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Renal and Osteodystrophy

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https://www.readbyqxmd.com/read/30050395/laboratory-aspects-and-clinical-utility-of-bone-turnover-markers
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
https://www.readbyqxmd.com/read/29910605/role-of-etelcalcetide-in-the-management-of-secondary-hyperparathyroidism-in-hemodialysis-patients-a-review-on-current-data-and-place-in-therapy
#7
REVIEW
Claudia Friedl, Emanuel Zitt
Secondary hyperparathyroidism (sHPT) is a frequently occurring severe complication of advanced kidney disease. Its clinical consequences include extraskeletal vascular and valvular calcifications, changes in bone metabolism resulting in renal osteodystrophy, and an increased risk of cardiovascular morbidity and mortality. Calcimimetics are a cornerstone of parathyroid hormone (PTH)-lowering therapy, as confirmed by the recently updated 2017 Kidney Disease: Improving Global Outcomes chronic kidney disease - mineral and bone disorder clinical practice guidelines...
2018: Drug Design, Development and Therapy
https://www.readbyqxmd.com/read/29901142/targeted-resequencing-of-phosphorus-metabolism%C3%A2-related-genes-in-86-patients-with-hypophosphatemic-rickets-osteomalacia
#8
Jiemei Gu, Chun Wang, Hao Zhang, Hua Yue, Weiwei Hu, Jinwei He, Wenzhen Fu, Zhenlin Zhang
Hypophosphatemic rickets/osteomalacia is characterized by defective renal phosphate reabsorption and abnormal bone mineralization. Hypophosphatemic rickets/osteomalacia consists of inherited and acquired forms, many of which have unknown aetiology. In the present study, next‑generation sequencing‑based resequencing was used on samples from Chinese subjects with hypophosphatemic rickets/osteomalacia, aiming to detect the spectrum of pathogenic genes in these patients. A total of 86 hypophosphatemic rickets/osteomalacia patients (ranging from 3 to 70 years old) were recruited...
September 2018: International Journal of Molecular Medicine
https://www.readbyqxmd.com/read/29846712/sclerostin-in-chronic-kidney-disease-mineral-bone-disorder-think-first-before-you-block-it
#9
Vincent M Brandenburg, Anja Verhulst, Anne Babler, Patrick C D'Haese, Pieter Evenepoel, Nadine Kaesler
Canonical Wnt signalling activity is a major player in physiological and adaptive bone metabolism. Wnt signalling is regulated by soluble inhibitors, with sclerostin being the most widely studied. Sclerostin's main origin is the osteocyte and its major function is blockade of osteoblast differentiation and function. Therefore, sclerostin is a potent inhibitor of bone formation and mineralization. Consequently, blocking sclerostin via human monoclonal antibodies (such as romosozumab) represents a promising perspective for the treatment of (postmenopausal) osteoporosis...
May 24, 2018: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/29808090/role-of-the-wnt-%C3%AE-catenin-pathway-in-renal-osteodystrophy
#10
REVIEW
Sarah-Kim Bisson, Roth-Visal Ung, Fabrice Mac-Way
Vascular calcification and bone fragility are common and interrelated health problems that affect chronic kidney disease (CKD) patients. Bone fragility, which leads to higher risk of fracture and mortality, arises from the abnormal bone remodeling and mineralization that are seen in chronic kidney disease. Recently, sclerostin and Dickkopf-related protein 1 were suggested to play a significant role in CKD-related bone disease as they are known inhibitors of the Wnt pathway, thus preventing bone formation. This review focuses on new knowledge about the Wnt pathway in bone, how its function is affected by chronic kidney disease and how this affects bone structure...
2018: International Journal of Endocrinology
https://www.readbyqxmd.com/read/29791896/deterioration-of-cortical-bone-microarchitecture-critical-component-of-renal-osteodystrophy-evaluation
#11
Ashish K Sharma, Nigel D Toussaint, Rosemary Masterson, Stephen G Holt, Chamith S Rajapakse, Peter R Ebeling, Sindhu T Mohanty, Paul Baldock, Grahame J Elder
BACKGROUND: Cortical bone is a significant determinant of bone strength and its deterioration contributes to bone fragility. Thin cortices and increased cortical porosity have been noted in patients with chronic kidney disease (CKD), but the "Turnover Mineralization Volume" classification of renal osteodystrophy does not emphasize cortical bone as a key parameter. We aimed to assess trabecular and cortical bone microarchitecture by histomorphometry and micro-CT in patients with CKD G5 and 5D (dialysis)...
