Articular manifestations of renal osteodystrophy

The relationship between hyperparathyroid bone disorders and chronic renal diseases has been studied extensively for a long period of time. Zvaifler and Bywaters are the first to emphasize articular manifestations in hyperparathyroidism. Sundaram has found 30% in 80 hemodialysis patients presenting with articular disorders in hands. We reviewed routine radiographs of 258 uremia patients retrospectively and found that 36 patients had typical X-ray presentations of renal osteodystrophy. Sixteen among them (44.44%) were noted with articular involvement. Fourteen patients involved axial joints including sacroiliac, acromio-clavicular, sternoclavicular and symphysis pubis in decreasing order. Appendicular joints involvement were found in 6 patients, patellofemoral joints and small joints of hands involvement in 4 patients respectively and hip and shoulder joints in each one patient. None of the 16 patients complained joint pain. Diagnosis is easy because of the uncommon presentations of joint disorders in uremic patients. However, more knowledge about articular manifestations of renal osteodystrophy may eliminate the unnecessary investigations.