Ungual tufts in the follow-up of patients on maintenance hemodialysis

Abstract

A recent publication showed the earliest signs of renal osteodystrophy in patients on maintenance hemodialysis (MHD) to occur in the tufts [1]. We present three patients on MHD, in two of whom the earliest unequivocal radiographic improvement was seen in the tufts. The third patient had been on MHD and, following subtotal parathyroidectomy, showed significant osseous improvement in the hands with relatively equal improvement in the tufts and middle phalanges. It appears that, with the use of routine primary or secondary magnification, the tufts are radiographically a highly sensitive site for both the early occurrence and improvement of osteodystrophy in patients on MHD. We are not aware of any previous publication pointing out exclusive improvement in the tufts in patients on MHD with virtually no change in the mid-phalanges. Two of these three cases illustrate that renal osteodystrophy is reversible by maintenance hemodialysis alone.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Sundaram, M., Joyce, P.F., Shields, J.B., Riaz, M.A., Sagar, S.: Terminal tufts of the hands — site for earliest changes of renal osteodystrophy in patients on maintenance hemodialysis. Am. J. Roentgenol.133, 25 (1979)

    Google Scholar 

  2. 2.

    Doyle, F.H.: Radiological patterns of bone disease associated with renal glomerular failure in adults. Br. Med. Bull.28, 220 (1972)

    Google Scholar 

  3. 3.

    Eastwood, J.B., Bordier, P.H. J., deWardener, H.E.: Some biochemical, histological, radiological and clinical features of renal osteodystrophy, kidney international. Radiology4, 128 (1973)

    Google Scholar 

  4. 4.

    Parfitt, A.M.: Clinical and radiographic manifestations of renal osteodystrophy. In: Calcium metabolism in renal failure and nephrolithiasis, D.S. David, (ed.), p. 167. New York: John Wiley 1977

    Google Scholar 

  5. 5.

    Hosking, D.J.: Diseases of the urinary system — renal osteodystrophy. Br. Med. J.2, 110 (1977)

    Google Scholar 

  6. 6.

    Ritz, E., Malluche, H.H., Krempien, B., Mehls, O.: Bone histology in renal failure. In: Calcium metabolism in renal failure and nephrolithiasis, D.S. David (ed.), p. 220. New York: John Wiley 1977

    Google Scholar 

  7. 7.

    Stanbury, S.W.: Azotaemic renal osteodystrophy. In: Clinics in endocrinology and metabolism, I. MacIntyre, (ed.). Vol. I, p. 267. London: Saunders 1972

    Google Scholar 

  8. 8.

    Johnson, W.J., Goldsmith, R.S., Beabout, J.W., Jowsey, J., Kelly, P.J., Arnaud, C.D.: Prevention and reversal of progressive secondary hyperparathyroidism in patients maintained by hemodialysis. Am. J. Med.56, 827 (1974)

    Google Scholar 

  9. 9.

    David, D.S.: Mineral and bone hemostasis in renal failure: pathophysiology and management, In: Calcium metabolism in renal failure and nephrolithiasis, D.S. David (ed.), p. 26. New York: John Wiley 1977

    Google Scholar 

  10. 10.

    Curtis, J.R., Eastwood, J.B., Smith, E.K.M., Storey, J.M., Verroust, P.J., deWardener, H.E., Wing, A.J., Wolfson, E.M.: Maintenance hemodialysis. Q.J. Med.149, 49 (1969)

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Murali Sundaram M.D., F.R.C.R..

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Sundaram, M., Phillipp, S.R., Wolverson, M.K. et al. Ungual tufts in the follow-up of patients on maintenance hemodialysis. Skeletal Radiol. 5, 247–249 (1980). https://doi.org/10.1007/BF00580598

Download citation

Key words

  • Tufts
  • Occurrence
  • Improvement
  • Maintenance hemodialysis