Clinical Features and Manifestations of CKD-MBD

Severe maxillofacial renal osteodystrophy in two patients with chronic kidney disease

“…Patients with CKD commonly have alterations in several mineral metabolisms including hyperphosphatemia, hypocalcemia, and 1,25-dihydroxyvitamin D 3 or calcitrol (active metabolite of vitamin D), which eventually lead to a compensatory overproduction of PTH by parathyroid glands in a condition known as HPT-II [9][10][11]. As renal function declines, 1,25-dihydroxyvitamin D 3 synthesis becomes impaired, which leads to deficiency in renal calcium absorption, resulting in hypocalcemia.…”

“…As renal function declines, 1,25-dihydroxyvitamin D 3 synthesis becomes impaired, which leads to deficiency in renal calcium absorption, resulting in hypocalcemia. The calcium sensing receptor (CaSR), which is highly expressed in the parathyroid glands, senses the low serum calcium concentrations, leading to a compensatory increase in PTH (HPT-II) in the attempt to maintain the homeostasis of calcium [10]. In the meantime, the reduction of glomerular filtration also leads to impaired phosphate excretion, elevating the serum concentration of phosphate.…”

“…In the meantime, the reduction of glomerular filtration also leads to impaired phosphate excretion, elevating the serum concentration of phosphate. Hyperphosphatemia can act by directly stimulating PTH synthesis and parathyroid hyperplasia and indirectly promoting HPT-II by decreasing the serum calcium level [1,2,10]. Excess of PTH acts in the transformation of the inactive form of vitamin D to 1,25-dihydroxyvitamin D 3 in the kidney and influences the development and activity of osteoclasts, osteoblasts, and osteocytes, thereby affecting bone turnover [1,4].…”

“…Usually, the alterations in bone metabolism are diagnosed by laboratory tests before the development of macroscopic skeletal changes [7,10]. The majority of macroscopic manifestations of ROD present as diffuse jaw enlargement [13].…”

Accidental falling in community-dwelling elderly with chronic kidney disease

“…Patients with CKD have a higher rate of cognitive impairment, depressive symptoms, exhaustion, impaired mobility, polypharmacy, and frailty [ 8 ]. Patients with CKD are also more vulnerable for fractures, due to renal osteodystrophy [ 9 ]. The coexistence of factors such as polypharmacy, comorbidities, cognitive impairment, and depression suggests that patients with different degrees of CKD are more likely to fall than the general population.…”