title: Modulation of renal osteodystrophy by extrarenal production of calcitriol.
abstract: We report a patient with severe chronic renal failure who developed spontaneous bone fractures. He was found to have hypercalcemia, normal calcitriol levels (probably due to extrarenal production by noncaseating granulomas), and functional hypoparathyroidism. The bone biopsy showed low bone turn-over and the presence of noncaseating granulomas. Treatment with corticosteroids decreased the calcium and calcitriol levels and the parathyroid hormone levels rose. No further fractures occurred. A repeat bone biopsy revealed the presence of osteitis fibrosa. Renal osteodystrophy may be modulated by extrarenal production of calcitriol. In this case, excessive suppression of parathyroid hormone by endogenous calcitriol presumably caused an adynamic bone lesion and spontaneous fractures.
authors.affiliation: Chromalloy American Kidney Center, Washington University School of Medicine, St. Louis, MO 63110-1093.
authors.forename: J A
authors.initials: JA
authors.lastname: Delmez
authors.forename: A S
authors.initials: AS
authors.lastname: Dusso
authors.forename: E
authors.initials: E
authors.lastname: Slatopolsky
authors.forename: S L
authors.initials: SL
authors.lastname: Teitelbaum
mesh_terms: D000328:Adult; D001171:Arthritis, Juvenile / Q000150:complications / Q000378:metabolism; D001706:Biopsy; D001842:Bone and Bones / Q000473:pathology; D002117:Calcitriol / Q000096:biosynthesis*; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism*; D005264:Femoral Fractures / Q000209:etiology* / Q000378:metabolism; D005598:Fractures, Spontaneous / Q000209:etiology* / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D010281:Parathyroid Hormone / Q000378:metabolism; D011241:Prednisone / Q000627:therapeutic use; D012507:Sarcoidosis / Q000150:complications / Q000378:metabolism
chemical_list: D010281:Parathyroid Hormone; D002117:Calcitriol; D011241:Prednisone