Renal Osteodystrophy
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The medical term "renal" describes things related to the kidneys. Renal osteodystrophy is a bone disease that occurs when your kidneys fail to maintain the proper levels of calcium and phosphorus in your blood. It's a common problem in people with kidney disease and affects 90 percent of dialysis patients.
Renal osteodystrophy is most serious in children because their bones are still growing. The condition slows bone growth and causes deformities. One such deformity occurs when the legs bend inward toward each other or outward away from each other; this deformity is referred to as "renal rickets." Another important consequence is short stature. Symptoms can be seen in growing children with renal disease even before they start dialysis.
The bone changes from renal osteodystrophy can begin many years before symptoms appear in adults with kidney disease. For this reason, it's called the "silent crippler." The symptoms of renal osteodystrophy aren't usually seen in adults until they have been on dialysis for several years. Older patients and women who have gone through menopause are at greater risk for this disease because they're already vulnerable to osteoporosis, another bone disease, even without kidney disease. If left untreated, the bones gradually become thin and weak, and a person with renal osteodystrophy may begin to feel bone and joint pain. There's also an increased risk of bone fractures.
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Hormones and Minerals
In healthy adults, bone tissue is continually being remodeled and rebuilt. The kidneys play an important role in maintaining healthy bone mass and structure because one of their jobs is to balance calcium and phosphorus levels in the blood.
Calcium is a mineral that builds and strengthens bones. It's found in many foods, particularly milk and other dairy products. If calcium levels in the blood become too low, four small glands in the neck called the parathyroid glands release a hormone called parathyroid hormone (PTH). This hormone draws calcium from the bones to raise blood calcium levels. Too much PTH in the blood will remove too much calcium from the bones; over time, the constant removal of calcium weakens the bones.
Phosphorus, which is found in most foods, also helps regulate calcium levels in the bones. Healthy kidneys remove excess phosphorus from the blood. When the kidneys stop working normally, phosphorus levels in the blood can become too high, leading to lower levels of calcium in the blood and resulting in the loss of calcium from the bones.
Healthy kidneys produce calcitriol, a form of vitamin D, to help the body absorb dietary calcium into the blood and the bones. If calcitriol levels drop too low, PTH levels increase, and calcium is removed from the bones. Calcitriol and PTH work together to keep calcium balance normal and bones healthy. In a patient with kidney failure, the kidneys stop making calcitriol. The body then can't absorb calcium from food and starts removing it from the bones.
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Diagnosis
To diagnose renal osteodystrophy, your doctor may take a sample of your blood to measure levels of calcium, phosphorus, PTH, and calcitriol. The doctor may perform a bone biopsy to see how dense your bones are. A bone biopsy is done under local anesthesia and involves removing a small sample of bone from the hip and analyzing it under a microscope. Determining the cause of renal osteodystrophy helps the doctor decide on a course of treatment.
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Treatment
Controlling PTH levels prevents calcium from being withdrawn from the bones. Usually, overactive parathyroid glands are controllable with a change in diet, dialysis treatment, or medication. The drug cinacalcet hydrochloride (Sensipar), approved by the Food and Drug Administration in 2004, lowers PTH levels by imitating calcium. If PTH levels can't be controlled, the parathyroid glands may need to be removed surgically.
If your kidneys aren't making adequate amounts of calcitriol, you can take synthetic calcitriol as a pill or in an injectable form. Your doctor may prescribe a calcium supplement in addition to calcitriol.
These medications decrease the absorption of phosphorus into the blood.
Renal osteodystrophy can also be treated with changes in diet. Reducing dietary intake of phosphorus is one of the most important steps in preventing bone disease. Almost all foods contain phosphorus, but it's especially high in milk, cheese, dried beans, peas, nuts, and peanut butter. Limit drinks such as cocoa, dark sodas, and beer. Often, medications such as calcium carbonate (Tums), calcium acetate (PhosLo), sevelamer hydrochloride (Renagel), or lanthanum carbonate (Fosrenol) are prescribed with meals and snacks to bind phosphorus in the bowel. These decrease the absorption of phosphorus into the blood. Be sure your phosphate binder is aluminum-free because aluminum can be toxic and cause anemia. A renal dietitian can help develop a dietary plan to control phosphorus levels in the blood.
Exercise has been found to increase bone strength in some patients. It's important, however, to consult a doctor or health care professional before beginning any exercise program.
A good treatment program, including proper attention to dialysis, diet, and medications, can improve your body's ability to repair bones damaged by renal osteodystrophy.
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For More Information
American Association of Kidney Patients
3505 East Frontage Road
Suite 315
Tampa, FL 33607
Phone: 1–800–749–2257
Fax: 813–636–8122
Email: info@aakp.org
Internet: www.aakp.org
American Kidney Fund
6110 Executive Boulevard
Suite 1010
Rockville, MD 20852
Phone: 1–800–638–8299 or 301–881–3052
Fax: 301–881–0898
Email: helpline@kidneyfund.org
Internet: www.kidneyfund.org
National Kidney Foundation, Inc.
30 East 33rd Street
New York, NY 10016
Phone: 1–800–622–9010 or 212–889–2210
Fax: 212–689–9261
Email: info@kidney.org
Internet: www.kidney.org
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The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.
About the Kidney Failure Series
The NIDDK Kidney Failure Series
includes six booklets and seven fact sheets that can help you learn more about treatment methods for kidney failure, complications of dialysis, financial help for the treatment of kidney failure, and eating right on hemodialysis. For free single printed copies of this series, please contact the National Kidney and Urologic Diseases Information Clearinghouse.
National Kidney and Urologic Diseases Information Clearinghouse
3 Information Way
Bethesda, MD 20892–3580
Phone: 1–800–891–5390
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: nkudic@info.niddk.nih.gov
Internet: www.kidney.niddk.nih.gov/
The National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health of the U.S. Department of Health and Human Services. Established in 1987, the Clearinghouse provides information about diseases of the kidneys and urologic system to people with kidney and urologic disorders and to their families, health care professionals, and the public. The NKUDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about kidney and urologic diseases.
Publications produced by the clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This publication was reviewed by Dr. James Delmez, Washington University School of Medicine.
This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.
NIH Publication No. 05–4630
January 2005
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