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[Bone biopsy in the Chronic Kidney Disease (CKD)]
Luca Dalle Carbonare1, Maria Teresa Valenti1
1Department of Medicine, Section of Internal Medicine D, University of Verona, Italy.
Summary
Histomorphometry, a bone biopsy analysis, evaluates bone health and disease. This quantitative histology technique aids in diagnosing conditions like osteomalacia and assessing bone damage from treatments or chronic kidney disease.
Area of Science:
- Bone biology and histology
- Diagnostic pathology
- Nephrology
Background:
- Histomorphometry, or quantitative histology, analyzes bone resorption, formation, and structure.
- It's the sole method for dynamic osteoblast activity assessment via tetracycline labeling.
- Computed image analysis enables detailed bone microarchitecture evaluation.
Purpose of the Study:
- To detail the histomorphometric bone biopsy procedure and its applications.
- To highlight its role in diagnosing osteomalacia and evaluating treatment-related bone damage.
- To emphasize its utility in managing bone disease in Chronic Kidney Disease (CKD).
Main Methods:
- Bone biopsy performed at the iliac crest under local anesthesia and sedation.
- Sample processing in methyl-methacrylate resin for microscopic section preparation.
- Analysis of various histomorphometric parameters using computed image analyzers.
Main Results:
- Histomorphometry reliably diagnoses osteomalacia and assesses bone damage from medications (e.g., glucocorticoids) and rare diseases (e.g., osteogenesis imperfecta).
- It is crucial for differentiating high and low bone turnover osteodystrophy in CKD patients.
- Kidney Disease Improving Global Outcomes (KDIGO) guidelines specify indications for bone biopsy.
Conclusions:
- Histomorphometric bone biopsy is a reliable and well-tolerated procedure for detailed bone analysis.
- Its application extends from metabolic bone diseases to complex conditions like CKD-related bone disease.
- Future molecular biology techniques promise to enhance the accuracy and predictive value of histomorphometry.
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