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Recent advances and controversies in childhood renal osteodystrophy

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  • 22 Citations


Renal osteodystrophy starts very early in chronic renal failure. Although vitamin D levels are normal in patients with 70–80% function, the levels are not appropriate to the prevailing biochemical milieu. Renal osteodystrophy may contribute to renal growth failure but a correlation between the degree of renal osteodystrophy and growth failure is not observed. Catch-up growth cannot be obtained over a longer period of time with vitamin D. The main reason for osteomalacia is Al intoxication. Aluminium osteopathy is more common in pediatric renal patients than anticipated. The mechanism whereby Al produces its effect on bone is uncertain. Guidelines for the diagnosis and therapy of renal osteopathy are presented. Prophylaxis of renal osteopathy can be attempted by phosphate restriction and/or vitamin D and by avoiding Al-containing drugs. All vitamin D compounds can be used for treatment and all have their advantages and disadvantages.

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  1. 1.

    Fraser DR, Kodicek E (1970) Unique biosynthesis by kidney of a biologically active vitamin D metabolite. Nature 228: 764–766

  2. 2.

    Slatopolsky E, Calgar S, Pennell JP, Taggart DB, Canterbury JM, Reiss E, Bricker NS (1971) On the pathogenesis of hyperparathyroidism in chronic experimental insufficiency in the dog. J Clin. Invest 50: 492–499

  3. 3.

    Arnaud CD (1973) Hyperparathyroidism and renal failure. Kidney Int 4: 89–95

  4. 4.

    Reiss E, Canterbury JM, Bercovitz MA, Kaplan EL (1970) The role of phosphate on the secretion of parathyroid hormone in man. J Clin Invest 49: 2146–2149

  5. 5.

    Mehls O, Ritz E (1983) Early treatment of renal osteodystrophy. In: Buccianti G (ed): Early treatment of renal insufficiency. Contrib Nephrol 37: 17–22

  6. 6.

    Friis T, Hahnemann S, Weeke E (1968) Serum calcium and serum phosphorus in uremia during administration of sodium phytate and aluminium hydroxide. Acta Med Scand 183: 497

  7. 7.

    Ritz E, Malluche HH, Krempien B, Tschöpe W, Massry SG (1978) Pathogenesis of renal osteodystrophy: role of phosphate and skeletal resistance to PTH. Adv Exp Med Biol 103: 423–436

  8. 8.

    Portale AA, Booth BE, Halloran BP, Morris RC Jr (1984) Effect of dietary phosphorus on circulating concentrations of 1.25-dihydroxyvitamin D and immunoreactive parathyroid hormone in children with moderate renal insufficiency. Clin Invest 73: 1580–1589

  9. 9.

    Kleerekoper M, Cruz C, Bernstein RS, Lenin NW, Foreback CC, Parfitt AM (1980) The phosphaturic action of PTH in the steady state in patients. Adv Exp Med Biol 128: 145–151

  10. 10.

    Slatopolsky E, Gray R, Adams ND, Lewis J, Hruska K, Martin K, Klahr S, de Luca H, Leman J (1978) Low serum levels of 1.25 (OH)2D3 are not responsible for the development of secondary hyperparathyroidism in early renal failure. Kidney Int 14: 733

  11. 11.

    Ogura Y, Kawaguchi Y, Sakai S, Yamamoto M, Kimura Y, Oda Y, Imanura N, Tsukui I (1980) Plasma levels of vitamin D metabolites in renal diseases. Contrib Nephrol 22: 18–21

  12. 12.

    Chesney RW, Hamstra AJ, Mazess RB, Rose P, De Luca HF (1982) Circulating vitamin D metabolite concentrations in childhood renal diseases. Kidney Int 21: 65–69

  13. 13.

    Portale AA, Booth BE, Tsai HC, Morris RC Jr (1982) Reduced plasma concentration of 1,25-dihydroxy vitamin D in children with moderate renal insufficiency. Kidney Int 21: 627–632

  14. 14.

