Renal osteodystrophy or chronic kidney disease-mineral and bone disorder is a bone

Bone

Bones are rigid organs that constitute part of the endoskeleton of vertebrates. They support, and protect the various organs of the body, produce red and white blood cells and store minerals. Bone tissue is a type of dense connective tissue...

 pathology

Pathology

Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....

, characterized by bone mineralization deficiency, that is a direct result of the electrolyte

Electrolyte

In chemistry, an electrolyte is any substance containing free ions that make the substance electrically conductive. The most typical electrolyte is an ionic solution, but molten electrolytes and solid electrolytes are also possible....

 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:

• Bone pain
  Bone pain
  Bone pain is a debilitating form of pain emanating from the bone tissue. It occurs as a result of a wide range of diseases and/or physical conditions and may severely impair the quality of life for patients who suffer from it...
  
  
• Joint pain
  Arthralgia
  Arthralgia literally means joint pain; it is a symptom of injury, infection, illnesses or an allergic reaction to medication....
  
  
• Bone deformation
• Bone fracture
  Bone fracture
  A bone fracture is a medical condition in which there is a break in the continuity of the bone...
  
  

Diagnosis

Renal osteodystrophy is usually diagnosed after treatment for end-stage renal disease begins. Blood tests will indicate decreased calcium

Calcium

Calcium is the chemical element with the symbol Ca and atomic number 20. It has an atomic mass of 40.078 amu. Calcium is a soft gray alkaline earth metal, and is the fifth-most-abundant element by mass in the Earth's crust...

 and calcitriol

Calcitriol

Calcitriol , also called 1,25-dihydroxycholecalciferol or 1,25-dihydroxyvitamin D3, is the hormonally active form of vitamin D with three hydroxyl groups...

 and increased phosphate

Phosphate

A phosphate, an inorganic chemical, is a salt of phosphoric acid. In organic chemistry, a phosphate, or organophosphate, is an ester of phosphoric acid. Organic phosphates are important in biochemistry and biogeochemistry or ecology. Inorganic phosphates are mined to obtain phosphorus for use in...

 and parathyroid hormone

Parathyroid hormone

Parathyroid hormone , parathormone or parathyrin, is secreted by the chief cells of the parathyroid glands as a polypeptide containing 84 amino acids...

. X-rays will also show bone features of renal osteodystropy (chondrocalcinosis at the knees and pubic symphysis

Pubic symphysis

The pubic symphysis or symphysis pubis is the midline cartilaginous joint uniting the superior rami of the left and right pubic bones. It is located anterior to the urinary bladder and superior to the external genitalia; for females it is above the vulva and for males it is above the penis...

, osteopenia

Osteopenia

Osteopenia is a condition where bone mineral density is lower than normal. It is considered by many doctors to be a precursor to osteoporosis. However, not every person diagnosed with osteopenia will develop osteoporosis...

 and bone fractures) but may be difficult to differentiate from other conditions.

Pathogenesis

Renal osteodystrophy is thought to be the result of hyperparathyroidism

Hyperparathyroidism

Hyperparathyroidism is overactivity of the parathyroid glands resulting in excess production of parathyroid hormone . The parathyroid hormone regulates calcium and phosphate levels and helps to maintain these levels...

 secondary to hyperphosphatemia

Hyperphosphatemia

Hyperphosphatemia is an electrolyte disturbance in which there is an abnormally elevated level of phosphate in the blood. Often, calcium levels are lowered due to precipitation of phosphate with the calcium in tissues.-Signs and symptoms:...

 combined with hypocalcaemia

Hypocalcaemia

In medicine, hypocalcaemia is the presence of low serum calcium levels in the blood, usually taken as less than 2.1 mmol/L or 9 mg/dl or an ionized calcium level of less than 1.1 mmol/L or 4.5 mg/dL. It is a type of electrolyte disturbance...

, 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

Calcitriol

Calcitriol , also called 1,25-dihydroxycholecalciferol or 1,25-dihydroxyvitamin D3, is the hormonally active form of vitamin D with three hydroxyl groups...

, and result in further hypocalcaemia

Hypocalcaemia

In medicine, hypocalcaemia is the presence of low serum calcium levels in the blood, usually taken as less than 2.1 mmol/L or 9 mg/dl or an ionized calcium level of less than 1.1 mmol/L or 4.5 mg/dL. It is a type of electrolyte disturbance...

