summary Renal Osteodystrophy is a form of metabolic bone disease seen in patients with chronic renal insufficiency characterized by bone mineralization deficiency due to electrolyte and endocrine abnormalities. Patients present with osteomalacia, osteonecrosis and pathologic fractures. Diagnosis is made based on a thorough evaluation of serum labs, clinical features, and radiographic findings. Treatment involves medical management to resolve the etiology of the underlying renal condition. Etiology Pathophysiology hypocalcemia due to the inability of the damaged kidney to convert vitamin D3 to calcitrol (the active form) because of phosphate retention (hyperphosphatemia) hyperparathyroidism and secondary hyperphosphatemia caused by hypocalcemia and lack of phosphate excretion by damaged kidney uremia related phosphate retention is a key pathological step Associated conditions orthopaedic manifestations osteomalacia (adults) and growth retardation (children) AVN tendinitis and tendon rupture carpal tunnel syndrome deposition of amyloid (β2 microglobulin) pathologic fracture from brown tumors (hyperparathyroidism) or amyloid deposits osteomyelitis and septic arthritis Classification High-turnover renal bone disease (high PTH disease) chronically elevated phosphate leads to secondary hyperparathyroidism hyperphosphatemia lowers serum Ca, stimulating PTH phosphorus impairs renal 1α-hydroxylase, reducing 1,25(OH)2 vitamin D3 production phosphorus retention directly stimultes PTH production hyperplasia of chief cells of parathyroid gland associated lab values decreased calcium, increased serum phosphate, increased alkaline phosphate, increased parathyroid hormone Low turnover renal bone disease (normal PTH disease) characterized by lack of secondary hyperparathyroidism normal levels of PTH with characteristic bone lesions marked by low levels of bone formation excess deposition of aluminium into bone affects bone mineralization impairs differentiation of precursors into osteoblasts, and osteoblast proliferation impairs PTH release from parathyroid gland disrupts mineralization Presentation Symptom weakness bone pain pathological fracture commonest complication skeletal deformity symptoms of hypocalcemia abdominal pain muscle cramps dyspnea convulsions/seizures mental status changes Physical exam provocative tests for tetany Trousseau's Sign carpalpedal spasm after blood pressure readings Chvostek's Sign facial muscle contractions after tapping on the facial nerve Imaging Radiographs findings Looser's zones brown tumor osteosclerosis from mineralization of osteomalacic bone rugger jersey spine widened growth plate and zone of provisional calcification (children) varus deformity of the femurs (children) fracture soft-tissue calcification osteopenia CT osseous resorption Evaluation Histology thinned trabeculae amyloid stains pink on Congo red stain Labs decreased serum calcium increased serum phos increased PTH Treatment Nonoperative treat underlying renal condition or relieve urologic obstruction
QUESTIONS 1 of 5 1 2 3 4 5 Previous Next (OBQ12.37) Which of the following series of lab values is most consistent with a diagnosis of high turnover renal osteodystrophy? QID: 4397 Type & Select Correct Answer 1 Decreased calcium, increased serum phosphate, increased alkaline phosphatase, increased parathyroid hormone 57% (2479/4347) 2 Decreased calcium, decreased serum phosphate, increased alkaline phosphatase, increased parathyroid hormone 19% (817/4347) 3 Increased calcium, normal serum phosphate, increased alkaline phosphatase, normal parathyroid hormone 8% (359/4347) 4 Decreased calcium, increased serum phosphate, normal alkaline phosphatase, decreased parathyroid hormone 4% (177/4347) 5 Increased calcium, normal serum phosphate, normal or high alkaline phosphatase, increased parathyroid hormone 10% (449/4347) L 4 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (OBQ08.114) What laboratory findings would you expect to find in a patient newly diagnosed with renal osteodystrophy? QID: 500 Type & Select Correct Answer 1 Decreased PTH secretion, hypophosphatemia, and hypocalcemia 4% (75/1792) 2 Increased PTH secretion, hyperphosphatemia, and hypocalcemia 72% (1283/1792) 3 Decreased PTH secretion, hypophosphatemia, and hypercalcemia 6% (113/1792) 4 Increased PTH secretion, hyperphosphatemia, and hypercalcemia 13% (241/1792) 5 Hypophosphatemia and hypocalcemia 4% (73/1792) L 1 Question Complexity C Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review Tested Concept Review Full Topic (OBQ07.22) You are seeing a dialysis patient for a fragility fracture. This patient also carries a diagnosis of renal osteodystrophy. What is the key pathophysiological step that is responsible for his osteomalacia? QID: 683 Type & Select Correct Answer 1 Altered parathyoid hormone receptor sensitivity 26% (493/1870) 2 Chronic metabolic alkalosis 4% (68/1870) 3 Chronic imbalance of electrolytes during dialysis 4% (75/1870) 4 Uremia related phosphate retention 60% (1119/1870) 5 Tyrosine kinase receptor phosphorylation of the improper intracellular signalling proteins 6% (104/1870) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic
All Videos (2) Podcasts (1) Login to View Community Videos Login to View Community Videos Trousseau's Sign (hypocalcemia) Colin Woon Basic Science - Renal Osteodystrophy D 11/18/2012 4386 views 2.2 (17) Login to View Community Videos Login to View Community Videos Chvostek's Sign (hypocalcemia) Colin Woon Basic Science - Renal Osteodystrophy C 11/18/2012 2380 views 2.9 (11) Basic Science⎪Renal Osteodystrophy Basic Science - Renal Osteodystrophy Listen Now 11:38 min 8/13/2020 239 plays 5.0 (1)