    Taylor A, Norman ME (1982) Interrelationships of serum 25-hydroxy vitamin D3 and 1,25-dihydroxy vitamin D in juvenile renal osteodystrophy after therapy with 25-hydroxy vitamin D3. Metab Bone Dis Relat Res 4: 255–261

  15. 15.

    Rosen JF, Chesney RW (1983) Circulating calcitriol concentrations in health and disease. J Pediatr 103: 1–17

  16. 16.

    Werner E, Malluche HH, Ritz E (1978) Intestinal absorption of calcium in incipient and advanced renal failure. Miner Electrolyte Metab 1: 263–270

  17. 17.

    Portale AA, Halloran BP, Murphy MM, Morris RC (1984) Dietary phosphorus can determine the serum concentration of 1,25-(OH)2D by determining its production rate in humans. Clin Res 32: 405

  18. 18.

    Llach F, Massry SG, Koffler A, Malluche HH, Singer FR, Brickman AS, Kurokawa K (1977) Secondary hyperparathyroidism in early renal failure: role of phosphate retention. Kidney Int 12: 459

  19. 19.

    Healy MD, Malluche HH, Goldstein DA, Singer FR, Massry SG (1980) Effects of long-term therapy with calciferol in patients with moderate renal failure. Arch Intern Med 140: 1030–1033

  20. 20.

    Stickler GB, Bergen BJ (1973) A review: short stature in renal disease. Pediatr Res 7: 978–982

  21. 21.

    Schärer K, Gilli G (1984) Growth in children with chronic renal insufficiency. In: Fine RN, Gruskin AB (eds) Endstage renal disease in children. Saunders, Philadelphia, pp 271–290

  22. 22.

    Krempien B, Mehls O, Ritz E (1974) Morphological studies on pathogenesis of epiphyseal slipping in uremic children. Virchows Arch [A] 362: 129–143

  23. 23.

    Mehls O, Ritz E, Krempien B, Gilli G, Link K, Willich E, Schärer K (1975) Slipped epiphyses in renal osteodystrophy. Arch Dis Child 50: 545–554

  24. 24.

    Broyer M (1982) Growth in children with renal insufficiency. Pediatr Clin North Am 29: 991–1003

  25. 25.

    Hodson EM, Shaw PF, Evans RA, Dunstan CR, Hills EE, Wong SYP, Rosenberg AR, Roy LP (1983) Growth retardation and renal osteodystrophy in children with chronic renal failure. J Pediatr 103: 735–740

  26. 26.

    Mehls O, Ritz E (1986) Renal osteodystrophy. In: Holliday MA, Barratt TM, Vernier RL (eds) Pediatric nephrology. Williams and Wilkins, Baltimore (in press)

  27. 27.

    Kreusser W, Weinkauf R, Mehls O, Ritz E (1982) Effect of parathyroid hormone, calcitonin and growth hormone on cAMP content of growth cartilage in experimental uremia. Eur J Clin Invest 12: 337–343

  28. 28.

    Mehls O, Ritz E, Gilli G, Kreusser W (1978) Growth in renal failure. Nephron 21: 237–247

  29. 29.

    Langman CB, Mazur AT, Baron R, Norman ME (1982) 25-Hydroxyvitamin D3 (calciferol) therapy of juvenile renal osteodystrophy: beneficial effect on linear growth velocity. J Pediatr 100: 815–820

  30. 30.

    Chan JCM, De Luca HF (1977) Growth velocity in a child on prolonged hemodialysis: beneficial effect of 1-alpha-hydroxyvitamin D3. JAMA 238: 2053–2054

  31. 31.

    Chesney RW, Moorthy AV, Eisman JA, Jax DK, Mazess RB, De Luca HF (1978) Increased growth after long-term oral 1-alpha, 25-vitamin D3 in childhood renal osteodystrophy. N Engl J Med 298: 238–242

  32. 32.

