Bone biopsy results and serum bone turnover parameters in uremic children

Ziółkowska, Helena; Pańczyk-Tomaszewska, Małgorzata; DęLbiński, A; Polowiec, Z; Sawicki, Andrzej; Sieniawska, M

doi:10.1111/j.1651-2227.2000.tb00361.x

Cited by 47 publications

(21 citation statements)

References 20 publications

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“…Whereas early case series of bone biopsy results in children on maintenance dialysis reported high-turnover bone disease (osteitis fibrosa and mild lesions of secondary hyperparathyroidism) in the vast majority of patients [8][9][10], more recent series identified adynamic bone in a substantial proportion (27-33%) of children and adolescents [11][12][13]. The implications of low bone turnover for bone structure and strength during growth are not known; however, this bone lesion is associated with increased fracture risk in adults [14] -perhaps due to impaired microfracture repair.…”

Section: Histomorphometry Of Renal Osteodystrophymentioning

confidence: 99%

A structural approach to the assessment of fracture risk in children and adolescents with chronic kidney disease

Leonard

2007

Pediatr Nephrol

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Children with chronic kidney disease (CKD) have multiple risk factors for impaired accretion of trabecular and cortical bone. CKD during childhood poses an immediate fracture risk and compromises adult bone mass, resulting in significantly greater skeletal fragility throughout life. Highturnover disease initially results in thickened trabeculae, with greater bone volume. As disease progresses, resorption cavities dissect trabeculae, connectivity degrades, and bone volume decreases. Increased bone turnover also results in increased cortical porosity and decreased cortical thickness. Dual-energy X-ray absorptiometry (DXA)-based measures of bone mineral density (BMD) are derived from the total bone mass within the projected bone area (g/cm 2 ), concealing distinct disease effects in trabecular and cortical bone. In contrast, peripheral quantitative computed tomography (pQCT) estimates volumetric BMD (vBMD, g/cm 3 ), distinguishes between cortical and trabecular bone, and provides accurate estimates of cortical dimensions. Recent data have confirmed that pQCT measures of cortical vBMD and thickness provide substantially greater fracture discrimination in adult dialysis patients compared with hip or spine DXA. The following review considers the structural effects of renal osteodystrophy as it relates to fracture risk and the potential advantages and disadvantages of DXA and alternative measures of bone density, geometry, and microarchitecture, such as pQCT, micro-CT (μCT), and micro magnetic resonance imaging (μMRI) for fracture risk assessment.

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Section: Histomorphometry Of Renal Osteodystrophymentioning

confidence: 99%

A structural approach to the assessment of fracture risk in children and adolescents with chronic kidney disease

Leonard

2007

Pediatr Nephrol

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“…There is, however, little evidence on which to base recommendations for optimum PTH levels in children [25]. Published data relate to studies in dialyzed children [26,27,28] and, although concurring with adult data regarding the relationship between PTH levels, bone turnover, and ROD, are inconsistent with regard to effects upon growth. Recently two small studies, of 8 and 12 patients respectively [18,29], investigating C-PTH, concluded that the availability of a newer more specific PTH assay may have significant implications for the treatment of ROD in children.…”

Section: Introductionmentioning

confidence: 96%

Parathyroid hormone and its fragments in children with chronic renal failure

Waller

Reynolds

Ridout

et al. 2003

Pediatric Nephrology

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Parathyroid hormone (PTH) immunoradiometric assays (IRMA) exhibit cross-reactivity between 1-84 PTH and long carboxyl-terminal-PTH (C-PTH) molecules. C-PTH antagonizes the biological actions of 1-84 PTH and circulates in excess in chronic renal failure (CRF), partially explaining why supra-physiological PTH levels are recommended to maintain bone turnover. Furthermore, the ratio 1-84 PTH/C-PTH may be related to bone turnover. This study characterizes the 1-84 PTH/C-PTH ratio in children with varying severity of CRF and levels of PTH. Two hundred and forty-one children with CRF, managed with the aim of preventing the development of hyperparathyroidism, had PTH measured by 'intact' IRMA and a new more specific Cyclase-Activating-PTH (CAP) IRMA. C-PTH levels were calculated by subtracting CAP-IRMA from 'intact' IRMA. Fifty-three controls with normal renal function were also recruited. Mean 'intact' IRMA correlated with CAP-IRMA ( r=0.98), but was higher ( P<0.001). The mean 1-84 PTH/C-PTH ratio was lower than controls in dialysis patients ( P=0.022) and those with a glomerular filtration rate <30 ml/min per m(2 )( P=0.033). This ratio was comparable to controls when the PTH level was normal, but was lower with PTH levels outside the normal range ( P<0.01). These data suggest that CAP-IRMA gives a more accurate assessment of actual PTH levels than 'intact' IRMA in CRF. Maintenance of normal PTH levels throughout the course of CRF permits the maintenance of a normal 1-84 PTH/C-PTH ratio, the clinical significance of which requires further investigation in children.

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“…However, in children on dialysis ABD has been associated with lower PTH levels and poor growth [11]; however, these data may be confounded by the use of a high-dose calcitriol prescription. Others have found good growth in two children with ABD diagnosed by bone biopsy [12,13], although the type, if any, of vitamin D prescription in these patients was not clear. We have shown that catch-up growth (a concept that is hard to reconcile with ABD) can be achieved with PTH levels less than 2 times ULN [14].…”

Section: Introductionmentioning

confidence: 97%

Catch-up growth with normal parathyroid hormone levels in chronic renal failure

et al. 2003

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The optimum range for parathyroid hormone (PTH) levels in children with chronic renal failure (CRF) remains undefined. We aimed to determine growth velocity in children with CRF managed with normal PTH levels. We performed a retrospective case note review of 99 children (77 boys), with a glomerular filtration rate (GFR) <41 ml/min per 1.73 m(2), who had at least 2 years of 3-monthly follow-up. The age range at entry was 0.5-6.0 years; data collection was continued until 10 years of age or the commencement of growth hormone or renal replacement therapy. The median GFR was 22 ml/min per 1.73 m(2); over the study period mean serum calcium and phosphate levels were approximately equal to the mid-point of the respective normal ranges. Median PTH levels were equal to the upper limit of the normal range. Height standard deviation score (Ht SDS) at entry was -1.73. During the study period the overall mean change in Ht SDS was +0.3, significantly greater than the no change expected of a normal population ( P=0.004). The median dose of calcium carbonate was 150 mg/kg per day and 1-alpha calcidol 0.015 microg/kg per day. The growth rate was independent of all parameters, including age, PTH levels, the use of enteral feeds, and 1-alpha calcidol prescription. Our results indicate that catch-up growth can occur in infants and children with CRF when medical therapy is aimed at normalizing PTH levels.

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Bone biopsy results and serum bone turnover parameters in uremic children

Abstract: The biochemical markers of bone turnover have only limited value in the differentiation of renal osteodystrophy types.

Cited by 47 publications

References 20 publications

A structural approach to the assessment of fracture risk in children and adolescents with chronic kidney disease

A structural approach to the assessment of fracture risk in children and adolescents with chronic kidney disease

Parathyroid hormone and its fragments in children with chronic renal failure

Catch-up growth with normal parathyroid hormone levels in chronic renal failure

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