Skeletal Complications of Renal Insufficiency and Maintenance Haemodialysis

Ritz, Eberhard; Krempien, B.; Mehls, Otto; Malluche, H H; Strobel, Z; Zimmermann, H.

doi:10.1159/000180187

Cited by 15 publications

(4 citation statements)

References 4 publications

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“…There are few reports on the abnormalities of the physis in children with CRF. One case report [47] described an 8-year old girl who died of long-standing uraemia where an absent columnar cartilage and an irregular zone of calcification was found in the physis. Several authors claim that the columnar cartilage of the physis is irregularly formed in children with CRF [43-45, 47, 48], resembling the abnormalities of the physis that are observed in SCFE [3][4][5][6][7].…”

Section: Chronic Diseasementioning

confidence: 99%

Slipped capital femoral epiphysis and its association with endocrine, metabolic and chronic diseases: A systematic review of the literature

Witbreuk

Kemenade

Sluijs

et al. 2013

Journal of Children's Orthopaedics

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Purpose Puberty, obesity, endocrine and chronic systemic diseases are known to be associated with slipped capital femoral epiphysis (SCFE). The mechanical insufficiency of the physis in SCFE is thought to be the result of an abnormal weakening of the physis. However, the mechanism at the cellular level has not been unravelled up to now. Methods To understand the pathophysiology of endocrine and metabolic factors acting on the physis, we performed a systematic review focussing on published studies reporting on hormonal, morphological and cellular abnormalities of the physis in children with SCFE. In addition, we looked for studies of the effects of endocrinopathies on the human physis which can lead to cause SCFE and focussed in detail on hormonal signalling, hormone receptor expression and extracellular matrix (ECM) composition of the physis. We searched in the PubMed, EMBASE.com and The Cochrane Library (via Wiley) databases from inception to 11thSeptember 2012. The search generated a total of 689 references: 382 in PubMed, 232 in EMBASE.com and 75 in The Cochrane Library. After removing duplicate papers, 525 papers remained. Of these, 119 were selected based on titles and abstracts. After excluding 63 papers not related to the human physis, 56 papers were included in this review. Results Activation of the gonadal axis and the subsequent augmentation of the activity of the growth hormone-insulin-like growth factor 1 (GH-IGF-1) axis are important for the pubertal growth spurt, as well as for cessation of the physis at the end of puberty. The effects of leptin, thyroid hormone and corticosteroids on linear growth and on the physis are also discussed. Children with chronic diseases suffer from inflammation, acidosis and malnutrition. These consequences of chronic diseases affect the GH-IGF-1 axis, thereby, increasing the risk of the development of SCFE. The risk of SCFE and avascular necrosis in children with chronic renal insufficiency, growth hormone treatment and renal osteodystrophy remains equivocal. Conclusions SCFE is most likely the result of a multifactorial event during adolescence when height and weight increase dramatically and the delicate balance between the various hormonal equilibria can be disturbed. Up to now, there are no screening or diagnostic tests available to predict patients at risk.

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Section: Chronic Diseasementioning

confidence: 99%

Slipped capital femoral epiphysis and its association with endocrine, metabolic and chronic diseases: A systematic review of the literature

Witbreuk

Kemenade

Sluijs

et al. 2013

Journal of Children's Orthopaedics

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“…Ritz et al [26] described the histological features of GP in an 8-year-old girl dying from long-standing uremia. The columnar cartilage was absent, the zone of provisional calcification markedly irregular, and the primary spongiosa was composed of unmineralized woven bone with trabeculae appearing profoundly disorganized and without their normal longitudinal orientation.…”

Section: Gp In Uremic Childrenmentioning

confidence: 99%

Alterations of the growth plate in chronic renal failure

et al. 2004

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Chronic renal failure modifies the morphology and dynamics of the growth plate (GP) of long bones. In young uremic rats, the height of cartilage columns of GP may vary markedly. The reasons for this variation are unknown, although the severity and duration of renal failure and the type of renal osteodystrophy have been shown to influence the height of GP cartilage. Expansion of GP cartilage is associated with that of the hypertrophic stratum. The interference of uremia with the process of chondrocyte differentiation is suggested by some morphological features. However, analysis by immunohistochemistry and/or in situ hybridization of markers of chondrocyte maturation in the GP of uremic rats has yielded conflicting results. Thus, there have been reported normal and reduced mRNA levels for collagen X, parathyroid hormone/parathyroid hormone-related peptide receptor, and matrix metalloproteinase 9, as well as normal mRNA and protein expression for vascular endothelial growth factor and chondromodulin I, peptides related to the control of angiogenesis. In addition, a decreased immunohistochemical signal for growth hormone receptor and low insulin-like growth factor I mRNA in the proliferative zone of uremic GP are supportive of reduced chondrocyte proliferation. Growth hormone treatment improves chondrocyte maturation and activates bone metabolism in the primary spongiosa.

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“…' Financial support was obtained from the Swedish Medical Re search Council (project No. 79-I7X-02737-II) and the Herman Jarnhardt, Greta and Johan Kock and Alfred Osterlunds Founda tions Bone biopsy with the evaluation of pertinent bone morphologic parameters as presented by Bishop et al [8], Bordier and Tun Choi [9], Ritz et al [10], Duursma et al [11], Hruska et al [12] and others, seems to be more valuable in the evaluation of the underlying bone disease.…”

mentioning

confidence: 99%

Studies of Bone Morphology, Bone Densitometry and Laboratory Data in Patients on Maintenance Hemodialysis Treatment

Lindergård

Johnell

Nilsson

et al. 1985

Nephron

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Bone morphological parameters of renal osteodystrophy such as abundance of osteoid surface, osteoid seam width index, calcification fronts, osteoclast activity and trabecular bone volume were studied in 71 patients on maintenance hemodialysis and compared with bone densitometry, laboratory and clinical data. Increased osteoclast activity (hyperparathyroidism) was by far the most common bone morphological finding. Patients with chronic pyelonephritis or polycystic kidney disease had more than double the amount of osteoid than patients with chronic glomerulonephritis. The trabecular bone volume seemed to be increased in most patients in contrast to the cortical bone volume which was decreased, judged from bone densitometry and previously from X-ray. Despite that patients with polycystic kidney disease were older, their trabecular volume was larger than in patients with glomerulonephritis. The bone mineral content evaluated by bone densitometry was low in most patients, and more associated with bone morphological signs of osteomalacia than with secondary hyperparathyroidism. Serum phosphate (S-Po₄) and serum parathyroid hormone (S-PTH) seemed to discriminate better between osteomalacia and secondary hyperparathyroidism than serum alkaline phosphatase (S-Alk. phosph.), which was elevated in both groups. Patients who had been bilaterally nephrectomized were no more abnormal than other patients, and they had lower S-Alk. phosph. The abundance of osteoclasts was found to be a predictor of future development of clinical secondary hyperparathyroidism.

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Skeletal Complications of Renal Insufficiency and Maintenance Haemodialysis

Cited by 15 publications

References 4 publications

Slipped capital femoral epiphysis and its association with endocrine, metabolic and chronic diseases: A systematic review of the literature

Slipped capital femoral epiphysis and its association with endocrine, metabolic and chronic diseases: A systematic review of the literature

Alterations of the growth plate in chronic renal failure

Studies of Bone Morphology, Bone Densitometry and Laboratory Data in Patients on Maintenance Hemodialysis Treatment

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