    Chesney RW (1981) 1,25-dihydroxy-vitamin D3 in the treatment of juvenile renal osteodystrophy. In: Gruskin AB, Norman ME (eds) Pediatric nephrology. Nijhoff, The Hague, pp 209–217

  33. 33.

    Gilli G, Ritz E, Mehls O, von der Linden A (1980) Effect of vitamin D3 and 1,25(OH)2D3 on growth in experimental uremia. Pediatr Res 14: 990

  34. 34.

    Mehls O, Ritz E (1983) Skeletal growth in experimental uremia. Kidney Int 24 [Suppl 15]: S53–S62

  35. 35.

    Bulla M, Stock GJ, Delling G, Hofmann H, Offermann G (1980) Einfluß der Vitamin D3-Therapie auf die renale Osteodystrophie im Kindesalter. Klin Wochenschr 58: 237–247

  36. 36.

    Kleinknecht C, Broyer M, Gagnadoux MF, Marihenneberg C, Dartois AM, Kermanach C, Pouliquen M, Degoulet P, Usberti M, Roy MP (1980) Growth in children treated with long-term dialysis. A study of 76 patients. Adv Nephrol 9: 133–163

  37. 37.

    Bulla M, Delling G, Benz-Bohm G, Stock GI, Reutter AS, Ziegler R, Lühmann H, Severin M, Kalbitzer E, Manegold C (1980) Renale Osteodystrophie bei Kindern. Therapieversuch mit 1,25-dihydroxy-cholecalciferol. Klin Wochenschr 58: 511–519

  38. 38.

    Prader A, Illig R, Heierli E (1961) Eine besondere Form der primären Vitamin D-resistenten Rachitis mit Hypocalcämie und autosomal dominantem Erbgang. Helv Paediatr Acta 16: 452–468

  39. 39.

    Mehls O, Müller B, Schärer K (1971) Pseudomangelrachitis. Monatsschr Kinderheilk 119: 429–430

  40. 40.

    Balsan S, Garabedian M, Sorgniard R, Holick MF, Deluca HF (1975) 1,25-dihydroxyvitamin D3 and 1-alpha-hydroxyvitamin D3 in children: biologic and therapeutic effects in nutritional rickets and different types of vitamin D resistance. Pediatr Res 9: 586–593

  41. 41.

    Johannsen A, Nielsen HE, Hansen HE (1979) Bone maturation in children with chronic renal failure — effect of 1-alpha-hydroxy vitamin D and renal transplantation. Acta Radiol Diagn 20: 193–199

  42. 42.

    Coburn JW, Brickman AS, Sherrard DJ, Singer FR, Wong EGC, Baylink DJ, Norman AW (1977) Use of 1,25(OH)2 vitamin D3 to separate “types” of renal osteodystrophy. Proc Eur Dial Transplant Assoc 14: 442–450

  43. 43.

    Ward MK, Feest TG, Willis HA, Parkinson IS, Kerr DNS (1978) Osteomalacic dialysis osteodystrophy: evidence for a waterborne aetiologic agent, probably aluminium. Lancet I: 841–845

  44. 44.

    Parkinson IS, Feest TG, Ward MK, Fawcett RWP, Kerr DNS (1979) Fracturing dialysis osteodystrophy and dialysis encephalopathy: an epidermiological survey. Lancet I: 406–409

  45. 45.

    Ott SM, Maloney NA, Coburn JW, Alfrey AC, Sherrard DJ (1982) The prevalence of bone aluminium deposition in renal osteodystrophy and its relation to the response to calcitriol therapy. N Engl J Med 307: 709–713

  46. 46.

    Ellis HA (1982) Aluminium and osteomalacia after parathyroidectomy. Ann Intern Med 96: 533–534

  47. 47.

    Pierides AM, Edwards WG, Cullum UX, McCall JT, Ellis HA (1980) Hemodialysis encephalopathy with osteomalacia fractures and muscle weakness. Kidney Int 18: 115–124

  48. 48.

