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A Large Animal Model for Acute Kidney Injury by Temporary Bilateral Renal Artery Occlusion
Published on: February 2, 2021
Bone histomorphometry in children prior to commencing renal replacement therapy.
Simon Waller1, Rukshana Shroff, Anthony J Freemont
1Royal Sick Children's Hospital, Yorkhill, Dalnair St, Glasgow, G3 8SJ, UK. Simon.Waller@ggc.scot.nhs.uk
Pediatric Nephrology (Berlin, Germany)
|May 16, 2008
Summary
Renal osteodystrophy (ROD) is common in children with chronic kidney disease (CKD) starting renal replacement therapy (RRT). Bone turnover and parathyroid hormone (PTH) levels varied, with high turnover seen at lower PTH levels than expected.
Area of Science:
- Nephrology
- Pediatric Endocrinology
- Bone Metabolism
Background:
- Renal osteodystrophy (ROD) is an early complication of chronic kidney disease (CKD).
- Improving survival in pediatric CKD patients increases the relevance of ROD.
- Limited data exists on bone histology in children with CKD before renal replacement therapy (RRT).
Purpose of the Study:
- To investigate the presence and characteristics of ROD in children at the start of RRT.
- To explore relationships between bone histology, growth, and parathyroid hormone (PTH) levels in these patients.
Main Methods:
- Bone biopsies were obtained from children undergoing RRT surgery after double tetracycline labeling.
- Histological classification used the proposed turnover/mineralisation/volume (TMV) system.
- Biochemical data, including calcium, phosphate, and PTH levels, were collected during follow-up prior to biopsy.
Main Results:
- All eleven pediatric patients exhibited ROD at RRT commencement.
- Low bone turnover correlated with normal PTH levels; high turnover occurred at PTH levels below current guidelines.
- No significant relationship was found between bone turnover and patient growth.
Conclusions:
- ROD is universally present in children with severe CKD initiating RRT.
- Current PTH level guidelines may not accurately reflect bone turnover status in pediatric CKD.
- Further research is needed to understand ROD pathogenesis and optimize management in pediatric CKD.
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