Therapeutic problems relating to azotaemic osteodystrophy

Azotaemic osteodystrophy is a generic term encompassing the different bony lesions found in renal failure. The most important of these are parathyroid osteopathy and osteomalacia which may co-exist or occur singly. Both types of lesions have multifactorial aetiologies. Hyperparathyroidism is caused by hyperphosphataemia, hypocalcaemia and possibly, a lack of 1,25-dihydroxycholecalciferol. Osteomalacia is caused by vitamin D deficiency, a lack of dihydroxylated vitamin D metabolites and aluminium intoxication. Treatment modalities include phosphate binders, a tight control of calcium concentrations in the dialysis fluid, vitamin D and parathyroidectomy. Each of these is associated with certain hazards. In particular, vitamin D and parathyroidectomy may cause deterioration of residual renal function.