    Nathan E, Pedersen SE (1980) Dialysis encephalopathy in a non-dialyzed uremic boy treated with aluminium hydroxide orally. Acta Paediatr Scand 69: 793–796

  49. 49.

    Felsenfeld AJ, Gutman RA, Llach F, Harrelson JM (1982) Osteomalacia in chronic renal failure: a syndrome previously reported only with maintenance dialysis. Am J Nephrol 2: 147–154

  50. 50.

    Griswold WR, Reznik KV, Mendoza SA, Trauner D, Alfrey AC (1983) Accumulation of aluminium in an non-dialyzed uremic child receiving aluminium hydroxide. Pediatrics 71: 56–58

  51. 51.

    Randall ME (1983) Aluminium toxicity in an infant not on dialysis. Lancet I: 1327

  52. 52.

    Kaye M (1983) Oral toxicity in a non-dialyzed patient with renal failure. Clin Nephrol 20: 208–211

  53. 53.

    Andreoli SP, Bergstein JM, Sherrard DJ (1984) Aluminium intoxication from aluminium-containing phosphate binders in children with azotemia not undergoing dialysis. N Engl J Med 310: 1079–1084

  54. 54.

    Sedman AB, Miller NL, Warady BA, Lum GM, Alfrey AC (1984) Aluminium loading in children with chronic renal failure. Kidney int 26: 201–204

  55. 55.

    Kaenny WD, Hegg AP, Alfrey AC (1977) Gastrointestinal absorption of aluminium from aluminium-containing antacids. N Engl J Med 296: 1389–1390

  56. 56.

    Coburn JW, Nebeker HG, Hercz G, Milliner DS, Ott SM, Andress DL, Sherrard DJ, Alfrey AC (1984) Role of aluminium accumulation in renal osteodystrophy. In: Robinson RR (ed) Nephrology. Springer, New York Berlin Heidelberg pp 1383–1412

  57. 57.

    Alvarez-Ude F, Feest TG, Ward MK, Pierides AM, Ellis HA, Peart KM, Simpson W, Weightman D, Kerr DNS (1978) Hemodialysis bone disease: correlation between clinical, histological and other findings. Kidney Int 14: 68–73

  58. 58.

    Hodsman A, Sherrad DJ, Alfrey AC, Ott SM, Brickman AS, Miller NL, Maloney NA, Coburn JW (1982) Bone aluminium and histomorphometric features of renal osteodystrophy. J Clin Endocrinol Metab 54: 629–637

  59. 59.

    Salusky IB, Coburn JW, Paunier L, Sherrard DJ, Fine RN (1984) Role of aluminium hydroxide in raising serum aluminium levels in children undergoing continuous ambulatory peritoneal dialysis (CAPD). J Pediatr 105: 717–720

  60. 60.

    Sedman AB, Wilkening GN, Warady BA, Lum GM, Alfrey AC (1984) Clinical and laboratory observations. Encephalopathy in childhood secondary to aluminium toxicity. J Pediatr 105: 836–838

  61. 61.

    Salusky IB, Coburn JW, Foley J, Nelson P, Fine RN (1986) Effects of oral calcium carbonate on control of serum phosphorus and changes in plasma aluminium levels after discontinuation of aluminium-containing gels in children receiving dialysis. J Pediatr 108: 767–770

  62. 62.

    Shimada H, Nakamura M, Marumo F (1983) Influence of aluminium on the effect of 1 (OH)D3 on renal osteodystrophy. Nephron 35: 163–170

  63. 63.

    Versiek J, Cornelis R (1980) Measuring aluminium levels. N Engl J Med 302: 468–469

  64. 64.

    Alfrey AC (1983) Aluminium. Adv Clin Chem 21: 69–91

  65. 65.

    Moriniere P, Roussel A, Tahiri Y, Fournier A (1982) Substitution of aluminium hydroxide by high doses of calcium carbonate in patients on chronic hemodialysis: disappearance of hyperaluminemia and equal control of secondary hyperparathyroidism. Proc Eur Dial Transplant Assoc 19: 784–787

  66. 66.

