Correlation of bone histology with parathyroid hormone, vitamin D3, and radiology in end-stage renal disease

Abstract

We analyzed transiliac bone biopsy specimens from 30 end-stage renal failure patients, taken at the time of admission for CAPD training. Results were compared with values of iPTH, bone alkaline phosphatase, 1,25-dihydroxyvitamin D3, skeletal survey, quantitative computed tomography (QCT) and single photon absorptiometry (SPA) bone density measurements. Osteitis fibrosa was the most common histological diagnosis, present in 15 of the 30 patients (50%), with eight classified as "severe" and seven as "mild." Eight patients (27%) had adynamic bone lesion, four mixed renal osteodystrophy (13%), and two (7%) osteomalacia. The mean age of the adynamic group was higher than the osteitis fibrosa group (41 +/- 12.1 vs. 56 +/- 10.2 years; P < 0.01), and than the mixed group (39 +/- 7.5 vs. 56 +/- 10.2 years; P < 0.02). Levels of iPTH enabled discrimination between groups, but not between individual patients, and values correlated with bone alkaline phosphatase (r = 0.62; P < 0.001). Erosion of the terminal phalanges was seen on the plain X-rays of 7 of 15 patients with mild or severe OF, and in three patients with another diagnosis. The majority of patients (> 90%) had bone density measurements within the normal range. No significant correlation existed between QCT or SPA scores and any of the histomorphometric parameters, or iPTH. We conclude that iPTH is the most helpful non-invasive investigation in this group of patients. Plain X-ray of the hands is the most useful radiological investigation, but single measurements of bone density are not diagnostic.

Is Renal Osteodystrophy a Neglected Entity?

“…The frequency at the start of therapy for end stage renal disease has been reported by Hutchison AJ, et al, [5]. On review we have placed our case in variety of mixed disease according to this classification as features of Osteitis fibrosa were coexisting with Osteomalacia.…”

Evaluation of Bone Mineral Density in Hemodialysis Patients

“…Baz› çal›flmalarda, beklenildi¤i üzere, alkalen fosfataz ve iPTH ile KMY de¤erleri aras›nda negatif korelasyon oldu¤u bildirilmifltir (9,11). Di¤er çal›flmalarda ise bizim çal›flmam›zda oldu¤u gibi iPTH ile KMY aras›nda herhangi bir iliflki saptanmam›flt›r (8,(23)(24)(25)(26)(27). Bunun nedeni bu çal›flmalarda hasta say›s›n›n az olmas› ya da serum iPTH ölçüm yöntemlerinin farkl› olmas› olabilir.…”

Indicações de paratireoidectomia no hiperparatireoidismo secundário à insuficiência renal crônica

“…Primeiro, pacientes com IRC apresentam um acúmulo de grandes fragmentos da fração C-terminal que são dosados nos ensaios para a fração intacta, fato que pode ser responsável por um aumento de até 50% dos níveis deste hormônio (52,53). Por outro lado, em pacientes com taxa de filtração glomerular diminuída, existe uma resistência periférica ao PTH, que se eleva com a piora da uremia (10). Outros fatores, como a alteração do metabolismo da vitamina D, hiperfosfatemia, acidose (54) e redução na expressão do receptor do PTH (55) contribuem para a dessensibilização do esqueleto à ação do hormônio.…”

“…Em pacientes com a taxa de filtração glomerular menor que 60ml/minuto, 50% das biópsias ósseas apresentam histologia anormal (8,9). Ao cair para 20 a 40ml/minuto, praticamente todas as biópsias estão alteradas (10). Em segundo lugar, devido às inúmeras complicações a que os pacientes estão submetidos, pois a osteíte fibrosa císti-ca é responsável por perda de massa óssea generalizada.…”