Renal osteodystrophy

• a complex spectrum of abnormalities in patients with chronic renal disease

• renal disease automatically makes you think problems with vitamin D metabolism, problems with phosphorus, problems with Ca, some problems with alkaline phosphatase. depending on the severity and chronicity as well as treatment of the disease, the patient will manifest with a wide variety of clinical findings

• so renal osteodystrophy can be very, very complex

• manifestations can be

  • secondary hyperparathyroidism

  • osteomalacia (see below)

  • some other things not to be covered

Four consequences of renal osteodystrophy, manifest in varying amounts

• osteoporosis

• secondary hyperparathyroidism

• osteosclerosis

• osteomalacia

Skeletal deformities

• pediatric

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  • rachitic rosary, which are calcium deposits at the costochondral junctions

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• adults

  • bone pain

Extraskeletal problems

• a disturbance in calcium/phosphorus product causes supersaturated extracellular fluid favoring deposition of Ca in soft tissue

• this is termed dystrophic calcification

End points

• vessel wall calcification

• calciphylaxis

• visceral wall calcification

Manifestations

• secondary arthritis

• osteomalacia

• osteoporosis

Advanced renal osteodystrophy

• you see osteosclerosis and osteoporosis

• this results in severe pain and neurological deficits

• secondary osteroarthritis leads to deformation of bones

Category: Pathology Notes