Development of renal bone disease

Abstract

Renal osteodystrophy (ROD) develops as the early stages of chronic renal failure (CRF) and covers a spectrum of bone changes observed in the uraemic patient, which extend from high remodelling bone disease (frequently known as osteitis fibrosa) to low turnover, or adynamic disease. Between these two extremes there are also cases of bone mineralization compromised in variable degrees, as is the case of 'mixed bone disease' and osteomalacia. The dynamic process of bone remodelling is compromised in CRF, and a positive or negative bone balance can be observed in uraemic patients. In addition to the classic modulators of bone remodelling, like parathyroid hormone, calcitriol and calcitonin, other factors were recently identified as significant modulators of osteoblast and osteoclast activation in uraemic patients. In fact, different cytokines and growth factors, acting at an autocrine or paracrine level, seem to play a relevant role in the bone and mineral changes observed in uraemia. Recently, observations have been made of the development of more sensitive and specific techniques to assay different biochemical markers of bone turnover and mineral metabolism. Analogously, new contributions of conventional bone histology, bone immunocytochemistry and molecular biology, which enabled the understanding of some etiopathogenic mechanisms of ROD, were observed.

Effect of zinc supplementation on bone formation in hemodialysis patients with normal or low turnover bone

“…16 Participants in this study having intact PTH of 113 (6-310) pg/mL at baseline might be mostly composed of patients with low bone turnover, because more than one-third of the HD patients with serum intact PTH within the normal or high kidney disease outcomes quality initiative (K/DOQI) guideline range (150-300 pg/mL) was defined as low bone turnover by bone biopsy. 17 In addition, the baseline BAP in this study of 8.5 (6.7-18.5) mg/L (normal range: 3.7-20.9 mg/L) is similar to the BAP (10.8 ± 4.2 ng/mL, normal range: 4-25 ng/mL) in the HD patients defined as normal or low turnover bone disease by Fisher's exact probability test. bone biopsy.…”

Influence of Parathyroidectomy on Bone Metabolism and Bone Pain in Patients with Secondary Hyperparathyroidism

“…Osteocalcin is known as a protein-binding calcium [22]. The synthesis of osteocalcin depends on vitamin K and is stimulated by vitamin D 3 [22].…”

Prevalence of Relative Hypoparathyroidism among Hemodialysis Patients: Role of Vitamin D, Aluminium and Magnesium

“…Hyperphosphatemia was less frequent whereas the hypermagnesaemia and hyperparathyroidism were more common in HD patients. Low iPTH probably associates with hyperglycemia [32]. Relatively hypoparathyroidism patients had higher levels serum Al (61.6 ± 15.2), lower serum Mg (1.8 ± 0.48) and lower 25(OH)D (12.9 ± 4.0) than other HD patients and control groups.…”