[Osteomalacia as a result of aluminum poisoning during chronic hemodialysis]

The iliac crest biopsy of an uremic child, suffering from nephronophtisis, and hemodialyzed since the age of 11 1/2 years, was examined by histomorphometry, electron-probe X-ray microanalysis and ion microscopy. The results have been compared with those obtained with the same techniques in the bone tissue of 11 hemodialyzed aluminum-intoxicated adults. In this child, radiology of the skeleton and plasma biochemistry suggested secondary hyperparathyroidism; by contrast, histology showed impaired mineralization, little bone resorption, and aluminum deposits at the limit between osteoid and calcified tissue similar to those observed in the bone tissue of the adults. This observation, and the fact that the child had a high plasma aluminum level, and that dialysis was performed with softened aluminum-rich water, strongly suggests that the severe osteomalacia of this child was due to aluminum toxicity.