[A study using nondecalcified bone biopsy of the incidence and presentation forms of renal osteodystrophy].
BACKGROUND
Renal osteodystrophy (ROD) is a common complication of chronic renal failure. Fibrous osteitis and, to a lesser extent, osteomalacia are the predominant lesions. The aim of the present study was to evaluate the prevalence of the different forms of ROD.


METHODS
Nondecalcified bone biopsies were evaluated in 100 patients with end-stage renal disease (57 in pre-dialysis and 43 on hemodialysis) in whom biochemical (calcium, phosphorus, alkaline phosphatase, parathyroid hormone) and histomorphometric studies were carried out. Bone biopsies were classified in four histological groups: mild, fibrous osteitis (FO), osteomalacia (OM) and mixed type (FO + OM).


RESULTS
96% of patients had histological findings of ROD with the following distribution: 41% mild; 30% FO; 14% OM; and 11% mixed. The most advanced types of ROD were seen in interstitial renal diseases. Pre-dialysis OM was associated with metabolic acidosis, a low phosphocalcic product and relative hypophosphoremia. Chronic aluminium poisoning was uncommon (7%) and was basically associated with OM. No instance of aluminium poisoning with osteodystrophy and bone fractures was seen.


CONCLUSIONS
The most severe histological forms of OM were found in hemodialysis patients with persistent hypophosphoremia and associated with osteosclerosis.
Lorenzo Sellares
V
V
Servicio de Nefrología, Hospital Universitario de Canarias, Santa Cruz de Tenerife.
Torres Ramírez
A
A
Hernández Marrero
D
D
Rodríguez Pérez
J
J
González Posada
J
J
Losada Cabrera
M
M
Maceira Cruz
B
B
Hernández Nieto
L
L
D000293:Adolescent; D000328:Adult; D001669:Biochemical Phenomena; D001671:Biochemistry; D001706:Biopsy; D001842:Bone and Bones / Q000473:pathology*; D002648:Child; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology*; D015331:Cohort Studies; D005355:Fibrosis / Q000473:pathology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000628:therapy; D008875:Middle Aged; D010000:Osteitis / Q000378:metabolism / Q000473:pathology*; D010018:Osteomalacia / Q000378:metabolism / Q000473:pathology*; D010026:Osteosclerosis / Q000473:pathology; D006435:Renal Dialysis
Estudio con biopsia ósea sin descalcificar de la incidencia y formas de presentación de la osteodistrofia renal.