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[Renal osteodystrophy Guidelines].

P Messa,

    Giornale Italiano Di Nefrologia : Organo Ufficiale Della Societa Italiana Di Nefrologia
    |December 11, 2003
    PubMed
    Summary
    This summary is machine-generated.

    Renal osteodystrophy (ROD) is a complication in uremic patients. While bone biopsy is gold standard, biochemical markers like intact PTH and bone alkaline phosphatase offer predictive value for diagnosis and treatment monitoring.

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    Area of Science:

    • Nephrology
    • Endocrinology
    • Bone Metabolism

    Background:

    • Renal osteodystrophy (ROD) is a significant long-term complication in patients with uremia.
    • Bone histomorphometry is the gold standard for ROD diagnosis but has low patient acceptance.
    • Existing instrumental assessments lack sufficient sensitivity for ROD diagnosis.

    Framework:

    • Serum intact PTH (i-PTH) levels can predict high (>450 pg/mL) or low (<120 pg/mL) bone turnover, but lack predictive value in intermediate ranges.
    • Bone alkaline phosphatase is a more reliable indicator of bone turnover than i-PTH.
    • Serum aluminum (Al) levels above 60 mg/L are highly diagnostic for Al overload, warranting a deferoxamine (DFO) test.

    Implementation:

    • Treatment goals include maintaining i-PTH between 120-150 pg/mL, phosphate <5.5 mg/dL, calcium 9.2-10.4 mg/dL, Ca x Pi product <55 mg/dL, and Al <20 ug/L.

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  • Therapeutic strategies involve dietary phosphate control, phosphate binders (calcium salts, sevelamer), appropriate dialysis dose (KT/V >1.2), and controlled dialysate calcium.
  • Vitamin D is contraindicated with i-PTH <120 pg/mL, serum Ca >11 mg/dL, or Pi >6.5 mg/dL; dosage is PTH-dependent, with IV route preferred for very high i-PTH or treatment failure.

    • Implications:

    • Parathyroidectomy (PTX) is considered based on clinical, biochemical, and instrumental data, with 7/8 PTX being preferred.
    • Bone transplant disease (BTD), a complication post-renal transplant, presents as osteopenic-osteoporotic syndrome and fractures.
    • Reducing cumulative steroid dose is the primary treatment for BTD; bisphosphonates and vitamin D show no proven preventive role.