Renal osteodystrophy in dialyzed children.
The histological and biochemical features of renal osteodystrophy are described in pediatric patients undergoing continuous peritoneal dialysis (CAPD/CCPD). Fifty-eight patients aged between 1.2 and 20 years have been evaluated. Secondary hyperparathyroidism was present in 70% of patients, despite treatment with oral calcitriol. Low bone formation was found in 16% and one half of those had overt osteomalacia with evidence of aluminum accumulation. Aplastic bone was present in 9% of the patients and in most of these patients there was not evidence of aluminum accumulation. The biochemical determinations were poor predictors of the different bone lesions. The skeletal response to oral calcitriol therapy was evaluated in 16 patients aged 12 +/- 6 years and treated with CAPD/CCPD. All patients have bone biopsy findings of secondary hyperparathyroidism at initial biopsy and follow-up bone biopsies performed 14 +/- 5 months demonstrated persistence of secondary hyperparathyroidism in most of the patients. Modified techniques for oral calcitriol administration and the potential value of intraperitoneal calcitriol may have a new role in the management of secondary hyperparathyroidism in patients with chronic renal failure.
Salusky
I B
IB
Department of Pediatrics, UCLA School of Medicine.
Goodman
W G
WG
D000293:Adolescent; D000328:Adult; D000535:Aluminum / Q000009:adverse effects; D001842:Bone and Bones / Q000473:pathology; D002117:Calcitriol / Q000008:administration & dosage / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy / Q000209:etiology; D007223:Infant; D008297:Male; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects*
D000535:Aluminum; D002117:Calcitriol