Uremic Osteodystrophy



The development of bone disease is universal in patients with renal disease. Clinical manifes­tation varies widely, ranging from only laboratory abnormalities (elevated alkaline phosphatase) or radiographic findings to severe and disabling bone pain and fractures. Three distinctive metabolic bone diseases occur in association with ESRD. Although all are present to a variable de­gree, one subtype may dominate the clinical pic­ture. Hyperparathyroidism is universal in ESRD; the bone manifestations are the development of osteitis fibrosa cystica. In advanced renal disease, there is a failure to convert vitamin D to its active metabolite, l,25(OH)2 vitamin D and, as a con­sequence, rickets or osteomalacia develops. In ad­dition, recent evidence indicates that the accu­mulation of aluminum metabolites in bone results in a form of vitamin D-resistant rickets. Owing to a variety of factors, including sustained acidosis and poor nutrition, osteoporosis is common.





Uremic Osteodystrophy