renal osteodystrophy
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Etiology
Pathology
- 4 components:
- osteitis fibrosa cystica
- secondary hyperparathyroidism
- osteoclastic overactivity
- subperiosteal resorption of bone, most prominent at phalanges
- osteomalacia
- 1,25-dihydroxy-vitamin D deficiency
- increased osteoid formation within bone
- bone pain, bone fractures
- adynamic bone disease*
- relatively suppressed plasma PTH due to chronic illness, ESRD or vitamin D analogs
- risk for bone fractures increased by bisphosphonates
- osteoporosis*
- growth retardation
- osteitis fibrosa cystica
- pathophysiology
- phosphate retention
- stimulates parathyroid hormone (see secondary hyperparathyroidism)
- decrease in urinary calcium
- bone is often poorly responsive to PTH in chronic renal failure
- 1,25 dihydroxyvitamin D deficiency leads to:
- phosphate retention
- increasing PTH (see secondary hyperparathyroidism)
Laboratory
- serum PTH may be markedly increased
Radiology
Management
- renal diet: restriction of phosphate-rich foods
- intestinal phosphate binders
- calcitriol
More general terms
More specific terms
Additional terms
- hyperparathyroidism
- osteitis fibrosa cystica; von Recklinghausen's disease of bone
- osteomalacia
- osteoporosis
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 617
- ↑ Carvalho C, Alves CM, Frazao JM. The role of bone biopsy for the diagnosis of renal osteodystrophy: a short overview and future perspectives. J Nephrol. 2016 Oct;29(5):617-26. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27473148
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 19. American College of Physicians, Philadelphia 2021
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ Renal Osteodystrophy http://kidney.niddk.nih.gov/kudiseases/pubs/renalosteodystrophy/index.htm