Renal osteodystrophy (renal rickets) includes bone changes in patients with chronic renal failure. These changes are caused by disturbances in calcium and phosphate metabolism, which lead to abnormalities in bone formation, resorption and mineralization.
Renal osteodystrophy( renal rickets ) is characterized by bone disorders due to changes in the calcium-phosphorus balance.
Renal osteodystrophy: types
- osteodystrophy with accelerated bone turnover,caused by secondary hyperparathyroidism and excess parathyroid hormone (PTH); this osteodystrophy is characterized by increased bone breakdown and partially accelerated bone reconstruction; in more severe cases, there is fibrosis within the myeloid cavity;
- slow bone turnover osteodystrophy- divided into osteomalacia, aluminum osteomalacia and adynamic bone disease;osteomalaciadevelops as a result of vitamin D deficiency or bone tissue resistance to its action - bones become soft and prone to fractures;aluminum osteopathydevelops in patients treated with aluminum or on dialysis who come into contact with aluminum compounds;adynamic bone diseaseoccurs in patients treated with high doses of vitamin D or after parathyroidectomy
- osteodystrophy due to beta-2-microglubulin deposition( dialysis amyloidosis ,amyloidosis ) mainly in the bones and around the joints in dialysis patients, often leading to symptoms of carpal tunnel syndrome
Renal osteodystrophy: symptoms
The features of renal osteodystrophy are not very characteristic and appear late in the course of chronic renal failure. Patients complain about:
- bone pain and joint pain
- muscle weakness
- itchy skin
- sometimes there is acute arthritis or rupture of tendons
- as the disease progresses, deformities and pathological bone fractures are observed
- deposition of calcium s alts in the eye leads to visual disturbances and conjunctivitis
- s alt accumulation in the kidney is responsible for the progression of chronic kidney failure
Renal osteodystrophy: diagnosis
In order to diagnose the disease, laboratory tests of calcium and phosphorus metabolism should be performed. Additionally, X-rays of the bones and X-rays of the abdominal cavity organs and chest X-rays, bone scintigraphy, densitometry and quantitative computed tomography of the bones are performed. To be sure, you can also biopsy the iliac plate and examine the tissue under a microscope.
Renal osteodystrophy: treatment
Treatment of renal osteodystrophy consists primarily in maintaining the correct calcium-phosphate metabolism (serum calcium, phosphorus, parathyroid hormone levels and the product of calcium and phosphorus concentrations in the blood) within optimal limits.
The goal is to normalize the parathyroid gland function (treatment of hyperfunction in the forms with accelerated bone metabolism, and stimulation of parathyroid function in adynamic bone disease), and in the case of aluminum osteopathy to eliminate aluminum exposure and lower its level in blood serum.
Osteomalacia is treated with vitamin D.
For dialysis amyloidosis, a kidney transplant is required.