Renal osteodystrophy: an underdiagnosed condition

With the availability of 1-alpha-hydroxycholecalciferol it is even more relevant to detect the earliest stages of renal osteodystrophy. Sixty-two patients, either on haemodialysis or recent recipients of a renal transplant and 10 controls underwent hand radiography by a standard technique and by a direct magnification technique employing a 0.1 mm focal spot. A comparison of intracortical striations, subperiosteal resorption and soft tissue calcification was made in the two groups and hand score calculated on the non-magnification radiographs. The results were assessed independently by two radiologists. In subperiosteal resorption, the non-magnification technique gave a 6% positive result compared to 47% with magnification (P less than 0.01). For intracortical striations, the non-magnification technique gave an 11% positive results, whereas magnification resulted in a 45% positive result (P less than 0.01). Soft tissue calcification was found in one patient only, and reduction in hand score was a rare occurrence. The use of a standard technique only, without magnification, for radiographing hands in patients with renal disease, will result in evidence of renal osteodystrophy being missed in a significant proportion of patients.