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Query: UMLS:C0005940 (bone disease)
 7,459 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One of the most important complication of patients with chronic renal failure is osteodystrophy. This causes skeletal deformities, growth failure, bone pain and decreased physical activity. Osteodystrophy is more frequent among children than uraemic adults. In fact, 50-80% of children with chronic renal failure may occur in metabolic bone disease and the incidence tends to be higher in those children who have been in uraemic state for a long time before starting chronic haemodialysis. Osteodystrophy is a result of: 1) lesions of rickets; 2) lesions of osteitis fibrosa: 3) osteosclerosis. In contrast to adult, metastatic calcifications are virtually never observed in uraemic children. Hyperphosphoraemia, that is secondary to the reduction of G.F.R., may be the principal responsible of hyperparathyroidism that is the main cause of osteodystrophy. Hyperparathyroidism is also maintained and increased by deficit of 1,25(OH)2D3 which is responsible for lesions of rickets. Haemodialysis may markedly improve osteitis fibrosa and it is efficacious in reversing the mineral defect. Dialysate calcium concentration should be maintained at approximately 3,5 mEq/l. In this case we can raise serum calcium. On the contrary dialysate has to be lacking in phosphorus to correct hyperphosphoraemia. It must be noted that we have to prepare a dialysate with deionized water lacking in aluminum to avoid encephalopathy compliance.
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PMID:[Osteodystrophy in children with chronic renal insufficiency in dialysis therapy]. 628 42

Because of the high prevalence of metabolic bone disease in older persons, we investigated the possibility of impaired intestinal absorptive capacity for vitamin D3 in aging animals. Using a single-pass technique, we measured vitamin D absorption and mucosal accumulation in male rats 9 to 101 weeks of age. Intestinal length, water absorption, and vitamin D3 intestinal tissue concentration remained constant after 41 weeks of age. Vitamin D3 absorption increased from 1209 pmol/100 cm/hr at 9 weeks of age to 2114 pmol/100 cm/hr at 41 weeks of age and remained relatively constant thereafter. Because vitamin D3 absorption rate is partly regulated by the dimensions of the unstirred water layer, we assessed the dimensions of the UWL of our aging animals. As the animals aged, the surface area of the UWL increased from 197 to 316 cm2/100 cm, and its resistance decreased from 1.2 to 0.7 min/cm3/100 cm by 41 weeks of age and remained stable thereafter. Inasmuch as the UWL is a major regulatory step in the absorption of vitamin D, its constant dimensions after 41 weeks of age explain the normal absorption of vitamin D3 observed in our aging animals. If these findings are found to be true in humans as well, they would argue against the possibility of vitamin D3 malabsorption as a cause of metabolic bone disease seen in aging individuals.
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PMID:Influence of aging on vitamin D absorption and unstirred water layer dimensions in the rat. 632 19

Characteristic skeletal changes of dialysis bone disease associated with multiple fractures were found in ten patients on prolonged regular (high aluminium) haemodialysis. A subsequent prospective investigation with serial radiography demonstrated healing approximately twelve months after a changed treatment regime. The treatment used was deionized or reverse osmosis water dialysis and renal transplantation. The typical osteomalacic and osteosclerotic changes and particularly metaphyseal sclerosis were found to be associated with more rapid clinical healing, whereas secondary hyperparathyroidism indicated delayed healing. It is suggested that plasma aluminium imbalance may lead to disturbance of bone formation with fractures, while healing is associated with normal serum aluminium levels and is manifested radiologically by osteosclerosis, particularly in the metaphyses.
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PMID:Radiography of healing dialysis osteodystrophy. 637 66

The histories of five long term dialysis patients, all of whom showed the characteristic features of dialysis bone disease are considered. One population, on hospital dialysis, also suffered dialysis encephalopathy, whilst the home dialysis population did not. It is postulated that the excessive polyvalent ion content of the water supply to a new hospital building displaced aluminum from the bone stores and precipitated encephalopathy in three patients over three months. The relationship of bone lysis (corticosteroids, immobilisation and orthopaedic procedures) to encephalopathy is considered in the light of this experience.
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PMID:Dialysis encephalopathy associated with polyvalent ion contamination. 658 79

