Renal osteodystrophy
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| Renal osteodystrophy Classification and external resources | |
| ICD-10 | N25.0 |
|---|---|
| ICD-9 | 588.0 |
| eMedicine | radio/500 |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
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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]
References
- ↑ 1.0 1.1 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. PMID 9829478.
External links
WikiDoc Research Resources for Renal osteodystrophy | |
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| Articles on Renal osteodystrophy | Most recent articles on Renal osteodystrophy • Most cited articles on Renal osteodystrophy • Review articles on Renal osteodystrophy • Articles on Renal osteodystrophy in N Eng J Med, Lancet, BMJ |
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| Evidence Based Medicine Regarding Renal osteodystrophy | Cochrane Collaboration on Renal osteodystrophy • Bandolier on Renal osteodystrophy • TRIP on Renal osteodystrophy |
| Cost Effectiveness of Renal osteodystrophy | Cost Effectiveness of Renal osteodystrophy |
| Clinical Trials Involving Renal osteodystrophy | Ongoing Trials on Renal osteodystrophy at Clinical Trials.gov • Trial results on Renal osteodystrophy • Clinical Trials on Renal osteodystrophy at Google |
| Guidelines / Policies / Government Resources (FDA/CDC) Regarding Renal osteodystrophy | US National Guidelines Clearinghouse on Renal osteodystrophy • NICE Guidance on Renal osteodystrophy • NHS PRODIGY Guidance • FDA on Renal osteodystrophy • CDC on Renal osteodystrophy |
| Textbook Information on Renal osteodystrophy | Books and Textbook Information on Renal osteodystrophy |
| Pharmacology Resources on Renal osteodystrophy | Dosing of Renal osteodystrophy • Drug interactions with Renal osteodystrophy • Side effects of Renal osteodystrophy • Allergic reactions to Renal osteodystrophy • Overdose information on Renal osteodystrophy • Carcinogenicity information on Renal osteodystrophy • Renal osteodystrophy in pregnancy • Pharmacokinetics of Renal osteodystrophy • |
| Genetics, Pharmacogenomics, and Proteinomics of Renal osteodystrophy | Genetics of Renal osteodystrophy • Pharmacogenomics of Renal osteodystrophy • Proteomics of Renal osteodystrophy |
| Newstories on Renal osteodystrophy | Renal osteodystrophy in the news • Be alerted to news on Renal osteodystrophy • News trends on Renal osteodystrophy |
| Commentary on Renal osteodystrophy | Blogs on Renal osteodystrophy |
| Patient Resources on Renal osteodystrophy | Patient resources on Renal osteodystrophy • Discussion groups on Renal osteodystrophy • Patient Handouts on Renal osteodystrophy • Directions to Hospitals Treating Renal osteodystrophy • Risk calculators and risk factors for Renal osteodystrophy |
| Healthcare Provider Resources on Renal osteodystrophy | Symptoms of Renal osteodystrophy • Causes & Risk Factors for Renal osteodystrophy • Diagnostic studies for Renal osteodystrophy • Treatment of Renal osteodystrophy |
| Continuing Medical Education (CME) Programs on Renal osteodystrophy | CME Programs on Renal osteodystrophy |
| International Resources on Renal osteodystrophy | Renal osteodystrophy en Espanol • Renal osteodystrophy en Francais |
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| Informatics Resources on Renal osteodystrophy | List of terms related to Renal osteodystrophy |
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Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
