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Bone disease in pediatric chronic kidney disease
1Department of Pediatrics, David Geffen School of Medicine at UCLA, A2-383 MDCC, 650 Charles Young Drive, Los Angeles, CA, 90095, USA. kwesseling@mednet.ucla.edu
Insights
Children with chronic kidney disease (CKD) often have bone disease, leading to disability. New research highlights the importance of assessing bone turnover, mineralization, and volume (TMV) for a better understanding of renal osteodystrophy (ROD) progression in CKD.
Area of Science:
- Nephrology
- Pediatric Nephrology
- Bone Metabolism
Background:
- Children with chronic kidney disease (CKD) exhibit significant bone disease, including deformities and fractures, causing long-term disability.
- Skeletal mineralization abnormalities are prevalent in pediatric CKD patients, contributing to chronic morbidity.
Purpose of the Study:
- To explore the progression of renal osteodystrophy (ROD) in chronic kidney disease (CKD).
- To investigate the cell biology alterations associated with ROD.
- To emphasize the importance of assessing bone turnover (T), mineralization (M), and volume (V) (TMV) in CKD bone disease.
Main Methods:
- Review of recent data on ROD progression in CKD.
- Analysis of cell biology alterations accompanying ROD.
- Discussion of the TMV classification for ROD assessment.
Main Results:
- Recent data provide insights into the progression of renal osteodystrophy (ROD) throughout the course of chronic kidney disease (CKD).
- Alterations in cell biology accompanying ROD have been elucidated.
- The limitations of assessing ROD due to the infrequent use of bone biopsy are highlighted.
Conclusions:
- A comprehensive understanding of ROD progression and its impact on bone health in CKD is crucial.
- The TMV assessment framework offers a standardized approach to evaluating bone disease in CKD patients.
- Further research is needed to overcome the limitations of bone biopsy and improve ROD management.
Abstract:
Children with long-standing chronic kidney disease (CKD) display clinical symptoms of bone disease, including bony deformities and fractures, which contribute to long-standing disability. Abnormalities in skeletal mineralization occur in a substantial proportion of this population and may contribute to chronic morbidity. Underscoring the potential contribution of parameters other than bone turnover to bone disease in CKD, a new definition for renal osteodystrophy (ROD), emphasizing the assessment of three key histologic descriptors, i.e., bone turnover (T), mineralization (M), and volume (V) (TMV), has been recommended in the assessment of all patients with CKD. Although bone biopsy is the only available method for assessing all three recommended areas of bone histology, this invasive procedure is not routinely used in any clinical setting; thus, a true understanding of the prevalence of abnormal turnover, defective mineralization, and altered bone volume throughout the course of CKD is limited. Recent data, however, have shed light on the progression of renal ROD throughout the course of CKD, including its early stages, as well as on the alterations in cell biology that accompany ROD.
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