    Salusky IB, Coburn JW, Foley J, Nelson P, Fine RN (1986) Effect of oral calcium carbonate on control of serum phosphorus and changes in plasma aluminium levels after discontinuation of aluminium-containing gels in children receiving dialysis. J Pediatr 108: 767–770

  67. 67.

    Slatopolsky E, Weerts C, Lopez-Hilker S, Norwood K, Zink M, Windus D, Delmez J (1986) Calcium carbonate as a phosphate binder in patients with chronic renal failure undergoing dialysis. N Engl J Med 315: 157–161

  68. 68.

    Milliner DS, Ott SM, Nebeker HG, Andress DL, Sherrard DJ, Alfrey AC, Slatopolsky E, Coburn JW (1984) Deferoxamine infusion test for diagnosis of aluminium-related osteomalacia. Ann Intern Med 101: 775–780

  69. 69.

    Malluche HH, Ritz E, Lange HP, Kutschera J, Hodgson M, Seiffert U, Schoeppe W (1976) Bone histology in incipient and advanced renal failure. Kidney Int 9: 355–362

  70. 70.

    Hodsman AB, Hood SA, Brown P, Cordy PE (1985) Do serum aluminium levels reflect underlying skeletal aluminium accumulation and bone histology before or after chelation by deferoxamine. J Lab Clin Med 106: 674–681

  71. 71.

    Llach F, Felsenfeld AJ, Coleman DD, Kereny JJ, Pederson JA, Medlock TR (1986) The natural corse of dialysis osteomalacia. Kidney Int 29 [Suppl 18]: S74-S79

  72. 72.

    Dunstan CR, Evans RA (1986) Aluminium and renal bone disease in Australia. Kidney Int 29 [Suppl 18]: S65–S74

  73. 73.

    Salusky IB, Goodman WG, Brill J, Slatopolsky E, Fine RN, Coburn JW (1986) Features of renal bone disease in dialyzed children: bone dynamics and aluminium burden. Kidney Int 29: 232

  74. 74.

    Kopp JB, Andress DL, Maloney N, Sherrard DJ (1986) A longitudinal study of bone aluminium accumulation in hemodialysis patients. Kidney Int 29: 218

  75. 75.

    Quarles LD, Dennis VW, Gitelman HJ, Harrelson JM, Drezner MK (1985) Aluminium deposition at the osteoid-bone interface: an epiphenomenon of the osteomalacic state in vitamin D-deficient dogs. J Clin Invest 75: 1441–1447

  76. 76.

    Ellis HA, McCarthy JH, Herrington J (1979) Bone aluminium in hemodialyzed patients and in rats injected with aluminium chloride: relationship to impaired bone mineralization. J Clin Pathol 32: 832–844

  77. 77.

    Goodman WG, Gilligan J, Horst R (1984) Short-term aluminium administration in the rat. J Clin Invest 73: 171–181

  78. 78.

    Cournot-Witmer G, Zingraff J, Plachot JJ, Escaig F, Lefevre R, Boumati P, Bourdeau A, Garabedian M, Galle P, Bourdon R, Drueke T, Balsan S (1981) Aluminium localization in bone from hemodialyzed patients: relationship to matrix mineralization. Kidney Int 20: 375–385

  79. 79.

    Blumenthal NC, Posner AS (1984) In vitro model of aluminium-induced osteomalacia: inhibition of hydoxyapatite formation and growth. Calcif Tiss Int 36: 439–441

  80. 80.

    Maloney NA, Ott S, Alfrey AC, Coburn JW, Sherrard DJ (1982) Histologic quantitation of aluminium in iliac bone from patients with renal failure. J Lab Clin Med 99: 206–216

  81. 81.

