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Related Experiment Videos

Renal osteodystrophy in dialyzed children.

I B Salusky1, W G Goodman

  • 1Department of Pediatrics, UCLA School of Medicine.

Mineral and Electrolyte Metabolism
|January 1, 1991
PubMed
Summary

Pediatric patients on continuous peritoneal dialysis often have persistent secondary hyperparathyroidism, even with calcitriol treatment. Bone disease management may require modified calcitriol administration or intraperitoneal routes.

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Area of Science:

  • Nephrology
  • Pediatric Endocrinology
  • Bone Metabolism

Background:

  • Renal osteodystrophy is a common complication in children with chronic kidney disease.
  • Continuous peritoneal dialysis (CAPD/CCPD) is a treatment modality used in pediatric patients.
  • Secondary hyperparathyroidism is a hallmark of renal osteodystrophy.

Purpose of the Study:

  • To describe the histological and biochemical features of renal osteodystrophy in pediatric patients undergoing CAPD/CCPD.
  • To evaluate the effectiveness of oral calcitriol therapy in managing secondary hyperparathyroidism.
  • To explore potential new therapeutic strategies for bone disease in this population.

Main Methods:

  • Histological and biochemical evaluation of bone biopsies from 58 pediatric patients (1.2-20 years) on CAPD/CCPD.
  • Assessment of secondary hyperparathyroidism, low bone formation, osteomalacia, and aplastic bone.
  • Evaluation of skeletal response to oral calcitriol in 16 patients with follow-up biopsies.

Main Results:

  • 70% of patients had secondary hyperparathyroidism despite oral calcitriol.
  • 16% showed low bone formation, with half having osteomalacia and aluminum accumulation.
  • Aplastic bone was found in 9%, mostly without aluminum accumulation.
  • Biochemical markers poorly predicted bone lesions.
  • Most patients on oral calcitriol showed persistent secondary hyperparathyroidism on follow-up.

Conclusions:

  • Oral calcitriol is often insufficient for managing secondary hyperparathyroidism in pediatric CAPD/CCPD patients.
  • Bone histology reveals diverse pathologies including osteomalacia and aplastic bone.
  • Modified oral calcitriol administration or intraperitoneal calcitriol may offer improved therapeutic options.

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