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Renal and Osteodystrophy

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https://www.readbyqxmd.com/read/30525179/bone-biopsy-in-nephrology-practice
#1
Fellype de Carvalho Barreto, Cleber Rafael Vieira da Costa, Luciene Machado Dos Reis, Melani Ribeiro Custódio
Renal osteodystrophy (ROD), a group of metabolic bone diseases secondary to chronic kidney disease (CKD), still represents a great challenge to nephrologists. Its management is tailored by the type of bone lesion - of high or low turnover - that cannot be accurately predicted by serum biomarkers of bone remodeling available in daily clinical practice, mainly parathyroid hormone (PTH) and alkaline phosphatase (AP). In view of this limitation, bone biopsy followed by bone quantitative histomorphometry, the gold-standard method for the diagnosis of ROD, is still considered of paramount importance...
November 29, 2018: Jornal Brasileiro de Nefrologia: ʹorgão Oficial de Sociedades Brasileira e Latino-Americana de Nefrologia
https://www.readbyqxmd.com/read/30487325/-secondary-osteoporosis-disordered-bone-metabolism-in-chronic-kidney-disease
#2
Yosuke Nakagawa, Hirotaka Komaba
In patients with chronic kidney disease(CKD), mineral metabolism abnormalities such as hyperphosphatemia, decreased 1,25-dihydroxyvitamin D, and elevated parathyroid hormone develop as kidney function declines, which lead to vascular calcification and a variety of skeletal abnormalities, collectively termed renal osteodystrophy. Because CKD patients have increased risk of bone fractures, it is important to assess fracture risk by measuring bone mineral density and bone metabolism markers. In addition to management of secondary hyperparathyroidism, medications for osteoporosis could be a reasonable option for preventing fracture...
2018: Clinical Calcium
https://www.readbyqxmd.com/read/30484132/evaluation-of-renal-osteodystrophy-in-the-dental-clinic-by-assessment-of-mandibular-and-phalangeal-cortical-indices
#3
Bruna Corrêa Massahud, João César Guimarães Henriques, Reinhilde Jacobs, Rafaela Rangel Rosa, Caio Vinícius Bardi Matai
OBJECTIVES: Secondary hyperparathyroidism (SHPT) is a disease that affects patients with chronic kidney disease, and is characterized by mineral disturbance and bone loss, known as renal osteodystrophy. The aim of this study was to assess the validity of using intraoral phosphor storage plates to take radiographs of the middle phalanges to evaluate bone loss resulting from SHPT during follow-up of these patients. METHODS: The sample consisted of 24 patients with chronic kidney disease, 12 with parathyroid hormone (PTH) levels ≥500 pg/ml, and 12 with PTH levels <500 pg/ml, who underwent hemodialysis weekly...
May 2018: Oral Radiology
https://www.readbyqxmd.com/read/30484027/radiological-manifestations-of-renal-osteodystrophy-in-the-orofacial-region-a-case-report-and-literature-review
#4
Meng You, Bei Tang, Zi-Jiang Wang, Kai-Li Wang, Hu Wang
Renal osteodystrophy (ROD) is a metabolic skeletal pathology that frequently affects the orofacial region and presents with characteristic radiological manifestations. This paper reports a case of ROD causing diffused orofacial bone alterations in a female patient with end-stage chronic kidney disease. The radiological features on panoramic, posteroanterior and lateral skull and computed tomography radiographs are described for this case. Previous reports in the literature are reviewed and discussed with a focus on radiological characteristics and differential diagnoses...
September 2018: Oral Radiology
https://www.readbyqxmd.com/read/30460334/rethinking-bone-disease-in-kidney-disease
#5
REVIEW
Matthew J Damasiewicz, Thomas L Nickolas
Renal osteodystrophy (ROD) is the bone component of chronic kidney disease mineral and bone disorder (CKD-MBD). ROD affects bone quality and strength through the numerous hormonal and metabolic disturbances that occur in patients with kidney disease. Collectively these disorders in bone quality increase fracture risk in CKD patients compared with the general population. Fractures are a serious complication of kidney disease and are associated with higher morbidity and mortality compared with the general population...