.

Differential diagnosis

To confirm diagnosis, renal osteodystrophy must be distinguished from:

• osteoporosis
  Osteoporosis
  Osteoporosis is a disease of bones that leads to an increased risk of fracture. In osteoporosis the bone mineral density is reduced, bone microarchitecture is deteriorating, and the amount and variety of proteins in bone is altered...
  
   (Alk Phos and PO₄ usually normal)
• osteopenia
  Osteopenia
  Osteopenia is a condition where bone mineral density is lower than normal. It is considered by many doctors to be a precursor to osteoporosis. However, not every person diagnosed with osteopenia will develop osteoporosis...
  
  
• osteomalacia
  Osteomalacia
  Osteomalacia is the softening of the bones caused by defective bone mineralization secondary to inadequate amounts of available phosphorus and calcium, or because of overactive resorption of calcium from the bone as a result of hyperparathyroidism...
  
  
• hyperparathyroidism
  Hyperparathyroidism
  Hyperparathyroidism is overactivity of the parathyroid glands resulting in excess production of parathyroid hormone . The parathyroid hormone regulates calcium and phosphate levels and helps to maintain these levels...
  
  
• multiple myeloma
  Multiple myeloma
  Multiple myeloma , also known as plasma cell myeloma or Kahler's disease , is a cancer of plasma cells, a type of white blood cell normally responsible for the production of antibodies...
  
  
• soft tissue calcification
• chondrocalcinosis
• hypervitaminosis

Treatment

Treatment for renal osteodystrophy includes:

• calcium and vitamin D
  Vitamin D
  Vitamin D is a group of fat-soluble secosteroids. In humans, vitamin D is unique both because it functions as a prohormone and because the body can synthesize it when sun exposure is adequate ....
  
   supplementation
• restriction of dietary phosphate
• phosphate binders
  Phosphate binders
  Phosphate binders are a group of medications used to reduce the absorption of phosphate and taken with meals and snacks. They are typically used in patients with chronic renal failure as they cannot get rid of the phosphates that get into their blood Phosphate binders are a group of medications...
  
   such as calcium carbonate
  Calcium carbonate
  Calcium carbonate is a chemical compound with the formula CaCO3. It is a common substance found in rocks in all parts of the world, and is the main component of shells of marine organisms, snails, coal balls, pearls, and eggshells. Calcium carbonate is the active ingredient in agricultural lime,...
  
  , calcium acetate
  Calcium acetate
  The chemical compound calcium acetate is the calcium salt of acetic acid. It has the formula Ca2. Its standard name is calcium acetate, while calcium ethanoate is the systematic IUPAC name. An older name is acetate of lime...
  
  , sevelamer
  Sevelamer
  Sevelamer is a phosphate binding drug used to prevent hyperphosphatemia in patients with chronic renal failure. When taken with meals, it binds to dietary phosphate and prevents its absorption...
  
   hydrochloride, or lanthanum carbonate
  Lanthanum carbonate
  Lanthanum carbonate, La23, is the salt formed by lanthanum cations and carbonate anions. It is an ore of lanthanum metal, along with monazite.- Chemistry :...
  
  
• cinacalcet
  Cinacalcet
  Cinacalcet is a drug that acts as a calcimimetic by allosteric activation of the calcium-sensing receptor that is expressed in various human organ tissues. It is sold by Amgen under the trade name Sensipar in North America and Australia and as Mimpara in Europe...
  
  
• renal transplantation
• hemodialysis
  Hemodialysis
  In medicine, hemodialysis is a method for removing waste products such as creatinine and urea, as well as free water from the blood when the kidneys are in renal failure. Hemodialysis is one of three renal replacement therapies .Hemodialysis can be an outpatient or inpatient therapy...
  
   five times a week is thought to be of benefit

Prognosis

Recovery from renal osteodystrophy has been observed post renal transplantation. Renal osteodystrophy is a chronic

Chronic (medicine)

A chronic disease is a disease or other human health condition that is persistent or long-lasting in nature. The term chronic is usually applied when the course of the disease lasts for more than three months. Common chronic diseases include asthma, cancer, diabetes and HIV/AIDS.In medicine, the...

condition with a conventional hemodialysis schedule.

External links

• Renal Osteodystrophy - NKUDIC, NIH