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Bone biopsy in nephrology practice

Fellype de Carvalho Barreto1, Cleber Rafael Vieira da Costa2, Luciene Machado Dos Reis3

  • 1Universidade Federal do Paraná, Divisão de Nefrologia, Curitiba, PR, Brasil.

Jornal Brasileiro De Nefrologia
|December 8, 2018
PubMed

Insights

Bone biopsy with histomorphometry is crucial for diagnosing renal osteodystrophy (ROD) in chronic kidney disease (CKD) patients. This gold-standard method provides vital bone metabolism insights beyond serum biomarkers.

Area of Science:

  • Nephrology
  • Bone Metabolism
  • Histopathology

Background:

  • Renal osteodystrophy (ROD) is a significant complication of chronic kidney disease (CKD).
  • Current serum biomarkers like parathyroid hormone (PTH) and alkaline phosphatase (AP) inadequately predict bone lesion types (high vs. low turnover).
  • Accurate diagnosis is essential for effective management and treatment selection, including osteoporosis therapies in CKD patients.

Purpose of the Study:

  • To review the technique, indications, and diagnostic value of bone biopsy in the context of ROD and CKD.
  • To highlight the limitations of current clinical practice in diagnosing ROD.
  • To advocate for the renewed importance and training in bone biopsy for nephrologists.

Main Methods:

  • Discussion of bone biopsy technique and quantitative histomorphometry.
  • Analysis of trabecular and cortical bone parameters (structure, dynamics, thickness, porosity).
  • Detection of metal deposition (e.g., aluminum, iron) in bone tissue.

Main Results:

  • Bone biopsy is the gold-standard for diagnosing ROD, offering superior diagnostic accuracy compared to serum biomarkers.
  • It provides unique dynamic insights into bone metabolism, structural integrity, and potential toxic metal accumulation.
  • Despite its value, interest and specialized centers for bone histomorphometry have declined.

Conclusions:

  • Bone biopsy remains indispensable for accurate ROD diagnosis and management in CKD.
  • Nephrologists require training to perform and interpret bone biopsies.
  • Renewed focus on bone biopsy can improve patient outcomes in CKD-mineral and bone disorder.

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