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Bone Histo-Morphology in Chronic Kidney Disease Mineral Bone Disorder

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Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

Chronic Kidney Disease-Mineral Bone Disorder(CKD-MBD) is a systemic disorder of the mineral and bone metabolism seen in patients with Chronic Kidney Disease(CKD). It is manifested by either one or a combination of the following: (a) Abnormalities of calcium, phosphorus, PTH, or vitamin D metabolism. (b) Abnormalities in bone turnover, mineralization, volume, linear growth, or strength. (c) Vascular or other soft- tissue calcification. Renal osteodystrophy measures the skeletal component of CKD-MBD. To study the histomorphology of bone marrow biopsy in patients with CKD-MBD and correlate the histological features of bone biopsy with the clinicobiochemical parameters. 32 cases of diagnosed CKD-MBD formed the study group. Detailed clinical history and biochemical analysis was done for them. Bone marrow trephine biopsies were conducted and the histology was studied. The clinicobiochemical and the histomorphological findings were correlated. Based on the bone biopsy findings, Hyperparathyroid bone disease consisted of-14 cases (44%), Mixed uremic osteodystrophy of-16 cases (50%) and one case (3%) each of Low turnover disease (Adynamic bone disease) and Normal histology. The mean blood urea, S. Creatinine, S Phosphate and the S. Vit D3 were found to be statistically significant between the two major subgroups. The area of the bone trabeculae and the osteoid percentage was found to be more in the MUO group and was found to be statistically significant. Conclusion: A trephine biopsy helps us in understanding the skeletal symptoms of the CKD when the clinical and biochemical parameters are not conclusive. A biopsy in unexplained bone pain/fractures, unexplained hypercalcemia and elevated phosphate levels helps in guiding the proper management of the patient.

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Authors and Affiliations

  1. Department of Pathology, Maulana Azad Medical College, 64 Kala Vihar Apt, Mayur Vihar Phase 1 extn, New Delhi, 91, India

    Khuraijam Bembem, Tejinder Singh & Shyama Lata Jain

  2. Department of Medicine, Maulana Azad Medical College, New Delhi, India

    Narinder Pal Singh

  3. Department of Biochemistry, Maulana Azad Medical College, New Delhi, India

    Alpana Saxena

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  1. Khuraijam Bembem
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  2. Tejinder Singh
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  4. Alpana Saxena
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  5. Shyama Lata Jain
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Correspondence to Khuraijam Bembem.

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There is no conflict of interest regarding the manuscript and the study was cleared by the ethical committee of the institute and was conducted under the guidance of the said co- authors.

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Informed consents were taken from the patients included in the study (A blank form enclosed along with the manuscript).

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Bembem, K., Singh, T., Singh, N.P. et al. Bone Histo-Morphology in Chronic Kidney Disease Mineral Bone Disorder. Indian J Hematol Blood Transfus 33, 603–610 (2017). https://doi.org/10.1007/s12288-016-0754-z

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  • DOI: https://doi.org/10.1007/s12288-016-0754-z

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