Medical history (history of the patient) represents an important component in the diagnosis of renal osteopathy. Family history Is there a frequent history of kidney disease in your family? Social history Current medical history/systemic history (somatic and psychological complaints). Do you suffer from bone pain? Where exactly is the pain localized? How long has the … Renal Osteopathy: Medical History
Endocrine, nutritional and metabolic diseases (E00-E90). Amyloidosis – extracellular (“outside the cell”) deposits of amyloids (degradation-resistant proteins) that can lead to cardiomyopathy (heart muscle disease), neuropathy (peripheral nervous system disease), and hepatomegaly (liver enlargement), among other conditions. Musculoskeletal system and connective tissue (M00-M99). Adynamic bone disease – form of renal osteopathy, the exact pathogenesis of … Renal Osteopathy: Or something else? Differential Diagnosis
The following are the most important diseases or complications that may be contributed to by renal osteopathy: Musculoskeletal system and connective tissue (M00-M99). Gait disorders due to muscle weakness Bone pain Pathological fracture – bone fracture that occurs during normal stress on the pathologically altered bone.
A comprehensive clinical examination is the basis for selecting further diagnostic steps: General physical examination – including blood pressure, pulse, body weight, height; further: Inspection (viewing). Skin (normal: intact; abrasions/wounds, redness, hematomas (bruising), scars) and mucous membranes [anemia (anemia), edema (water retention), pruritus (itching)] Gait pattern (fluid, limping). Body or joint posture (upright, bent, gentle … Renal Osteopathy: Examination
1st order laboratory parameters – obligatory laboratory tests. Small blood count Renal parameters – creatinine, urea, creatinine clearance. Phosphate [hyperphosphatemia (excess phosphate) (in renal secondary hyperparathyroidism/parathyroid hyperfunction) – common, especially when glomerular filtration rate (GFR) falls below 30%] Serum parathyroid hormone and calcium [in secondary hyperparathyroidism: serum parathyroid hormone ↑ and calcium ↓] Alkaline phosphatase … Renal Osteopathy: Test and Diagnosis
Obligatory medical device diagnostics. Radiography of the affected region – in case of bone pain [juxtaposition of osteopenic and osteosclerotic structural changes; in tertiary hyperparathyroidism: osteoclastomas, chondrocalcinosis, ectopic mineralizations]. Osteodensitometry (bone densitometry) – should be performed at regular intervals. Optional medical device diagnostics – depending on the results of the history, physical examination and mandatory … Renal Osteopathy: Diagnostic Tests
Secondary hyperparathyroidism (shPT) In rare cases, subtotal parathyroidectomy (partial removal of the parathyroid gland) may be necessary. Indications: secondary hyperparathyroidism (shPT) with: Severe hypercalcemia (tertiary hyperparathyroidism: parathyroid hormone level ↑, calcium level ↑). Kidney transplant patients with hypercalcemia (calcium excess) and progressive functional decline of the graft (without other explanation of the genesis). Therapy-resistant pruritus … Renal Osteopathy: Surgery
Although radiographic signs of renal osteopathy are detectable in nearly half of affected individuals, symptoms occur in only up to 10%. These include: Leading symptoms Bone pain Muscle weakness, occurring mainly in the proximal (trunk) muscles Spontaneous fractures – spontaneous bone fractures. Further notes In children, there are growth disturbances similar to rickets (short stature) … Renal Osteopathy: Symptoms, Complaints, Signs
Pathogenesis (development of disease) In chronic renal insufficiency (kidney weakness), various changes occur in the bone, which are called renal osteopathy. High-turnover osteopathy (high bone turnover and acute bone substance loss) can be distinguished from low-turnover osteopathy. In addition, mixed forms may also be present. In high-turnover osteopathy, secondary hyperparathyroidism/parathyroid hyperfunction (parathyroid hormone level ↑, … Renal Osteopathy: Causes
General measures Any concomitant medical conditions should be carefully monitored and treated. Blood pressure should be optimally adjusted. Blood lipids (blood fats) should be controlled and, if necessary, brought to a low level. Nicotine restriction (refrain from tobacco use). Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per … Renal Osteopathy: Therapy
Therapeutic target Improvement of the symptomatology Therapy recommendations Phosphate binders (dose adjustment according to serum phosphate level). If necessary, calcitriol substitution* (lowers the level of intact parathyroid hormone); indication: renal insufficiency (renal weakness; increase in the concentration of urinary substances) with elevated parathyroid hormone levels. Calcimimetic (parathyroid hormone release ↓); Indication: therapy of secondary hyperparathyroidism … Renal Osteopathy: Drug Therapy