November 2018: JBMR plus
https://www.readbyqxmd.com/read/30365152/fibroblast-growth-factor-23-may-serve-as-a-novel-biomarker-for-renal-osteodystrophy-progression
#6
Si Yan Liu, Dong Dong Zhang, Yang Fang Wu, Huang Huang Luo, Guang Mei Jiang, Yao Xu, Yue Wu, Xun Xia, Wei Wei, Bo Hu, Peng Hu
The purpose of the present study was to determine whether fibroblast growth factor (FGF)‑23 could serve as a novel biomarker for renal osteodystrophy (ROD) progression. A rat model of ROD was induced by left nephrectomy plus intravenous injection of Adriamycin. Serum FGF‑23 was determined using an enzyme‑linked immunosorbent assay. Serum level and bone expression of FGF‑23 were both significantly elevated in the ROD group at 24 h post‑surgery. Serum FGF‑23 was negatively correlated with calcium, phosphate, 25‑hydroxyvitamin D, conventional bone biomarkers and bone collagen X...
October 15, 2018: International Journal of Molecular Medicine
https://www.readbyqxmd.com/read/30348285/impaired-osteocyte-maturation-in-the-pathogenesis-of-renal-osteodystrophy
#7
Renata C Pereira, Isidro B Salusky, Paul Roschger, Klaus Klaushofer, Ora Yadin, Earl G Freymiller, Richard Bowen, Anne M Delany, Nadja Fratzl-Zelman, Katherine Wesseling-Perry
Pediatric renal osteodystrophy is characterized by skeletal mineralization defects, but the role of osteoblast and osteocyte maturation in the pathogenesis of these defects is unknown. We evaluated markers of osteocyte maturation and programmed cell death in iliac crest biopsy samples from pediatric dialysis patients and healthy controls. We evaluated the relationship between numbers of fibroblast growth factor 23 (FGF23)-expressing osteocytes and histomorphometric parameters of skeletal mineralization. We confirmed that chronic kidney disease (CKD) causes intrinsic changes in bone cell maturation using an in vitro model of primary osteoblasts from patients with CKD and healthy controls...
November 2018: Kidney International
https://www.readbyqxmd.com/read/30298663/mineral-bone-disorders-in-chronic-kidney-disease
#8
REVIEW
Yi-Chou Hou, Chien-Lin Lu, Kuo-Cheng Lu
As the GFR loss aggravates, the disturbed mineral metabolism worsens the bone microstructure and remodelling - scenario, which is known as CKD-mineral bone disease (MBD). CKD-MBD is characterized by : (i) abnormal metabolism of calcium, phosphorus, parathyroid hormone (PTH), or vitamin D; (ii) abnormalities in bone turnover, mineralization, volume linear growth or strength; (iii) soft-tissue calcifications, either vascular or extra-osseous. Uremic vascular calcification and osteoporosis are the most common complications related to CKD-MBD...
October 2018: Nephrology
https://www.readbyqxmd.com/read/30283905/sixty-two-year-old-male-suffering-from-uremic-leontiasis-ossea-caused-by-severe-secondary-hyperparathyroidism
#9
Yogendranath Purrunsing, Jingjing Zhang, Ying Cui, Wei Liu, Yi Xu, Xunning Hong, Changying Xing, Xiaoming Zha, Ningning Wang
Secondary hyperparathyroidism (SHPT) is a long-term complication of chronic kidney disease-mineral and bone disorder (CKD-MBD). SHPT is characterized by hyperplasia of the parathyroid glands and abnormal secretion of parathyroid hormones (PTH), calcium and phosphorous metabolic disorders, renal osteodystrophy, vascular and soft tissue calcification, malnutrition, and other multiple system complications, which can seriously affect the quality of life of the patient and increase the risk of cardiovascular disease and mortality rate...
July 2018: JBMR Plus
https://www.readbyqxmd.com/read/30173686/acrophobia-in-a-young-girl-with-parathyroid-hormone-resistance-pseudohypoparathyroidism
#10
Mehwish Gilani, Asif Ali Memon, Naveed Asif, Nida Basharat
Pseudohypoparathyroidism (PHP) is an extremely rare group of disorders. It is a spectrum of disorders caused by end organ resistance to parathyroid hormone (PTH) and is represented by impaired signalling that activates cAMP dependent pathways via alpha subunit of G-protein (GS). It is characterised by hypocalcemia, hyperphosphatemia, raised PTH levels due to insensitivity to biological activity of PTH, and normal renal function tests. We describe a case of 10-year girl who presented with fear of falling down from heights...
