Renal osteodystrophy

bone disease
Renal osteodystrophy is currently defined as an alteration of bone morphology in patients with chronic kidney disease (CKD).wikipedia
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Chronic kidney disease

chronic renal failurerenal insufficiencyend-stage renal disease
Renal osteodystrophy is currently defined as an alteration of bone morphology in patients with chronic kidney disease (CKD).
Complications may include heart disease, high blood pressure, bone disease, or anemia.

Chronic kidney disease-mineral and bone disorder

chronic kidney disease-mineral bone disorder (CKD-MBD)chronic kidney disease–mineral and bone disorder
It is one measure of the skeletal component of the systemic disorder of chronic kidney disease-mineral and bone disorder (CKD-MBD).
CKD-MBD broadens the "old" concept of "renal osteodystrophy", which now should be restricted to describing the bone pathology associated with CKD.

Hyperparathyroidism

Foot NoteH'''yperparathyroidismHyperparathyroidism, unspec.
Renal osteodystrophy has been classically described to be the result of hyperparathyroidism secondary to hyperphosphatemia combined with hypocalcemia, both of which are due to decreased excretion of phosphate by the damaged kidney.
In secondary hyperparathyroidism the parathyroid gland is behaving normally; clinical problems are due to bone resorption and manifest as bone syndromes such as rickets, osteomalacia and renal osteodystrophy.

Hyperphosphatemia

hyperphosphataemiaphosphorusrenal failure
Renal osteodystrophy has been classically described to be the result of hyperparathyroidism secondary to hyperphosphatemia combined with hypocalcemia, both of which are due to decreased excretion of phosphate by the damaged kidney.
Signs and symptoms include ectopic calcification, secondary hyperparathyroidism, and renal osteodystrophy.

Osteomalacia

rachiticricketssoftening of the bones
The traditional types of renal osteodystrophy have been defined on the basis of turnover and mineralization as follows: 1) mild, slight increase in turnover and normal mineralization; 2) osteitis fibrosa, increased turnover and normal mineralization; 3) osteomalacia, decreased turnover and abnormal mineralization; 4) adynamic, decreased turnover and acellularity; and, 5) mixed, increased turnover with abnormal mineralization.
Low serum phosphate, except in cases of renal osteodystrophy

Calcitriol

1,25-Dihydroxycholecalciferol1,25 dihydroxyvitamin D 3 1,25-dihydroxyvitamin D 3
Low activated vitamin D 3 levels are a result of the damaged kidneys' inability to convert vitamin D 3 into its active form, calcitriol, and result in further hypocalcaemia. In advanced stages, blood tests will indicate decreased calcium and calcitriol (vitamin D) and increased phosphate, and parathyroid hormone levels.
Treatment of hypocalcaemia – hypoparathyroidism, osteomalacia (adults), rickets (infants, children), renal osteodystrophy, chronic kidney disease

Osteoporosis

bone lossosteoporoticpostmenopausal osteoporosis
osteoporosis
Renal insufficiency can lead to renal osteodystrophy.

Pubic symphysis

symphysis pubisarcuate pubic ligamentsymphysis
X-rays will also show bone features of renal osteodystrophy (subperiostic bone resorption, chondrocalcinosis at the knees and pubic symphysis, osteopenia and bone fractures) but may be difficult to differentiate from other conditions.
Metabolic diseases, such as renal osteodystrophy, produce widening, while ochronosis results in calcific deposits in the symphysis.

Brown tumor

brown tumor should be considered as the top-line diagnosis if a mass-forming lesion is present.
Brown tumors may be rarely associated with ectopic parathyroid adenomas or end stage renal osteodystrophy.

Bone fracture

fracturefracturescompound fracture
Bone fracture The broader concept of chronic kidney disease-mineral and bone disorder (CKD-MBD) is not only associated with fractures but also with cardiovascular calcification, poor quality of life and increased morbidity and mortality in CKD patients (the so-called bone-vascular axis). These clinical consequences are acquiring such an importance that scientific working groups (such as the ERA-EDTA CKD-MBD Working Group ) or international initiatives are trying to promote research in the field including basic, translational and clinical research.