    Lieberherr M, Gorsse B, Cournot-Witmer G, Thil CL, Balsan S (1982) In vitro effects of aluminium on bone phosphatases: possible interaction with bPTH and vitamin D3 metabolites. Calcif Tissue Int 34: 280–283

  82. 82.

    Andress DL, Ott SM, Maloney NA, Sherrard DJ (1985) Effect of parathyroidectomy on aluminium accumulation in chronic renal failure. N Engl J Med 312: 468–473

  83. 83.

    Brown EM, Wilson RE, Thatcher JG, Marynick SP (1981) Abnormal calcium regulated PTH release in normal parathyroid tissue from patients with adenoma. Am J Med 71: 565–570

  84. 84.

    Martin KJ, Hruska KA, Lewis J, Anderson C, Slatopolsky E (1977) The renal handling of parathryoid hormone. Role of peritubular uptake and glomerular filtration. J Clin Invest 60: 808–814

  85. 85.

    Massry SG, Stein R, Garty J, Arieff AI, Norman AW, Coburn JW, Friedler RM (1976) Skeletal resistance to calcemic action of parathyroid hormone: role of 1,25(OH)2D3. Kidney Int 9: 467–474

  86. 86.

    Brown E (1981) Set point for calcium: its role in normal and abnormal secretion. In: Cohn DV, Talmage RV, Matthews JL (eds) Hormonal control of calcium metabolism. Excerpta Medica, Amsterdam, pp 35–47

  87. 87.

    Brown EM, Wilson RE, Eastman RC, Pallotta J, Marynick SP (1982) Abnormal regulation of parathyroid hormone release by calcium in secondary hyperparathyroidism due to chronic renal failure. J Clin Endocrinol Metab 54: 172–179

  88. 88.

    Ritz E, Mehls O, Krempien B (1980) Calcium and phosphorus metabolism in maintenance hemodialysis. In: Hamburger J, Crosnier J, Grünfeld JP, Maxwell MH (eds) Advances in nephrology 9. pp 71–108

  89. 89.

    Schmidt-Gayk H, Ritz E, Mehls O, Goossen J, Förster P (1977) 25-OH-vitamin D in experimental and clinical uremia. Calcif Tissue Res [Suppl]22: 430–433

  90. 90.

    Hart W, Duursma SA, Visser WJ, Nijo LKF (1975) The hydroxyproline content of plasma of patients with impaired renal function. Clin Nephrol 4: 104–108

  91. 91.

    Deftos LJ, Catherwood BD (1983) BGP and bone metabolism. In: Frame B, Potts JT (eds) Clinical disorders of bone and mineral metabolism. Excerpta Medica, Amsterdam, pp 105–107

  92. 92.

    Chesney RW, Mehls O, Anast CS, Brown E, Hammerman MR, Portale A, Fallon MD, Mahan J Jr, Alfrey AC (1986) Renal osteodystrophy in children: the role of vitamin D, phosphorus, and parathyroid hormone. Am J Kidney Dis 7: 275–284

  93. 93.

    Parfitt AM (1977) Clinical and radiographic manifestations of renal osteodystrophy. In: David DS (ed) Calcium metabolism in renal failure and nephrolithiasis. Wiley, New York, pp 145–196

  94. 94.

    Mehls O, Ritz E, Krempien B, Willich E, Bommer J, Schärer K (1973) Roentgenological signs in the skeleton of uremic children. An analysis on the anatomical principle underlying the roentgenological changes. Pediatr Radiol 1: 183–190

  95. 95.

    Mankin HJ (1974) Rickets, osteomalacia and renal osteodystrophy, part I. J Bone Joint Surg [Am] 56: 101–128

  96. 96.

    Mankin HJ (1974) Rickets, osteomalacia and renal osteodystrophy, part II. J Bone Joint Surg [Am] 56: 352–386

  97. 97.

    Ritz E, Malluche A, Krempien B, Mehls O (1977) Bone histology in renal insufficiency. In: David DS (ed) Calcium metabolism in renal failure and nephrolithiasis. Wiley, New York, pp 197–233

  98. 98.