September 2018: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
https://www.readbyqxmd.com/read/30167423/simultaneous-non-traumatic-bilateral-neck-femur-fractures-in-uremic-renal-osteodystrophy-a-report-of-three-cases-and-literature-review
#11
Rakesh John, Prasoon Kumar, Sameer Aggarwal, Rajesh Kumar Rajnish, Saurabh Agarwal, Kuldeep Vatsyan
Introduction: Bilateral, simultaneous, non-traumatic, pathological femur neck fractures due to renal osteodystrophy (RO) in chronic renal failure cases are uncommon but are increasingly being reported in the literature. Seizure episodes due to uremic encephalopathy could lead to such fractures. Case Reports: We describe three cases of patients with end-stage renal disease and RO, who presented with bilateral, non-traumatic femur neck fractures after episodes of grand mal con-vulsions...
March 2018: Journal of Orthopaedic Case Reports
https://www.readbyqxmd.com/read/30153138/tertiary-hyperparathyroidism-with-renal-osteodystrophy-on-18f-fluorocholine-pet-ct
#12
Wouter A M Broos, Maurits Wondergem, Friso M van der Zant, Remco J J Knol
A 27-year-old man, with a history of chronic renal failure due to obstructive uropathy, treated with hemodialysis and awaiting kidney transplantation, presented with tertiary hyperparathyroidism. Despite regulation of phosphate and calcium and treatment with cinacalcet, the serum parathyroid hormone levels remained elevated. The patient was referred for parathyroidectomy, and a F-fluorocholine PET/CT was acquired for preoperative planning. Besides visualization of the hyperfunctioning parathyroid glands, the scan also showed a typical picture of renal osteodystrophy, a finding on F-fluorocholine PET/CT that has not been reported before...
October 2018: Clinical Nuclear Medicine
https://www.readbyqxmd.com/read/30142896/systemic-activation-of-activin-a-signaling-causes-chronic-kidney-disease-mineral-bone-disorder
#13
REVIEW
Toshifumi Sugatani
The high cardiovascular mortality associated with chronic kidney disease (CKD) is caused in part by the CKD-mineral bone disorder (CKD-MBD) syndrome. The CKD-MBD consists of skeletal, vascular and cardiac pathology caused by metabolic derangements produced by kidney disease. The prevalence of osteopenia/osteoporosis resulting from the skeletal component of the CKD-MBD, renal osteodystrophy (ROD), in patients with CKD exceeds that of the general population and is a major public health concern. That CKD is associated with compromised bone health is widely accepted, yet the mechanisms underlying impaired bone metabolism in CKD are not fully understood...
August 23, 2018: International Journal of Molecular Sciences
https://www.readbyqxmd.com/read/30136087/the-unexpected-presence-of-iron-in-bone-biopsies-of-hemodialysis-patients
#14
Melani R Custodio, Rosilene M Elias, Wagner D Velasquez, Luciene M Dos Reis, Ivone B Oliveira, Rosa M A Moysés, Aluizio B Carvalho, Vanda Jorgetti
PURPOSE: Bone biopsy defines classical diseases that constitute the renal osteodystrophy. There is a recent concern regarding other histological findings that are not appreciated by using the turnover, mineralization, and volume (TMV) classification. Iron (Fe) overload has been considered a new challenge and the real significance of the presence of this metal in bones is not completely elucidated. Therefore, the main goal of the current study was to not only to identify bone Fe, but also correlate its presence with demographic, and biochemical characteristics...
October 2018: International Urology and Nephrology
https://www.readbyqxmd.com/read/30050395/laboratory-aspects-and-clinical-utility-of-bone-turnover-markers
#15
Harjit Pal Bhattoa
With an aging population, there is a marked increase in prevalence of metabolic bone diseases, especially osteoporosis. Perhaps the most dreaded complication of metabolic bone disease, fractures typically impose a huge burden on the ailing body and are associated with high co-morbidity and mortality. The consequent public health and socioeconomic burden warrant timely diagnosis, treatment and follow-up of these disorders. Knowing the limitations of radiological techniques, biochemical markers of bone turnover measurements come handy since the changes in their levels readily reflect bone physiology...
