Diagnostyka i klinika zaburzeń metabolizmu kostnego w przewlekłej niewydolności nerek

Streszczenie
Chronic renal failure is associated with a cascade of events that adversely affect mineral metabolism, leading to renal osteodystrophy: phosphate retention, secondary hyperparathyroidism, decreased synthesis of calcitriol, accumulation of b2-microglobulin and aluminum. Renal osteodystrophy encompasses a wide spectrum of bone disorders that may occur in patients with chronic renal failure. Renal osteodystrophy may be present in the form of: high turnover renal osteodystrophy (osteitis fibrosa), low turnover renal osteodystrophy (adynamic bone disease, osteomalacia, aluminum-related bone disease), mixed osteodystrophy, dialysis-related amyloidosis induced by ?2-microglobulin. Diagnosis of renal osteodystrophy is made by invasive methods like bone biopsy- the „golden standard”. Imaging methods: plain film radiography, densitometry, ultrasonography are used to assess the risk of fractures or to visualize the parathyroid gland. Bone turnover may be also evaluated by studying in serum and/or urine markers of bone formation and resorption. After successful kidney transplantation many abnormalities of bone metabolism resolves, but „de novo” new disturbaces of bone turnover may develop: painful leg syndrome, osteonecrosis, osteopenia - immunosuppression-related bone disease.

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