2018: American Journal of Nephrology
https://www.readbyqxmd.com/read/29773914/risk-factors-for-severe-hypocalcemia-after-parathyroidectomy-in-dialysis-patients-with-secondary-hyperparathyroidism
#12
Xiaoliang Sun, Xiaoqing Zhang, Yao Lu, Ling Zhang, Meng Yang
Severe hypocalcemia (SH) is a common and serious complication in dialysis patients with secondary hyperparathyroidism (SHPT) after parathyroidectomy (PTX). The aim is to explore the risk predictors of SH in post-PTX dialysis ESRD patients with SHPT. 129 consecutive dialysis patients with SHPT underwent PTX were retrospectively reviewed. A total of 22 clinical parameters were included in the study. SH was defined as the minimum values of serum calcium lower than 1.875 mmol/L (7.5 mg/dL) after surgery. Univariate analysis showed that pruritus, lumbar X-ray changes of renal osteodystrophy, pre- and post-operative intact parathyroid hormone (iPTH), Calcium, alkaline phosphatase, and gland mass were significantly different between SH and non-SH groups...
May 17, 2018: Scientific Reports
https://www.readbyqxmd.com/read/29733407/bone-inflammation-and-the-bone-marrow-niche-in-chronic-kidney-disease-what-do-we-know
#13
Sandro Mazzaferro, Giuseppe Cianciolo, Antonio De Pascalis, Chiara Guglielmo, Pablo A Urena Torres, Jordi Bover, Lida Tartaglione, Marzia Pasquali, Gaetano La Manna
Recent improvements in our understanding of physiology have altered the way in which bone is perceived: no longer is it considered as simply the repository of divalent ions, but rather as a sophisticated endocrine organ with potential extraskeletal effects. Indeed, a number of pathologic conditions involving bone in different ways can now be reconsidered from a bone-centred perspective. For example, in metabolic bone diseases like osteoporosis (OP) and renal osteodystrophy (ROD), the association with a worse cardiovascular outcome can be tentatively explained by the possible derangements of three recently discovered bone hormones (osteocalcin, fibroblast growth factor 23 and sclerostin) and a bone-specific enzyme (alkaline phosphatase)...
May 4, 2018: Nephrology, Dialysis, Transplantation
https://www.readbyqxmd.com/read/29725779/expansive-renal-osteitis-fibrosa-a-case-report
#14
Gabriel Silva Andrade, Abrahão Cavalcante Gomes de Souza Carvalho, Tibério Gomes Magalhães, Edson Luiz Cetira Filho, Roberta Barroso Cavalcante, Renato Luiz Maia Nogueira
Hyperparathyroidism (HPT) is an endocrine metabolic disorder characterized by increased secretion of parathyroid hormone. Untreated secondary HPT leads to renal osteodystrophy (ROD). Facial skeletal abnormalities in patients with ROD are rare. The purpose of this paper is to report a conservative surgical approach of exuberant osteitis fibrosa lesions in patient with chronic kidney disease. A 24-year-old female was referred to maxillofacial surgery department with giants ROD affecting palate, maxilla, and mandible, resulting in esthetic and functional impairment...
May 4, 2018: Oral and Maxillofacial Surgery
https://www.readbyqxmd.com/read/29716795/metformin-prevents-the-development-of-severe-chronic-kidney-disease-and-its-associated-mineral-and-bone-disorder
#15
Ellen Neven, Benjamin Vervaet, Kerstin Brand, Ulrike Gottwald-Hostalek, Britt Opdebeeck, Annelies De Maré, Anja Verhulst, Jean-Daniel Lalau, Said Kamel, Marc E De Broe, Patrick C D'Haese
Chronic kidney disease (CKD) causes dysregulation of mineral metabolism, vascular calcification and renal osteodystrophy, an entity called 'CKD-Mineral and Bone Disorder' (CKD-MBD). Here we determine whether metformin, an anti-diabetic drug, exerts favorable effects on progressive, severe CKD and concomitant mineral metabolism disturbances. Rats with CKD-MBD, induced by a 0.25% adenine diet for eight weeks, were treated with 200 mg/kg/day metformin or vehicle from one week after CKD induction onward. Severe, stable CKD along with marked hyperphosphatemia and hypocalcemia developed in these rats which led to arterial calcification and high bone turnover disease...