July 2018: EJIFCC
https://www.readbyqxmd.com/read/30031443/bones-and-the-sex-hormones
#16
Radhika R Narla, Susan M Ott
Sex hormones act in multiple ways to maintain a strong skeleton. In men, estrogen regulates cortical bone turnover, but testosterone maintains trabecular turnover. In normal men, sex hormone-binding protein is an independent risk factor for fractures. This led Aleksova and colleagues to measure the sex hormones and their binding protein in men receiving dialysis. Both higher sex hormone-binding globulin and higher total testosterone were associated with prevalent nonvertebral fractures, adding another layer of complexity to renal osteodystrophy...
August 2018: Kidney International
https://www.readbyqxmd.com/read/29998151/sagliker-syndrome-in-a-patient-with-secondary-hyperparathyroidism-and-chronic-renal-insufficiency-a-case-report
#17
Sara Shakeri, Soroush Zarehparvar Moghadam, Ramin Sadeghi, Narjess Ayati
Sagliker syndrome is a rare form of renal osteodystrophy resulted from untreated secondary hyperparathyroidism. It is described by severe skeletal deformities, high level of PTH in patients with chronic renal failure, and deformed face. This paper reports a 44-year-old male patient with the mentioned characteristics. In addition to the unique clinical features, high levels of ALP and PTH hormones encouraged us to search for syndrome-like a disease, which clinically and paraclinically matched the Sagliker syndrome...
2018: Asia Oceania Journal of Nuclear Medicine & Biology
https://www.readbyqxmd.com/read/29979398/a-case-report-of-pediatric-calciphylaxis-a-rare-and-potentially-fatal-under-diagnosed-condition
#18
Magdalena Stârcea, Cristina Gavrilovici, Andra Elsayed, Mihaela Munteanu, Vasile Valeriu Lupu, Elena Cojocaru, Ingrith Miron, Lucian Miron
RATIONALE: Though to be rare, calcific uremic arteriolophathy (CUA) is an ectopic calcification entity causing pain and disabilities in patients with chronic renal insufficiency, thus increasing the morbidity and mortality. PATIENT CONCERN: We report a case of four years old boy admitted with acute respiratory failure. Physical examination revealed: irritability, purple subcutaneous hard nodules, tachypnea, dry spasmodic cough, respiratory rate 45/min, heart rate 110/min, blood pressure 100/60 mmHg, with normal heart sounds, no murmurs, hepatomegaly with hepato-jugular reflux...
July 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29955631/bone-histomorphometry-in-the-evaluation-of-osteomalacia
#19
Arti Bhan, Shijing Qiu, Sudhaker D Rao
With the widespread use of measurement of bone mineral density to detect, diagnose, and monitor therapy in the management of osteoporosis, bone histomorphometry has largely been relegated to research settings and academic pursuits. However, bone density measurement cannot distinguish between osteoporosis and other metabolic bone disorders such as different types of osteomalacia, osteitis fibrosa, renal osteodystrophy, hypophosphatasia, and Paget's disease of bone. Furthermore, bone density test cannot tell us anything about microarchitecture of bone, tissue level dynamics, bone cellular activity, bone mineralization and bone remodeling, understanding of which is essential to make a specific diagnosis of a suspected metabolic bone disease, to evaluate beneficial (or adverse) effects of various therapies, treatment (medical or surgical) decisions in hyperparathyroid states...
June 2018: Bone Reports
https://www.readbyqxmd.com/read/29925739/-treatment-of-mandibular-fracture-associated-infectious-pseudarthrosis-accompanied-by-osteomyelitis-in-a-peritoneal-dialysis-patient
#20
Soichi Hirashima, Akihiko Miyawaki, Kotaro Oho, Yawaka Shitozawa, Motohiro Arai, Norihiko Furuta, Ryoichi Oya
Peritoneal dialysis can be performed at home, and the transfer of solutes in the blood and other body fluids is slow compared to hemodialysis, reducing the load on the circulatory organs and lessening the frequency of hospital visits. We encountered a male patient in his 70s on peritoneal dialysis for end-stage renal failure who developed obsolete mandibular fracture-associated pseudarthrosis accompanied by osteomyelitis, which was treated with noninvasive reduction and fixation using circumferential wiring after the resolution of inflammation...
2018: Journal of UOEH
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