Evolution of Bone Disease over 10 Years in 135 Patients with Terminal Renal Failure

Abstract

SummaryAn objective radiographic study of erosions, fractures, and periarticular and vascular calcification was made in a series of 135 patients over 10 years of maintenance haemodialysis therapy. The four lesions progressed at different rates, consistent with variation in the response of tissues to a changing biochemical milieu and deficiency in vitamin D metabolites. The half time for development of individual radiographic signs was 3-4 years for vascular calcification, 9 years for fractures, 16 years for periarticular calcification, and 22-9 years for erosions. Calcification of the dorsalis pedis artery seen as a developing ring or tube was an early and valuable sign of disturbed calcium metabolism. In these patients renal osteodystrophy is a chronic condition with a prolonged time course.

Complete Resorption of Massive Soft Tissue Calcification in a Hemodialysis Patient after Parathyroidectomy

“…P product below 70 mg [13]. We use a regular dialysate Ca content of 3.5 mEq/l which might have added more tissue calcification as significant intradialytic flux of ionized Ca from dialysate to patient is expected with 3.5 mEq/l Ca dialysate.…”

Calcific Aortic Stenosis: A Complication of Chronic Uraemia

“…Disordered calcium metabolism and metastatic calci fication are common findings in uraemia [18,19]. Hypercalcaemia with or without uraemia may cause aortic or mitral valvular calcification [20].…”

Therapeutic Interactions in Terminal Renal Failure

“…b). We now regard this sign as the first objective evidence of renal osteodystrophy in this programme [38], There is as yet no similar longitudinal radiological study with which to compare these findings, but it seems likely that there are differences between groups of patients treated in different units. Thus Siddiqui and Kerr [35] reported patients in whom the incidence of secondary hyperparathyroidism was lower than osteomalacia and osteoporosis, and that severe symptoms were common and disabling.…”

“…The 'ring' (a) and 'tube' (b) calcification seen in the dorsalis pedis artery between the first and second metatarsal heads. This was the first radiological sign of renal osteo dystrophy in the Royal Free Hospital series [38], The first dorsal metatarsal artery is also calcified. 40 had nc radiological evidence of bone disease and 38 had radiological evi dence of renal osteodystrophy including subperiosteal erosions, fractures, vascular calcification, and periarticular calcification.…”

“…R it z et al [33] have shown that the plasma concentration of parathyroid hormone is high in patients with radiological evidence of renal osteodystrophy. A recent retro spective analysis of radiopathological signs in patients treated for up to 9 years at the Royal Free Hospital has shown that X-ray changes of hyperpara thyroidism are common in uraemic patients and increase in frequency through out the period of treatment [38] (table I). In order to minimise the tendency to subjective assessment of radiographs, the frequency but not the severity of erosions, fractures, and vascularand periarticular calcification were calculated E s n. for each year of treatment.…”