CKD-RENAL OSTEODYSTROPHY

SUMMARY

RENAL BONE DISEASE TYPES
1. Osteitis fibrosa cystica due to secondary hyperparathyroidism (high bone-turnover disorder)
2. Adynamic bone disease due to over-suppression of parathyroid hormone release (low bone-turnover disorder)
3. Osteomalacia (low bone-turnover disorder associated with unmineralized bone)

INX & MANAGEMENT
4. Clinical findings: asymptomatic, but may develop bone pain and have increased risk of fractures.
5. Radiographs show subperiosteal bone resorption in the distal clavicle and the phalanges.
6. Treat this by following intact PTH (iPTH) levels.
7. Maintain serum Ca and PO₄ levels using phosphate binders, activated Vit D/analogs (paricalcitol, doxercalciferol), +/- calcimimetics (cinacalcet).

Reference(s)

Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. Get it on Amazon.
Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. Get it on Amazon.
Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].