Comparing Populations
Gary L. Rosner, Purushottam W. Laud, Wesley O. Johnson in Bayesian Thinking in Biostatistics, 2021
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).
Diabetic Nephropathy
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
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.
Renal Diseases
Stephan Strobel, Lewis Spitz, Stephen D. Marks in Great Ormond Street Handbook of Paediatrics, 2019
The principles of management of renal osteodystrophy are: Correction of acidosis using sodium bicarbonate.Phosphate restriction by control of dietary intake and the use of a phosphate binder (e.g. calcium carbonate to maintain plasma phosphate within the normal range for age).Supplements of oral 1-α-hydroxycholecalciferol or 1,25 dihydroxycholecalciferol to maintain the PTH within normal range, if not achieved by control of plasma phosphate. This may require the total calcium to be maintained at the upper end of the normal range. Total calcium is a measurement of bound, ionised and complexed calcium. The proportion may increase in CKD, reflected by total hypercalcaemia. However, if the ionised calcium is within the normal range, treatment with vitamin D analogues may continue.
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].
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].
Related Knowledge Centers
- Bone Pain
- Calcification
- Chronic Kidney Disease
- Hyperparathyroidism
- Hyperphosphatemia
- Kidney Failure
- Osteomalacia
- Bone Fracture
- Arthralgia
- Chronic Kidney Disease-Mineral & Bone Disorder