Bone histomorphometry for the diagnosis of renal osteodystrophy - a European consensus statement

Area of Science:

• Nephrology
• Histopathology
• Bone Metabolism

Background:

• Histomorphometric analysis of iliac bone biopsy is the gold standard for diagnosing renal osteodystrophy (ROD).
• ROD is a manifestation of chronic kidney disease (CKD)-associated osteoporosis.
• Bone biopsy use has declined due to reduced expertise and variability in sample processing and reporting.

Purpose of the Study:

• To address issues related to bone histomorphometry in the diagnosis of ROD.
• To establish a consensus among European experts on bone biopsy procedures, sample handling, and reporting.

Main Methods:

• A consensus initiative by the European Renal Osteodystrophy group.
• Discussions involving 28 experts from 14 European countries.
• Focus on bone biopsy procedure, sample handling, and interpretation of findings.

Main Results:

• Recommendation to adopt the turnover, mineralization, and volume (TMV) classification for reporting diagnostic findings.
• Prioritization of external quality control to ensure validity and reproducibility.
• Acknowledgement of the lack of accepted normative references as a barrier to uniform diagnostic definitions.

Conclusions:

• Standardized reporting using the TMV classification is recommended for practitioners.
• External quality control is crucial for reliable bone histomorphometry in ROD.
• Further collaborative efforts are needed to establish normative references for bone histomorphometry in CKD patients.