Renal Osteodystrophy

  • Farahnak Assadi


A 19-year old female patient has been treated with hemodialysis for the past 14 years after rejection of a cadaver transplant. Her original disease was Henoch-Schonlein purpura. She now presents with ascending pain and weakness in her hands and feet. There are prominent contractures of her extremities that have caused her to become bedridden over the last four months. Her major problems associated with hemodialysis had been hyperphosphatemia (7 to 8.5 mg/dl) and hypercalcemia (10 to 11 mg/dl) after vitamin D therapy. Her parathyroid hormone (PTH) levels are mildly elevated at 56 pg/ml, although they have been substantially higher in the past. A work-up for collagen vascular disease, including vasculitis, has been negative, as well as Lyme titer and thyroid function tests. Blood glucose has never been elevated. Electromyography and nerve conduction studies are normal. Muscle biopsy shows atrophy and intravascular calcification.


Correct Answer Phosphate Binder Pediatric Nephrology Renal Osteodystrophy Lanthanum Carbonate 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Kunis CL, Markowitz GS, Liu-Jarin X, et al. (2001) Painful myopathy and end-stage renal disease. Am J Kidney Dis 37:1098–1104CrossRefPubMedGoogle Scholar
  2. Bleyer AJ, Burke SK, Dillon M, et al. (1999) A comparison of the calcium-free phosphate binder Sevelamer hydrochloride with calcium acetate in the treatment of hyperphosphatemia in dialysis patients. Am J Kidney Dis 33:694–701CrossRefPubMedGoogle Scholar
  3. Mazhar AR, Johnson RJ, Gillen D, et al. (2001) Risk factors and mortality associated with calciphylaxis in end-stage renal disease. Kidney Int 60:324–332CrossRefPubMedGoogle Scholar
  4. Malberti F, Marcelli D, Conte F, et al. (2001) Parathyroidectomy in patients on renal replacement therapy: an epidemiologic study. J Am Soc Nephrol 12:1242–1248PubMedGoogle Scholar
  5. Stehman-Breen CO, Sherrard DJ, Alem AM, et al. (2000) Risks factors for hip fracture among patients with end-stage renal disease. Kidney Int 58:22002205CrossRefGoogle Scholar
  6. Ferreria MA (2000) Diagnosis of renal osteodystrophy: when and how to use biochemical markers and non-invasive methods; when bone biopsy is needed. Nephrol Dial Transplant 5:S8–S14CrossRefGoogle Scholar
  7. Schomig M, Ritz E (2000) Management of disturbed calcium metabolism in uremic patients: 2. Indications for parathyroidectomy. Nephrol Dial Transpl 5:25–9CrossRefGoogle Scholar
  8. Green J, Debby H, Lederer E, et al. (2001) Evidence for a PTH-independent humeral mechanism in post-transplant hypophosphatemia and phosphaturia. Kidney Int 60: 1182–1196CrossRefPubMedGoogle Scholar
  9. Uribarri J, Calvo MS (2003) Hidden sources of phosphorus in the typical American diet: does it matter in nephrology? Semin Dial 16:186–188CrossRefPubMedGoogle Scholar
  10. Colandonato JA, Szczech LA, Friedman EA, et al. (2002) Does calcium kill ESRD patients-the skeptic’s perspective? Nephrol Dial Transplant 17:229–232CrossRefGoogle Scholar
  11. Jonsson KB, Zahradnik R, Larsson T, et al. (2003) Fibroblast growth factor 23 in oncogenic osteomalacia and x-linked hypophosphatemia. N Engl J Med 348:1656–1563Google Scholar
  12. Lindberg JS, Moe SM, Goodman WG, et al. (2003) The calcimimetic AMG 073 reduces parathyroid hormone and calcium × phosphorous in secondary hyperparathyroidism. Kidney Int 63:248–254CrossRefPubMedGoogle Scholar
  13. Tanaka R, Kakuta T, Fujisaki T, et al.. (2003) Long-term (3-years) prognosis of parathyroid function in chronic dialysis patients after percutaneous ethanol injection therapy guided by color Doppler ultrasonography. Nephrol Dial Transpl 3: (suppl 3) 58–S58–S61Google Scholar
  14. Wilmer WA, Magro CM (2002) Calciphylaxis: emerging concept in prevention, diagnosis, and treatment. Semin Dial 15:172–186CrossRefPubMedGoogle Scholar