    Fallon MD, Teitelbaum SL (1981) A simple procedure for the rapid histologic diagnosis of metabolic bone disease. Calcif Tissue Int 33: 281–283

  99. 99.

    Fallon MD, Teitelbaum SL (1982) The interpretation of fluorescent tetracycline markers in the diagnosis of metabolic bone diseases. Hum Pathol 13: 416–417

  100. 100.

    Delling G (1975) Endokrine Osteopathien. Veröffentlichungen aus der Pathologie, vol 28. Fischer, Stuttgart

  101. 101.

    Mehls O, Krempien B, Ritz E, Schärer K, Schüler HW (1973) Renal osteodystrophy in children on maintenance hemodialysis. Proc Eur Dial Transplant Assoc 10: 197–202

  102. 102.

    Wittmer J, Margolis A, Fantaine O, Fritsch J, Lenoir G, Broyer M, Balsan S (1976) Effects of 25-hydroxycholecalciferol on bone lesions of children with terminal renal failure. Kidney Int 10: 395–408

  103. 103.

    Luciani JC, Meunier PJ, Dumas R (1979) Dialysis bone disease in childhood: treatment with 25-hydroxycholecalciferol. Pediatr Res 13: 1105–1108

  104. 104.

    Mak RHK, Turner C, Thompson T, Powell H, Haycock GB, Chantler C (1985) Suppression of secondary hyperparathyroidism in children with chronic renal failure by high dose phosphate binders: calcium carbonate versus aluminium hydroxide. Br Med J 291: 623–626

  105. 105.

    Potter DE, Wilson CJ, Ozonoff MB (1974) Hyperparathyroid bone disease in children undergoing long-term hemodialysis: treatment with vitamin D. J Pediatr 85: 60–66

  106. 106.

    Mehls O, Ritz E, Parsch K, Gilli G, Schärer K, Bommer J (1976) Management of epiphyseal slipping in uremia. Klin Wochenschr 54: 405–413

  107. 107.

    Bulla M, Delling G, Offermann G, Ziegler R, Benz G, Lühmann H, Sanchez de Reutter A (1979) Renal bone disorder in children: therapy with vitamin D3 or 1,25-dihydroxycholecalciferol. In: Norman AW (ed) Vitamin D, basic research and its clinical application. De Gruyter, Berlin, pp 853–859

  108. 108.

    Balsan M, Garabedian M, Dumas R, Broyer M (1981) Effets des métabolites de la vitamine D sur l'hyperparathroidie chez l'enfant insuffisant rénal. Actual Necker 9: 139–149

  109. 109.

    Malekzadeh MH, Stanley P, Ettenger R, Pennisi A, Uittenbogaart C, Fine RN (1977) Treatment of renal osteodystrophy in children on hemodialysis with dihydrotachysterol. In: Norman AW, Schaefer K, Coburn JW, (eds) Biochemical, chemical and clinical aspects related to calcium metabolism. De Gruyter, Berlin, pp 681–683

  110. 110.

    Chesney RW, Hamstra A, Jax DK (1980) Influence of long-term oral 1,25 vitamin D in childhood renal osteodystrophy. Contrib Nephrol 18: 55–71

  111. 111.

    Dabbagh S, Chesney RW (1984) Treatment of renal osteodystrophy during childhood. In Fine RN, Gruskin AB (eds) End-stage renal disease in children. Saunders, Philadelphia, pp 251–270

  112. 112.

    Slatopolsky E, Weerts C, Thielan J, Horst R, Harter H, Martin KJ (1984) Marked suppression of secondary hyperparathyroidism by intravenous administration of 1,25-dihydroxy-cholecalciferol in uremic patients. J Clin Invest 74: 2136–2143

  113. 113.

    Fournier A, Moriniere Ph, Sebert JL, Dkhissi H, Atik A, Leflon P, Renaud H, Gueris J, Gregoire I, Idrissi A, Garabedian M (1986) Calcium carbonate, an aluminium-free agent for control of hyperphosphatemia, hypocalcemia, and hyperparathyroidism in uremia. Kidney Int 29 [Suppl 18]: S114-S119

  114. 114.