Calcification

calcifieduncalcifiedcalcifying
The broader concept of chronic kidney disease-mineral and bone disorder (CKD-MBD) is not only associated with fractures but also with cardiovascular calcification, poor quality of life and increased morbidity and mortality in CKD patients (the so-called bone-vascular axis). These clinical consequences are acquiring such an importance that scientific working groups (such as the ERA-EDTA CKD-MBD Working Group ) or international initiatives are trying to promote research in the field including basic, translational and clinical research.

Cholecalciferol

vitamin D 3 vitamin D3colecalciferol
Low activated vitamin D 3 levels are a result of the damaged kidneys' inability to convert vitamin D 3 into its active form, calcitriol, and result in further hypocalcaemia.

Hypocalcaemia

hypocalcemialow blood calciumcalcium deficiency
Renal osteodystrophy has been classically described to be the result of hyperparathyroidism secondary to hyperphosphatemia combined with hypocalcemia, both of which are due to decreased excretion of phosphate by the damaged kidney. Low activated vitamin D 3 levels are a result of the damaged kidneys' inability to convert vitamin D 3 into its active form, calcitriol, and result in further hypocalcaemia.

Fibroblast growth factor 23

Fibroblast growth factor 23(FGF23)fibroblast growth factor-23FGF 23
High levels of fibroblast growth factor 23 seem now to be the most important cause of decreased calcitriol levels in CKD patients.

Parathyroid hormone

PTHparathyroid hyperplasiaParathormone
In CKD, the excessive production of parathyroid hormone increases the bone resorption rate and leads to histologic bone signs of secondary hyperparathyroidism. In advanced stages, blood tests will indicate decreased calcium and calcitriol (vitamin D) and increased phosphate, and parathyroid hormone levels.

Calcimimetic

However, in other situations, the initial increase in parathyroid hormone and bone remodeling may be slowed down excessively by a multitude of factors, including age, ethnic origin, sex, and treatments such as vitamin D, calcium salts, calcimimetic s, steroids, and so forth, leading to low bone turnover or adynamic bone disease.

Calcium

CaCa 2+ calcium ion
In advanced stages, blood tests will indicate decreased calcium and calcitriol (vitamin D) and increased phosphate, and parathyroid hormone levels.

Phosphate

phosphatesphosphate groupinorganic phosphate
In advanced stages, blood tests will indicate decreased calcium and calcitriol (vitamin D) and increased phosphate, and parathyroid hormone levels.

Chondrocalcinosis

calcifiedcalcium pyrophosphate dihydrate crystal depositionspseudogout
X-rays will also show bone features of renal osteodystrophy (subperiostic bone resorption, chondrocalcinosis at the knees and pubic symphysis, osteopenia and bone fractures) but may be difficult to differentiate from other conditions.

Osteopenia

Reduced bone massDiminished bone density
X-rays will also show bone features of renal osteodystrophy (subperiostic bone resorption, chondrocalcinosis at the knees and pubic symphysis, osteopenia and bone fractures) but may be difficult to differentiate from other conditions.

Vitamin D

Dcalciferol1,25 Dihydroxy vitamin D
calcium and/or native vitamin D supplementation

Phosphate binder

phosphate binderslanthanum saltphosphate binding
phosphate binders such as calcium carbonate, calcium acetate, sevelamer hydrochloride or carbonate, lanthanum carbonate, sucroferric oxyhydroxide, ferric citrate among others

Calcium carbonate

CaCO 3 calcareouscalcium
phosphate binders such as calcium carbonate, calcium acetate, sevelamer hydrochloride or carbonate, lanthanum carbonate, sucroferric oxyhydroxide, ferric citrate among others