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The unexpected presence of iron in bone biopsies of hemodialysis patients

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Abstract

Purpose

Bone biopsy defines classical diseases that constitute the renal osteodystrophy. There is a recent concern regarding other histological findings that are not appreciated by using the turnover, mineralization, and volume (TMV) classification. Iron (Fe) overload has been considered a new challenge and the real significance of the presence of this metal in bones is not completely elucidated. Therefore, the main goal of the current study was to not only to identify bone Fe, but also correlate its presence with demographic, and biochemical characteristics.

Methods

This is a cross-sectional analysis of bone biopsies performed in 604 patients on dialysis from 2010 to 2014 in a tertiary academic Hospital.

Results

Histomorphometric findings revealed the presence of Fe in 29.1%. Fe was associated with higher levels of serum ferritin and serum calcium. No TMV status was related to Fe bone overload.

Conclusion

Our study has highlighted that the presence of Fe in one-third of bone samples has unknown clinical significance. The lack of other contemporary bone biopsy study reporting Fe prevents us from comparison. The findings presented here should be specifically addressed in a future research and will require attention prior to implementation of any clinical guideline. If any proposed treatment, however, would change the bone Fe-related morbidity is undetermined.

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Acknowledgements

The authors thank the team of technicians of the Laboratory of Medical Investigation (LIM 16) of the University of Sao Paulo for all assistance with data collection. The authors’ roles: Study design: MRC, ABC, and VJ. Study conduct: MRC, WDV, LMR, IBO. Data collection: MRC, WDV, LMR, IBO. Data analysis: RME. Data interpretation: MRC, RME, RMAM, ABC, VJ. Drafting manuscript: MRC and RME. Revising manuscript content: MRC, RME, RMAM, ABC, VJ. Approving final version of manuscript: MRC, RME, RMAM, ABC, and VJ. MRC and RME take responsibility for the integrity of the data analysis.

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Correspondence to Melani R. Custodio.

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Custodio, M.R., Elias, R.M., Velasquez, W.D. et al. The unexpected presence of iron in bone biopsies of hemodialysis patients. Int Urol Nephrol 50, 1907–1912 (2018). https://doi.org/10.1007/s11255-018-1936-4

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Keywords

  • Bone biopsy
  • Iron
  • Dialysis
  • Histomorphometry
  • Ferritin