Renal osteodystrophy

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Renal osteodystrophy Classification and external resources ICD-10 N25.0 ICD-9 588.0 eMedicine radio/500

Renal osteodystrophy is a bone pathology, characterized by defective mineralization, that results from renal disease. renal - refers to kidney, osteo - refers to bone, and dystrophy - means degenerative disorder (like dystrophy in muscular dystrophy). There are different forms of renal osteodystrophy. Renal osteodystrophy that is characterized by high bone turnover, and renal osteodystrophy that is characterized by low bone turnover.

Contents
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1 Signs and symptoms 2 Diagnosis 3 Pathogenesis 4 Differential diagnosis 5 Treatment 6 Prognosis 7 References 8 External links

[edit] Signs and symptoms

Silent (no symptoms). Bone pain. Joint pain. Bone deformation. Fractures.

[edit] Diagnosis
Usually diagnosed after treatment for end-stage renal disease (ESRD) begins.

Blood tests - calcium (is decreased), phosphate (is elevated), calcitriol (vitamin D) (is decreased), PTH (is elevated).

Can be recognized on X-ray (but may be difficult to differentiate from other conditions). Features on X-ray:

Calcification of cartilage (chondrocalcinosis) - typically at the knees and pubic symphysis. Bone loss - "patchy" appearance (osteopenia) Fractures

[edit] Pathogenesis
The mineral content of bone is calcium hydroxyapatite, Ca5(PO4)3(OH). When calcium is being actively resorbed from bone, the phosphate also enters the blood stream. The kidney is the primary means of excreting excess phosphate. Renal osteodystrophy results from an abnormally elevated serum phosphate (hyperphosphatemia) and low serum calcium (hypocalcemia), both of which are due to decreased excretion of phosphate by the damaged kidney, low vitamin D levels or tertiary hyperparathyroidism (a dysfunction of the parathyroid gland due to constant stimulation).

[edit] Differential diagnosis

osteoporosis osteopenia osteomalacia hyperparathyroidism multiple myeloma soft tissue calcification including collagen vascular disease hydroxyapatite crystal deposition disease hypervitaminosis

[edit] Treatment

calcium supplementation dietary phosphate restriction vitamin D phosphate binders calcium carbonate (Tums), calcium acetate (PhosLo), sevelamer hydrochloride (Renagel), or lanthanum carbonate (Fosrenol) cinacalcet - a calcimimetic frequent hemodialysis (five times a week) is thought to be of benefit[1] renal transplantation

[edit] Prognosis
Recovery from renal osteodystrophy has been observed post renal transplantation. Renal osteodystrophy is a chronic (persistent) condition with a conventional hemodialysis schedule.[1]

.. Phosphate binders
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(Redirected from Phosphate binder) Jump to: navigation, search Phosphate binders are a group of medications used to reduce the absorption of phosphate and taken with meals and snacks. They are typically used in patients with chronic renal failure (CRF) as they cannot get rid of the phosphate that gets into their blood (i.e. the serum phosphate in chronic renal failure is typically elevated).

Contents
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1 Clinical use 2 Mechanism of action 3 Adverse effects 4 Common phosphate binders 5 References 6 External links
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6.1 Common Phosphate Binders (Generic)

[edit] Clinical use

For patients with chronic renal failure, controlling serum phosphate is important because it is associated with bone pathology and regulated together with serum calcium by the parathyroid hormone (PTH). High (serum) phosphate levels (known as hyperphosphatemia) normally results in an elevation of the PTH level, which then leads to more phosphate excretion into the urine.[1] If the kidneys do not function properly the phosphate level increases. Also, the serum calcium levels tend to be low. This is because the kidneys in chronic renal failure do not produce the active form of vitamin D (1,25dihydroxycholecalciferol), which is important for calcium absorption from food. Low serum calcium levels, like high phosphate, also lead to a high PTH.

A high PTH leads to a large mobilization of calcium from the bone and, if it is not replaced, bone is lost. Bone loss and damage due to CRF is called renal osteodystrophy. To avoid a high PTH and bone loss in patients with CRF, CRF patients typically avoid high phosphate intake and take calcium supplements, vitamin D and phosphate binders.

[edit] Mechanism of action

These agents work by binding to phosphate in the GI tract, thereby making it unavailable to the body for absorption. Hence, these drugs are usually taken with meals to bind any phosphate that may be present in the ingested food. Phosphate binders may be simple molecular entities (such as aluminum, calcium, or lanthanum salts) that react with phosphate and form an insoluble compound. Phosphate binders, such as sevelamer, may also be polymeric structures which bind to phosphate and are then excreted.

[edit] Adverse effects

With regard to phosphate binders, aluminum-containing compounds (such as aluminum hydroxide) are the least preferred because prolonged aluminum intake can cause encephalopathy and osteomalacia. If calcium is already being used as a supplement, additional calcium used as a phosphate binder may cause hypercalcemia and tissuedamaging calcinosis. One may avoid these adverse effects by using phosphate binders that do not contain calcium or aluminum as active ingredients, such as lanthanum carbonate or sevelamer.

[edit] Common phosphate binders

Aluminum hydroxide (Alucaps) Calcium carbonate (Calcichew, Titralac) Calcium acetate (Phosex, PhosLo) Lanthanum carbonate (Fosrenol) Sevelamer (Renagel, Renvela))

[edit] References
1. ^ Lederer E, Ouseph R, Erbeck K. Hyperphosphatemia, eMedicine.com, URL: http://www.emedicine.com/med/topic1097.htm, Accessed on July 14, 2005.

[edit] External links

High Phosphate Control - Official Fosrenol Homepage* Phosphate Binders: What Are They And How Do They Work? - American Association of Kidney Patients* Phosphate Binders - National Kidney Foundation Phosphate Binders - Northwest Kidney Centers - a center that provides services for people with ESRD in the Seattle area.

High Phosphate - Phophorus Control - Information for healthcare professionals on the treatment and management of hyperphosphatemia

[edit] Common Phosphate Binders (Generic)

Lanthanum - medlineplus.org Sevelamer - medlineplus.org

Hyperphosphatemia is an electrolyte disturbance in which there is an abnormally elevated level of phosphate in the blood. Often, calcium levels are lowered (hypocalcemia) due to precipitation of phosphate with the calcium in tissues. It can be caused by hypoparathyroidism due to the lack of PTH effect of inhibiting renal reabsorption of phosophate. It is also commonly seen in chronic renal failure. High phosphate levels can be avoided with phosphate binders and dietary restriction of phosphate. This can also be caused by taking oral sodium phosphate solutions prescribed for bowel prepration for colonoscopy in children. Signs and symptoms include ectopic calcification, secondary hyperparathyroidism, and renal osteodystrophy.