Renal osteodystrophy: an underdiagnosed condition.
With the availability of 1-alpha-hydroxycholecalciferol it is even more relevant to detect the earliest stages of renal osteodystrophy. Sixty-two patients, either on haemodialysis or recent recipients of a renal transplant and 10 controls underwent hand radiography by a standard technique and by a direct magnification technique employing a 0.1 mm focal spot. A comparison of intracortical striations, subperiosteal resorption and soft tissue calcification was made in the two groups and hand score calculated on the non-magnification radiographs. The results were assessed independently by two radiologists. In subperiosteal resorption, the non-magnification technique gave a 6% positive result compared to 47% with magnification (P less than 0.01). For intracortical striations, the non-magnification technique gave an 11% positive results, whereas magnification resulted in a 45% positive result (P less than 0.01). Soft tissue calcification was found in one patient only, and reduction in hand score was a rare occurrence. The use of a standard technique only, without magnification, for radiographing hands in patients with renal disease, will result in evidence of renal osteodystrophy being missed in a significant proportion of patients.
D000293:Adolescent; D000328:Adult; D001862:Bone Resorption / Q000000981:diagnostic imaging / Q000209:etiology; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000209:etiology; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D011858:Radiographic Magnification