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Diagnosis and Management of Renal Osteodystrophy in Children

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Pediatric Dialysis

Abstract

The kidney plays a major role in bone and ­mineral homeostasis by regulating calcium, phosphorus, parathyroid hormone (PTH), fibroblast growth factor-23 (FGF-23), and calcitriol (1,25 dihydroxyvitamin D3, 1,25(OH)2 D3) metabolism. Disordered regulation of mineral metabolism occurs early in the course of chronic kidney disease (CKD) and results in alterations in bone modeling, remodeling, and growth. These alterations have been a focus of CKD management in children for decades. However, a growing awareness that cardiovascular calcifications accompany CKD, that cardiovascular disease is the leading cause of mortality in both adults and children with kidney disease, and that therapies designed to treat the skeletal consequences of CKD affect the progression of vascular pathology, has led to a reclassification of the mineral, skeletal, and vascular complications associated with progressive kidney disease. Together, these alterations are termed “CKD Mineral and Bone Disorder” (“CKD-MBD”) [1], and the management of bone disease must consider effects on the cardiovascular system as well as on overall mortality in the pediatric CKD population. “Renal osteodystrophy” is the specific term used to describe the bone pathology that occurs as a complication of CKD and is therefore one aspect of the CKD-MBD. Traditionally, such lesions have been defined according to alterations in bone turnover, ranging from high bone turnover (secondary hyperparathyroidism, osteitis fibrosa) to lesions of low bone turnover (adynamic bone disease and osteomalacia). However, alterations in skeletal mineralization and volume are also common in patients with CKD [1] and may contribute to outcomes such as fractures, skeletal deformities, and poor growth which persist despite normalization of bone turnover [2].

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Authors and Affiliations

  1. Department of Pediatrics, University of California-Los, Los Angeles, CA, USA

    Katherine Wesseling-Perry MD

  2. Department of Pediatric Nephrology, University of California-Los Angeles, Los Angeles, CA, USA

    Isidro B. Salusky MD

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  1. Katherine Wesseling-Perry MD
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Correspondence to Katherine Wesseling-Perry MD .

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  1. Children’s Mercy Hospital and Clinics, Department of Pediatrics, Section of Pediatric Nephrology, School of Medicine, Kansas City, 64108, Missouri, USA

    Bradley A. Warady

  2. Center for Pediatrics, and Adolescent Medicine, Division of Pediatric Nephrology, Im Neuenheimer Feld 150, Heidelberg, 69120, Germany

    Franz Schaefer

  3. Department of Pediatrics, Stanford University School of Medicine, Division of Pediatric Nephrology, Welch Road 770, Palo Alto, 94304, California, USA

    Steven R. Alexander

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Wesseling-Perry, K., Salusky, I.B. (2012). Diagnosis and Management of Renal Osteodystrophy in Children. In: Warady, B., Schaefer, F., Alexander, S. (eds) Pediatric Dialysis. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-0721-8_25

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