The role of vitamin D metabolites in the osteomalacia of renal disease

Abstract

Osteomalacia is commonly found in patients with severe renal impairment. Its aetiology is multifactional and not simply due to deficient production of active metabolites of vitamin D. Decreased availability of calcium and phosphate and the accumulation of aluminium is some dialysis-treated patients are also important aetiological factors. The treatment of osteomalacia depends, in part, upon its accurate diagnosis, and identifying and reversing the underlying cause.

Vitamin D and skeletal tissues

“…Clinical management of renal osteodystrophy includes the use of phosphate binders (aluminum hydroxide, calcium carbonate) to control phosphate intake, helping to maintain normal serum phosphate concentrations, and then treatment with 1,25(OH),D, (0.25-2.0 [i,g/d) (263). Some authors have suggested that a combined treatment with both 25(OH)D, (0.5-0.75 fxg/d) and 1,25(OH),D, (0.5-2.0 |ig/ d) is more efficacious than treatment with 1,25(OH),D, alone (264).…”

Vitamin D deficiency—a new cause of cochlear deafness

“…Osteomalacia is commonly found in patients with severe renal impairment, and its aetiology is multifactorial (Stanbury and Mawer, 1978b;Kanis et al, 1981). The kidney is the major site of production of the active metabolite 1,25(OH)2D.…”

“…Such patients commonly suffer from generalized bone disease including osteomalacia. Although the aetiology of this renal osteodystrophy is multifactorial, attention in recent years has centred on the role of disturbed vitamin D metabolism (Kanis et al, 1981). Numerous reasons have been suggested for the perceptive deafness associated with chronic renal failure, including osmotic disturbances during haemodialysis, potentiation of ototoxic drugs, premature arteriosclerosis, electrolyte imbalance and inadequate dialysis (Bergstrom et al, 1980;Kligerman et al, 1981).…”