  15. Wang Ay, Wang M, Woo J, et al. (2003) Cardiac valve calcification as an important predictor for all cause mortality and cardiovascular mortality in long-term peritoneal dialysis patients: a prospective study. J Am Soc Nephrol 14:159–168CrossRefPubMedGoogle Scholar
  16. Goodman WG, Juppner H, Salusky IB, et al. (2003) Parathyroid hormone (PTH), PTH-derived peptides, and new PTH assays in renal osteodystrophy. Kidney Int 63:1–11CrossRefPubMedGoogle Scholar
  17. Horwitz MJ, Tedesco MB, Sereiks SM, et al. (2003) Direct comparison of sustained infusion of human parathyroid hormone-related protein (hPTHrP-(1–36) versus hPTH-(1–34) on serum calcium, plasma 1,25-dihydroxyvitamin D concentrations, and fractional calcium excretion in healthy human volunteers. J Clin Endocrinol Metab 88:1603–1609CrossRefPubMedGoogle Scholar
  18. DeSevaux RG, Hoitsma AJ, Corstens FH, et al. (2002) Treatment with vitamin D and calcium reduces bone loss after renal transplantation: a randomized study. J Am Soc Nephrol 13: 1608–1614CrossRefGoogle Scholar
  19. Silver J, Levi R. Regulation of PTH synthesis and secretion relevant to the management of secondary hyperparathyroidism in chronic kidney disease. Kidney Int Suppl. 2005;95:S8–S12CrossRefPubMedGoogle Scholar
  20. Rodriguez M, Nemeth E, Martin D. The calcium-sensing receptor: a key factor in the pathogenesis of secondary hyperparathyroidism. Am J Physiol Renal Physiol 2005; 288:F253–264CrossRefPubMedGoogle Scholar
  21. Fukagawa M, Tominaga Y, Kitaoka M, Kakuta T, Kurokawa K. Medical and surgical aspects of parathyroidectomy. Kidney Int suppl 1999; 73:S65–S69CrossRefPubMedGoogle Scholar
  22. Moe SM, Chertow GM, Coburn JW, et al. (2005) Achieving NKF-K/DOQI bone metabolism and disease treatment goals with cinacalcet HCL. Kidney Int. 67:760–771CrossRefPubMedGoogle Scholar
  23. Rodriguez M, Nemeth E, Martin D. The calcium-sensing receptor: a key factor in the pathogenesis of secondary hyperparathyroidism. Am J Physiol Renal Physiol 2005; 288:F253–264CrossRefPubMedGoogle Scholar
  24. Ritz E (1994) Which is the preferred treatment of advanced hyperparathyroidism in a renal patient? II. Early parathyroidectomy should be considered as the first choice. Nephrol Dial Transplant 9:1819–1821PubMedGoogle Scholar
  25. Block GA, Martin KJ, de Francisco AL, et al. (2004) Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis. N Engl J Med 350:1516–1525CrossRefPubMedGoogle Scholar
  26. Emmett M (2004) A comparison of clinically useful phosphorus binders for patients with chronic kidney failure. Kidney Int 90: S25–S32CrossRefGoogle Scholar
  27. Martin KJ, Olgaard K, Coburn JW, et al. (2004) Bone Turnover Work Group: Diagnosis, assessment, and treatment of bone turnover abnormalities in renal osteodystrophy. Am J Kidney Dis 43:558CrossRefPubMedGoogle Scholar
  28. Teng M, Wolf M, Lowrie E, et al. (2003) Survival of patients undergoing hemodialysis with paricalcitol or calcitriol therapy. N Engl J Med 349:446–456CrossRefPubMedGoogle Scholar
  29. El-Agroudy AE, El-Husseini AA, El-Sayed M, et al. (2003) Preventing bone loss in renal transplant recipients with vitamin D. J Am Soc Nephrol 14:2975–2979CrossRefPubMedGoogle Scholar
  30. Emmett M (2004) A comparison of clinically useful phosphorus binders for patients with chronic kidney failure. Kidney Int Suppl 90:S25–S32CrossRefPubMedGoogle Scholar
  31. Choyke PL, Knopp MV (2003) Pseudohypocalcemia with MR imaging contrast agents: a cautionary tale. Radiology 227:627–628CrossRefPubMedGoogle Scholar
  32. Behets GJ, Verberckmoes SC, D’Haese PC, et al. (2004) Lanthanum carbonate:a new phosphate binder. Curr Opin Nephrol Hypertens 13:403–409CrossRefPubMedGoogle Scholar
  33. Vattikuti R, Towler DA (2004) Osteogenic regulation of vascular calcification: an early perspective. Am J Physiol Endocrinol Metab 286:E686–696CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Farahnak Assadi
    • 1
  1. 1.Rush University Medical CenterChicago

Personalised recommendations