Abstract
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.
Similar content being viewed by others
References
Fraser DR, Kodicek E (1970) Unique biosynthesis by kidney of a biologically active vitamin D metabolite. Nature 228: 764–766
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
Arnaud CD (1973) Hyperparathyroidism and renal failure. Kidney Int 4: 89–95
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
Mehls O, Ritz E (1983) Early treatment of renal osteodystrophy. In: Buccianti G (ed): Early treatment of renal insufficiency. Contrib Nephrol 37: 17–22
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
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
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
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
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
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
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
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
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
Rosen JF, Chesney RW (1983) Circulating calcitriol concentrations in health and disease. J Pediatr 103: 1–17
Werner E, Malluche HH, Ritz E (1978) Intestinal absorption of calcium in incipient and advanced renal failure. Miner Electrolyte Metab 1: 263–270
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
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
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
Stickler GB, Bergen BJ (1973) A review: short stature in renal disease. Pediatr Res 7: 978–982
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
Krempien B, Mehls O, Ritz E (1974) Morphological studies on pathogenesis of epiphyseal slipping in uremic children. Virchows Arch [A] 362: 129–143
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
Broyer M (1982) Growth in children with renal insufficiency. Pediatr Clin North Am 29: 991–1003
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
Mehls O, Ritz E (1986) Renal osteodystrophy. In: Holliday MA, Barratt TM, Vernier RL (eds) Pediatric nephrology. Williams and Wilkins, Baltimore (in press)
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
Mehls O, Ritz E, Gilli G, Kreusser W (1978) Growth in renal failure. Nephron 21: 237–247
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
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
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
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
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
Mehls O, Ritz E (1983) Skeletal growth in experimental uremia. Kidney Int 24 [Suppl 15]: S53–S62
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
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
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
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
Mehls O, Müller B, Schärer K (1971) Pseudomangelrachitis. Monatsschr Kinderheilk 119: 429–430
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
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
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
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
Parkinson IS, Feest TG, Ward MK, Fawcett RWP, Kerr DNS (1979) Fracturing dialysis osteodystrophy and dialysis encephalopathy: an epidermiological survey. Lancet I: 406–409
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
Ellis HA (1982) Aluminium and osteomalacia after parathyroidectomy. Ann Intern Med 96: 533–534
Pierides AM, Edwards WG, Cullum UX, McCall JT, Ellis HA (1980) Hemodialysis encephalopathy with osteomalacia fractures and muscle weakness. Kidney Int 18: 115–124
Nathan E, Pedersen SE (1980) Dialysis encephalopathy in a non-dialyzed uremic boy treated with aluminium hydroxide orally. Acta Paediatr Scand 69: 793–796
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
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
Randall ME (1983) Aluminium toxicity in an infant not on dialysis. Lancet I: 1327
Kaye M (1983) Oral toxicity in a non-dialyzed patient with renal failure. Clin Nephrol 20: 208–211
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
Sedman AB, Miller NL, Warady BA, Lum GM, Alfrey AC (1984) Aluminium loading in children with chronic renal failure. Kidney int 26: 201–204
Kaenny WD, Hegg AP, Alfrey AC (1977) Gastrointestinal absorption of aluminium from aluminium-containing antacids. N Engl J Med 296: 1389–1390
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
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
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
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
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
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
Shimada H, Nakamura M, Marumo F (1983) Influence of aluminium on the effect of 1 (OH)D3 on renal osteodystrophy. Nephron 35: 163–170
Versiek J, Cornelis R (1980) Measuring aluminium levels. N Engl J Med 302: 468–469
Alfrey AC (1983) Aluminium. Adv Clin Chem 21: 69–91
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
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
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
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
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
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
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
Dunstan CR, Evans RA (1986) Aluminium and renal bone disease in Australia. Kidney Int 29 [Suppl 18]: S65–S74
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
Kopp JB, Andress DL, Maloney N, Sherrard DJ (1986) A longitudinal study of bone aluminium accumulation in hemodialysis patients. Kidney Int 29: 218
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
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
Goodman WG, Gilligan J, Horst R (1984) Short-term aluminium administration in the rat. J Clin Invest 73: 171–181
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
Blumenthal NC, Posner AS (1984) In vitro model of aluminium-induced osteomalacia: inhibition of hydoxyapatite formation and growth. Calcif Tiss Int 36: 439–441
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Mankin HJ (1974) Rickets, osteomalacia and renal osteodystrophy, part I. J Bone Joint Surg [Am] 56: 101–128
Mankin HJ (1974) Rickets, osteomalacia and renal osteodystrophy, part II. J Bone Joint Surg [Am] 56: 352–386
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
Fallon MD, Teitelbaum SL (1981) A simple procedure for the rapid histologic diagnosis of metabolic bone disease. Calcif Tissue Int 33: 281–283
Fallon MD, Teitelbaum SL (1982) The interpretation of fluorescent tetracycline markers in the diagnosis of metabolic bone diseases. Hum Pathol 13: 416–417
Delling G (1975) Endokrine Osteopathien. Veröffentlichungen aus der Pathologie, vol 28. Fischer, Stuttgart
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
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
Luciani JC, Meunier PJ, Dumas R (1979) Dialysis bone disease in childhood: treatment with 25-hydroxycholecalciferol. Pediatr Res 13: 1105–1108
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
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
Mehls O, Ritz E, Parsch K, Gilli G, Schärer K, Bommer J (1976) Management of epiphyseal slipping in uremia. Klin Wochenschr 54: 405–413
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
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
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
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
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
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
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
Lopez S, Galceran T, Slatopolsky E (1984) Evaluation of calcium carbonate as an effective phosphorus-binding in the dog. Clin Res 32: 452
Nebeker HG, Schneider HW, Coburn JW (1985) A non-aluminium containing phosphate binder: polyuronic acid. Kidney Int 27: 147
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
Ott SM, Recker RR, Coburn JW, Sherrard DJ (1983) Vitamin D therapy in aluminium-releated osteomalacia. Kidney Int 23: 107 (A)
Ackrill P, Faiston AJ, Day JP, Hoope MC (1980) Successful removal of aluminium from patients with dialysis encephalopathy. Lancet II: 692–693
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
Andreoli SP, Dunn D, De Meyer W, Bergstein JM (1985) Intraperitoneal deferoxamine therapy for aluminium intoxication. J Pediatr 107: 760–763
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
Firor HV, Moore ES, Levitsky LL, Galvez M (1972) Parathyroidectomy in children with chronic renal failure. J Pediatr Surg 7: 565–570
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
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
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
Catell HS, Levin S, Kopitz S, Lyune ED (1971) Reconstructive surgery in children with azotemic osteodystrophy. J Bone Joint Surg 53: 216–228
Goldman AB, Lane JM, Salvati E (1978) Slipped capital femoral epiphyses complicating renal osteodystrophy: a report of three cases. Radiology 126: 333–339
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
Mehls O, Ritz E, Gilli G, Heinrich U (1986) Role of hormonal disturbances in uremic growth failure. Contrib Nephrol 50: 119–129
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
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
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00849295