Nada H. Abdulaziz, Banan Abdullah Alsaif, Amal Fahad Aljuhani, Mohamed Abdalbary, Eman Nagy, Mostafa Abdelsalam
Osteoporosis is an imbalance between bone resorption and formation. In patients with CKD, it might be presented as low or high bone turnover disease. To select the appropriate intervention, it is crucial to comprehend the etiology of bone loss [4]. In patients with CKD, the pathogenesis of osteoporosis is complex and multi-factorial. Many factors lead to bone loss in patients with kidney disease. Renal osteodystrophy is determined by an imbalance in bone remodeling, parathyroid hormone changes, bone mineral and vitamin D abnormalities. Furthermore, the uremic milieu, medication usage, disrupted gonadal hormones, and premature aging contribute to the increased prevalence of osteoporotic fractures among patients with ESKD [5]. Moreover, patients with CKD has not only a bone quantity but also a bone quality problem [6].
Complex spinal fixation of a cervical vertebra Brown tumour: report of an unusual case
Published in British Journal of Neurosurgery, 2019
Sebastian Miguel Toescu, Maria Ibrahim, Dominic G. O’Donovan, Gowrie Balasubramaniam, Karoly M. David
In pathophysiological terms, brown tumours are localised forms of osteitis fibrosa cystica (previously known as von Recklinghausen’s disease of bone) a classic manifestation of renal osteodystrophy. The clinical presentation of brown tumours is usually with bone pain, although when located in vertebrae they can – as in this case – present acutely due to neurological compromise or vertebral fracture. Radiographic signs of well-defined lytic lesions with thinned cortex and little reactive bone, are commonly seen. The term chronic kidney disease-mineral bone disorder (CKD-MBD) has now replaced renal osteodystrophy, in order to reflect other facets of this variegated pathology, such as adynamic bone disease, osteomalacia, and vascular calcification which leads to excess mortality through cerebro- and cardiovascular disease.
Neuro-urological sequelae of lumbar spinal stenosis
Published in International Journal of Neuroscience, 2018
Jason Gandhi, Janki Shah, Gargi Joshi, Sohrab Vatsia, Andrew DiMatteo, Gunjan Joshi, Noel L. Smith, Sardar Ali Khan
A case report revealed a possible link between renal osteodystrophy and LSS [28]. A woman with achondroplasia presented with symptoms of LSS; however, she also had end-stage renal disease with severe renal osteodystrophy [28]. The authors concluded that renal osteodystrophy might have accentuated the LSS, which is a standard feature of achondroplasia [28]. In another case of concurrent LSS and renal osteodystrophy, the presence of renal osteodystrophy eventually led to the onset of neurological symptoms [29]. This patient's case revealed a possible causative relationship between renal osteodystrophy and LSS [29]. Moreland et al. additionally reported an association between renal osteodystrophy and LSS [30]. Akin to LSS, thoracic spinal stenosis has also been linked to renal osteodystrophy [31].