July 2018: Kidney International
https://www.readbyqxmd.com/read/29697410/role-of-klotho-in-bone-and-implication-for-ckd
#16
Hirotaka Komaba, Beate Lanske
PURPOSE OF REVIEW: Klotho is a transmembrane protein that acts as a co-receptor for fibroblast growth factor 23 (FGF23). Recent investigations have discovered the presence of Klotho in bone-forming osteoblasts and osteocytes. This review summarizes emerging literature on the roles of bone Klotho in mineral and bone metabolism and discusses their possible involvement in renal osteodystrophy. RECENT FINDINGS: Mouse genetic studies have demonstrated that loss of Klotho in osteocytes leads to increased bone formation and bone volume...
July 2018: Current Opinion in Nephrology and Hypertension
https://www.readbyqxmd.com/read/29644525/determination-of-nf-%C3%AE%C2%BAb-and-rankl-levels-in-peripheral-blood-osteoclast-precursor-cells-in-chronic-kidney-disease-patients
#17
Gülcan Güneş, Nil Doğruer Ünal, Gülçin Eskandari, Ahmet Kiykim, Özlem Bölgen Çimen, Gülhan Temel, Mehmet Burak Y Çimen
PURPOSE: Chronic kidney disease (CKD) is a progressive condition characterized by irreversible loss of functional nephron mass due to variety of causes; an inevitable complication of CKD is metabolic bone disease, and this pathology is called as renal osteodystrophy (ROD). In this study, we aimed to determine the levels of serum sRANKL and intracellular NF-κB levels in peripheral blood osteoclast precursor cells in patients with stage 3 CKD. MATERIALS AND METHODS: Forty-one male patients aged 35-60 with CKD identified as stage 3 according to GFR calculated on the basis of creatinine values and 27 healthy male subjects with age ranging from 40 to 60 as control group were included in this study...
June 2018: International Urology and Nephrology
https://www.readbyqxmd.com/read/29644069/clinical-course-after-parathyroidectomy-in-adults-with-end-stage-renal-disease-on-maintenance-dialysis
#18
Christopher Thiam Seong Lim, Thevandra Kalaiselvam, Normayah Kitan, Bak Leong Goh
Background: Parathyroidectomy (PTX) is done in cases of secondary hyperparathyroidism from chronic kidney disease to improve renal osteodystrophy. Despite this widespread practice, clinical outcomes regarding the benefits of this procedure are still lacking. Most studies in the literature have opted to report the laboratory outcome instead. Our study aimed to evaluate the postoperative clinical course for patients who had undergone total PTX without autoimplantation. Methods and results: All patients who underwent PTX between January 2010 and February 2014 in a tertiary referral center were included in this study and followed up for 12 months...
April 2018: Clinical Kidney Journal
https://www.readbyqxmd.com/read/29642494/raman-spectroscopic-and-microscopic-analysis-for-monitoring-renal-osteodystrophy-signatures
#19
John D Ciubuc, Marian Manciu, Avudaiappan Maran, Michael J Yaszemski, Emma M Sundin, Kevin E Bennet, Felicia S Manciu
Defining the pathogenesis of renal osteodystrophy (ROD) and its treatment efficacy are difficult, since many factors potentially affect bone quality. In this study, confocal Raman microscopy and parallel statistical analysis were used to identify differences in bone composition between healthy and ROD bone tissues through direct visualization of three main compositional parametric ratios, namely, calcium content, mineral-to-matrix, and carbonate-to-matrix. Besides the substantially lower values found in ROD specimens for these representative ratios, an obvious accumulation of phenylalanine is Raman spectroscopically observed for the first time in ROD samples and reported here...
April 8, 2018: Biosensors
https://www.readbyqxmd.com/read/29555831/diagnostic-accuracy-of-biomarkers-and-imaging-for-bone-turnover-in-renal-osteodystrophy
#20
Syazrah Salam, Orla Gallagher, Fatma Gossiel, Margaret Paggiosi, Arif Khwaja, Richard Eastell
Background Renal osteodystrophy is common in advanced CKD, but characterization of bone turnover status can only be achieved by histomorphometric analysis of bone biopsy specimens (gold standard test). We tested whether bone biomarkers and high-resolution peripheral computed tomography (HR-pQCT) parameters can predict bone turnover status determined by histomorphometry. Methods We obtained fasting blood samples from 69 patients with CKD stages 4-5, including patients on dialysis, and 68 controls for biomarker analysis (intact parathyroid hormone [iPTH], procollagen type 1 N-terminal propeptide [PINP], bone alkaline phosphatase [bALP], collagen type 1 crosslinked C-telopeptide [CTX], and tartrate-resistant acid phosphatase 5b [TRAP5b]) and scanned the distal radius and tibia of participants by HR-pQCT...
May 2018: Journal of the American Society of Nephrology: JASN
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