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Spectrum of renal osteodystrophy in children on continuous ambulatory peritoneal dialysis
F Yalçinkaya1, E Ince, N Tümer
1Department of Pediatrics, Ankara University Faculty of Medicine, Turkey. yalcinkaya@tr-net.net.tr
Insights
High turnover renal osteodystrophy is common in children with chronic renal failure (CRF) on continuous ambulatory peritoneal dialysis (CAPD). Bone disease spectrum depends on CRF progression and primary kidney disease, with tubulo-interstitial nephritis increasing hyperparathyroid bone disease risk.
Area of Science:
- Pediatric Nephrology
- Bone Metabolism
- Renal Osteodystrophy
Background:
- Bone disease prevalence in chronic renal failure (CRF) has evolved.
- Continuous ambulatory peritoneal dialysis (CAPD) is a treatment for pediatric CRF.
- Understanding bone disease spectrum in pediatric CAPD patients is crucial.
Purpose of the Study:
- To evaluate the spectrum of bone disease in children with CRF undergoing CAPD.
- To identify factors influencing bone disease type in this population.
Main Methods:
- Seventeen children (7-20 years) with CRF on CAPD were assessed.
- Patients received vitamin D and calcium carbonate therapy prior to bone biopsy.
- Serum biochemistry, hand X-rays, and transiliac bone biopsies were analyzed.
Main Results:
- High turnover renal osteodystrophy (ROD) was most prevalent (47%).
- Low turnover bone disease occurred in 29%, and mixed ROD in 24%.
- Tubulo-interstitial nephritis correlated with high turnover ROD, while glomerulonephritis did not.
Conclusions:
- The bone disease spectrum in pediatric CAPD patients varies with CRF progression and etiology.
- Slowly progressing renal diseases, especially tubulo-interstitial nephritis, increase the risk of hyperparathyroid bone disease.
- Rapidly progressive glomerular diseases may pose a lower risk for high turnover bone disease, even with vitamin D therapy.
Background:
The prevalence of different types of bone disease in chronic renal failure (CRF) has changed significantly during the last decade. The aim of the present study is to evaluate the spectrum of bone disease in children with CRF undergoing continuous ambulatory peritoneal dialysis (CAPD).
Methods:
Seventeen children with CRF on CAPD aged 7-20 years were evaluated. All patients had received regular vitamin D and calcium carbonate therapy during the 6 months preceding the bone biopsy. Serum calcium, phosphate, alkaline phosphatase and immunoreactive parathyroid hormone (iPTH) levels were measured and hand X-rays were performed. Transiliac bone biopsies were analyzed for histologic diagnosis.
Results:
High turnover renal osteodystrophy (ROD) was the most common bone disease, present in eight patients (47%). Five patients (29%) had low turnover bone disease, and four (24%) had mixed ROD. The mean age of the high turnover ROD group was higher than that of the low turnover group (14 +/- 3 vs. 11 +/- 3 years, P < 0.05). Seven of the nine patients who had tubulo-interstitial nephritis were found to have high turnover bone disease. In contrast, none of the patients with glomerulonephritis exhibited high turnover bone lesions. Mean serum calcium levels were found to be significantly higher in the low turnover group compared with the patients with high turnover bone disease (P < 0.001). A serum iPTH level > 200 pg/mL was 100% sensitive and 66% specific in identifying patients with high turnover ROD.
Conclusion:
The spectrum of bone disease of the children with CRF undergoing CAPD seems to depend on the rate of CRF and primary disease. The risk of developing overt hyperparathyroid bone disease is high in children with slowly progressing forms of renal pathology and especially in those with tubulo-interstitial disease. In contrast, children with glomerular diseases who had a more rapidly progressive course may have a lesser risk of developing high turnover bone disease. The results of the present study indicate that even routinely prescribed regular vitamin D therapy early in the course of disease may lead to low turnover bone lesion in small children who have CRF due to rapidly progressive forms of renal pathology.