|Classification and external resources|
Renal osteodystrophy or chronic kidney disease-mineral and bone disorder (CKD-MBD) 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:
Renal osteodystrophy is usually diagnosed after treatment for end-stage renal disease begins. Blood tests will indicate decreased calcium and calcitriol (vitamin D) and increased phosphate and parathyroid hormone. X-rays will also show bone features of renal osteodystrophy (chondrocalcinosis at the knees and pubic symphysis, osteopenia and bone fractures) but may be difficult to differentiate from other conditions.
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.
To confirm diagnosis, renal osteodystrophy must be distinguished from:
- osteoporosis (Alk Phos and PO4 usually normal)
- multiple myeloma
- soft tissue calcification
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
- renal transplantation
- hemodialysis five times a week is thought to be of benefit
- Svára F (March 2009). "Chronic kidney disease-mineral and bone disorder (CKD-MBD): a new term for a complex approach". J Ren Care. 35 Suppl 1: 3–6. doi:10.1111/j.1755-6686.2009.00067.x. PMID 19222724.
- Bonomini V, Mioli V, Albertazzi A, Scolari P (1998). "Daily-dialysis programme: indications and results". Nephrol. Dial. Transplant. 13 (11): 2774–7; discussion 2777–8. doi:10.1093/ndt/13.11.2774. PMID 9829478.
- Renal Osteodystrophy - NKUDIC, NIH