    Lopez S, Galceran T, Slatopolsky E (1984) Evaluation of calcium carbonate as an effective phosphorus-binding in the dog. Clin Res 32: 452

  115. 115.

    Nebeker HG, Schneider HW, Coburn JW (1985) A non-aluminium containing phosphate binder: polyuronic acid. Kidney Int 27: 147

  116. 116.

    Hodsman JW, Wong EGC, Sherrard DJ, Brickman AS, Lee DBN, Singer FR, Norman AW, Coburn JW (1983) Preliminary trials with 24,25-dihydroxyvitamin D3 in dialysis osteomalacia. Am J Med 74: 407–414

  117. 117.

    Ott SM, Recker RR, Coburn JW, Sherrard DJ (1983) Vitamin D therapy in aluminium-releated osteomalacia. Kidney Int 23: 107 (A)

  118. 118.

    Ackrill P, Faiston AJ, Day JP, Hoope MC (1980) Successful removal of aluminium from patients with dialysis encephalopathy. Lancet II: 692–693

  119. 119.

    Ott SM, Andress DL, Nebeker H, Milliner DS, Maloney NA, Coburn JW, Sherrard DJ (1986) Changes in bone histology after treatment with desferrioxamine. Kidney Int 29 [Suppl 18]: S108–S113

  120. 120.

    Andreoli SP, Dunn D, De Meyer W, Bergstein JM (1985) Intraperitoneal deferoxamine therapy for aluminium intoxication. J Pediatr 107: 760–763

  121. 121.

    Freundlich M, Zilleruelo G, Faugere MC, Abitbol C, Strauss J, Malluche HH (1986) Treatment of aluminium toxicity in infantile uremia with deferoxamine. J Pediatr 109: 140–143

  122. 122.

    Firor HV, Moore ES, Levitsky LL, Galvez M (1972) Parathyroidectomy in children with chronic renal failure. J Pediatr Surg 7: 565–570

  123. 123.

    Talwalkar YB, Puri HC, Hawker CC, Tseng C, Campbell JR, Campbell RA (1979) Parathyroid autotransplantation in renal osteodystrophy. Am J Dis Child 133: 901–905

  124. 124.

    Frei U, Klempa I, Schneider M, Scheuermann EH, Koch KM (1981) Tumor-like growth of parathyroid autografts in uremic patients. Proc Eur Dial Transplant Assoc 18: 548–555

  125. 125.

    Lilien T von, Mehls O, Dietrich RB, Salusky IB, Leichter HE, Boechat MI, Kangarloo H, Fine RN (1985) Visualization of parathyroid glands by ultrasound in dialyzed children. Kidney Int 28: 246

  126. 126.

    Catell HS, Levin S, Kopitz S, Lyune ED (1971) Reconstructive surgery in children with azotemic osteodystrophy. J Bone Joint Surg 53: 216–228

  127. 127.

    Goldman AB, Lane JM, Salvati E (1978) Slipped capital femoral epiphyses complicating renal osteodystrophy: a report of three cases. Radiology 126: 333–339

  128. 128.

    Mehls O, Ritz E, Oppermann HC, Guignard JP (1981) Femoral head necrosis in uremic children without steroid treatment or transplantation. J Pediatr 6: 926–929

  129. 129.

    Mehls O, Ritz E, Gilli G, Heinrich U (1986) Role of hormonal disturbances in uremic growth failure. Contrib Nephrol 50: 119–129

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Mehls, O., Salusky, I.B. Recent advances and controversies in childhood renal osteodystrophy. Pediatr Nephrol 1, 212–223 (1987). https://doi.org/10.1007/BF00849295

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Key words

  • Renal osteodystrophy
  • Al osteopathy
  • iPTH
  • Vitamin D
  • Growth