title: Severe bone disease and low bone mineral density after juvenile renal failure.
abstract: BACKGROUND
  Little is known about the late effects of juvenile end-stage renal disease (ESRD) on bone integrity. To establish clinical manifestations of metabolic bone disease and bone mineral density (BMD) in young adult patients with juvenile ESRD, we performed a long-term outcome study.
  
  
  METHODS
  A cohort was formed of all Dutch patients with onset of ESRD between 1972 and 1992 at age 0 to 14 years, born before 1979. Data were collected by review of medical charts, current history, physical examination, and performing dual energy x-ray absorptiometry (DEXA) of the lumbar spine and the femoral neck.
  
  
  RESULTS
  Clinical information was retrieved in 247 out of 249 patients. Of all of these patients, 61.4% had severe growth retardation (<-2 SD), 36.8% had clinical symptoms of bone disease, and 17.8% were disabled by bone disease. Growth retardation and clinical bone disease were associated with a long duration of dialysis. DEXA was performed in 140 out of 187 living patients. Mean BMD +/- SD corrected for gender and age (Z score) of the lumbar spine was -2.12 +/- 1.4 and of the femoral neck was -1.77 +/- 1.4. A low lean body mass was associated with a low lumbar spine and a low femoral neck BMD; male gender, physical inactivity and aseptic bone necrosis were associated with a low lumbar spine BMD.
  
  
  CONCLUSIONS
  Bone disease is a major clinical problem in young adults with pediatric ESRD. Further follow-up is needed to establish the impact of the low bone mineral densities found in these patients.
authors.affiliation: Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center (AMC), Amsterdam, The Netherlands. j.w.groothoff@amc.uva.nl
authors.forename: Jaap W
authors.initials: JW
authors.lastname: Groothoff
authors.forename: Martin
authors.initials: M
authors.lastname: Offringa
authors.forename: Berthe L F
authors.initials: BL
authors.lastname: Van Eck-Smit
authors.forename: Mariken P
authors.initials: MP
authors.lastname: Gruppen
authors.forename: Nicole J
authors.initials: NJ
authors.lastname: Van De Kar
authors.forename: Eric D
authors.initials: ED
authors.lastname: Wolff
authors.forename: Marc R
authors.initials: MR
authors.lastname: Lilien
authors.forename: Jean Claude
authors.initials: JC
authors.lastname: Davin
authors.forename: Hugo S A
authors.initials: HS
authors.lastname: Heymans
authors.forename: Friedo W
authors.initials: FW
authors.lastname: Dekker
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D015519:Bone Density; D001851:Bone Diseases, Metabolic / Q000000981:diagnostic imaging / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors