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Treatment of Pediatric Chronic Kidney Disease-Mineral and Bone Disorder

  • Kidney and Bone (S Moe and I Salusky, Section Editors)
  • Published:
Current Osteoporosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

In this paper, we review the pathogenesis and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD), especially as it relates to pediatric CKD patients.

Recent Findings

Disordered regulation of bone and mineral metabolism in CKD may result in fractures, skeletal deformities, and poor growth, which is especially relevant for pediatric CKD patients. Moreover, CKD-MBD may result in extra-skeletal calcification and cardiovascular morbidity. Early increases in fibroblast growth factor 23 (FGF23) levels play a key, primary role in CKD-MBD pathogenesis. Therapeutic approaches in pediatric CKD-MBD aim to minimize complications to the growing skeleton and prevent extra-skeletal calcifications, mainly by addressing hyperphosphatemia and secondary hyperparathyroidism. Ongoing clinical trials are focused on assessing the benefit of FGF23 reduction in CKD.

Summary

CKD-MBD is a systemic disorder that has significant clinical implications. Treatment of CKD-MBD in children requires special consideration in order to maximize growth, optimize skeletal health, and prevent cardiovascular disease.

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Acknowledgments

The authors’ work has been supported by an NIH/NIDDK K08 Mentored Clinical Scientist Research Career Development Award (DK111980, to MRH), an NIH/NICHD K12 Child Health Research Career Development Award (HD034610, to MRH), a UCLA Clinical and Translational Science Institute & UCLA Children’s Discovery and Innovation Institute Children’s Health Team Science Award (to MRH and IBS), an NIH/NIDDK R01 grant (DK35423, to IBS), and an NIH/NIDDK U34 grant (DK104619, to IBS).

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Authors and Affiliations

  1. Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Mark R. Hanudel & Isidro B. Salusky

  2. Division of Pediatric Nephrology, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, MDCC A2-383, Los Angeles, CA, 90095-1752, USA

    Mark R. Hanudel

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Correspondence to Mark R. Hanudel.

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Mark Hanudel declares no conflict of interest.

Isidro Salusky reports grants from Amgen, grants from Abbvie, and serving on an advisory board from OPTKO, outside the submitted work.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Kidney and Bone

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Hanudel, M.R., Salusky, I.B. Treatment of Pediatric Chronic Kidney Disease-Mineral and Bone Disorder. Curr Osteoporos Rep 15, 198–206 (2017). https://doi.org/10.1007/s11914-017-0365-0

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