The Osteomalacia Syndrome After Colocystoplasty; A Cure With Sodium Bicarbonate Alone

Abstract

SUMMARY A patient presented 4 years after colocystoplasty with the osteomalacia syndrome in that she complained of pains in the bones, the serum phosphorus was low, the serum alkaline phosphatase was high, radiologically there was a Looser's zone in the pelvis and histologically there was an excess of osteoid in the bone. She also had a hyperchloræmic acidosis which was corrected with sodium bicarbonate. At the same time the bone pains disappeared, the serum phosphorus and alkaline phosphatase returned to normal levels and the Looser's zone healed.

Distal Renal Tubular Acidosis: Alkali Heals Osteomalacia and Increases Net Production of 1,25-Dihydroxyvitamin D

“…Unlike other forms of renal osteodystrophy, the osteomalacia/rickets of dRTA is clearly dependent on the presence of acidosis, for it does not occur in patients in whom acidosis is prevented by alkali treatment, or in those with the incomplete syndrome of dRTA in whom the acidification defect is not sufficiently severe to cause acidosis, and when present it can be healed by correction of acidosis with alkali. Furthermore osteomalacia can complicate the very similar hyperchloraemic acidosis of uretero-colic anastomosis, where the kidneys are not diseased, and here, as in dRTA, the bone disease heals when acidosis is corrected by alkali treatment [15, 16]. Paradoxically osteomalacia/rickets has not been reported in many hereditary forms of chronic metabolic acidosis, such as methyl-malonic and propionic acidaemias, in which acidosis is present from birth and usually even more severe than in dRTA.…”

Osteomalacia due to a Bladder Reconstruction Performed 35 Years Previously

“…Previous reports on osteomalacia after a bladder reconstruction are shown in Table 3. In patients who have undergone bladder reconstruction using the colon and have developed osteomalacia due to metabolic acidosis, the serum Cl level is markedly increased (1)(2)(3). Patients with osteomalacia that occurred after urinary diversion using the ileum or colon, such as ureterosigmoidostomy or ileal replacement of the ureter, also have high serum Cl levels (3,9).…”

“…In patients with bladder reconstruction using the ileum or colon, high-chloride (Cl) metabolic acidosis has been reported as a late complication, which may sometimes result in osteomalacia (1)(2)(3). The report by Yoshida et al (2) is the only report in Japan on this complication.…”

Metabolische Langzeitprobleme bei der Harnableitung

“…Osteoporose, so z. B. nach Ureterosigmoidostomie [21,29,30], Kolozystoplastik [31], Kock-Pouch [32] oder nach Harnleiterersatz mit Ileum [33]. Die Art der Harnableitung scheint nicht immer eine wesentliche Rolle zu spielen, wie eine vergleichende Studie zeigte [34], Davidson et al [35] fanden interessanter Weise keinen Unterschied zwischen einer kontinenten und einer inkontinenten Form der Harnableitung.…”