Pathophysiology of renal osteodystrophy

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Abstract

Renal osteodystrophy is a common complication of chronic Kidney disease, and abnormalities of bone metabolism are a reflection of broad-based disturbances in the control mechanisms for mineral metabolism. Secondary hyperparathyroidism is a major contributor to the high turnover form of renal osteodystrophy. Detailed investigations over the past several decades have uncovered many of the mechanisms involved in the initiation and maintenance of secondary hyperparathyroidism and it is these mechanisms that provide the basis for therapeutic intervention to control this complication of chronic kidney disease. An additional form of renal osteodystropy is characterized by abnormally low bone turnover, which also is multi-factorial in origin. Again, an understanding of the mechanisms involved in abnormal bone and mineral homeostasis provide the basis for therapy. It is only with a through understanding of the mechanisms involved in the initiation and maintenance of these complications that rational approaches to treatment may be instituted.