In X-linked hypophosphataemia (Hyp gene) there is reduced renal tubule re-absorption of phosphate and an osteomalacic bone disorder. To determine whether altered phosphate transport also occurs in the salivary gland, saliva was analysed from normal and Hyp mice at 10 weeks of age. The effect of plasma inorganic phosphate on the composition of saliva was controlled by placing both genotypes on either a control diet or a low-P diet for three days. Inorganic phosphate, total phosphate, calcium, sodium, potassium, chloride, amylase, sialic acid, protein, osmotic pressure, percentage water, percentage inorganic solids and sample volume were measured. The Hyp mice fed the control diet showed a significant decrease in salivary-inorganic phosphate, total phosphate, osmotic pressure and sialic acid. These four variables were similarly lower in the normal mice fed the low-phosphate diet. The changes seem to stem from the low plasma inorganic phosphate and not from expression of the Hyp gene in the salivary gland. The total evidence from various organ systems suggests that the altered phosphate transport in X-linked hypophosphataemia may be restricted to the kidney and is not a generalized phosphate-transport deficiency.
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PMID:Normal handling of phosphate in the salivary glands of X-linked hypophosphataemic mice. 659 59

Patients with X-linked hypophosphatemia and mice bearing the Hyp gene have reduced renal tubular reabsorption of phosphate and an osteomalacic bone disease. To test if altered phosphate transport also exists in the mammary glands, milk was analyzed from normal (n = 9) and heterozygous Hyp (n = 8) mice 14 days after giving birth. Inorganic phosphate, total phosphate, calcium, magnesium, sodium, and potassium were measured; percent cream, fat, water, and nonfat organic solids were measured; and protein was measured. No significant differences (NSD) were found except for greater sodium in Hyp milk. There was also NSD in litter weight. The lactating Hyp had a lower body weight and remained hypophosphatemic relative to lactating normals, but both groups had higher plasma phosphate than nonlactating controls of the same genotype. The data suggest that Hyp mice can accumulate a normal amount of phosphate in their milk despite the plasma phosphate being two-thirds of normal. These data, with other recent reports of different organ systems, suggest that the altered phosphate transport activity may be restricted to the kidney.
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PMID:Normal milk composition in lactating X-linked hypophosphatemic mice despite continued hypophosphatemia. 668 37

Ten patients developed fracturing-bone disease (osteomalacia) while on dialysis against water with high levels of aluminium. Eight patients remained on dialysis, using de-ionized or reverse-osmosis water, and 2 received a renal transplant. Clinical improvement as regards bone pain and proximal muscle weakness occurred in 6 months and radiographic evidence of healing of the pseudofractures was seen at approximately 12 months. Associated osteopenia and hyperparathyroidism were found in most patients, but no significant change in either was noted during the study period. The serum parathyroid hormone levels rose significantly in the patients who remained on dialysis. The chest and pelvic deformities typical of healed osteomalacia were seen. This dramatic improvement can only be attributed to the removal of some water-borne element, either by changing the water used in the dialysis or by successful renal transplantation. Aluminium-containing phosphate binders were used throughout the study in the patients on dialysis, and hypophosphataemia was never a feature.
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PMID:Healing of fracturing-bone disease occurring in patients on dialysis. A prospective study. 708 62

In the Plymouth area, 95 patients with end-stage renal failure have undergone haemodialysis for 6 months or longer. Of the 47 patients beginning dialysis between 1967 and 1973, when water deionisers were not used routinely, a bone disease with multiple fractures, 'fracturing osteodystrophy', occurred in 18 patients and dialysis encephalopathy in 10. Of the 48 patients first dialysing between 1974 and 1979, when water deionisers used commonly, fracturing osteodystrophy occurred in only one and dialysis encephalopathy also in only one. Duration of dialysis without a water deioniser appeared to be the most important factor in the development of these two conditions. The use of water deionisers usually led to healing of fractures in patients with fracturing osteodystrophy and also led to improvement in 4 of the 11 patients with dialysis encephalopathy. Neither condition has occurred in any patient using a water deioniser from the first dialysis. Water deionisers, therefore, appeared to be effective in both the treatment and prevention of fracturing osteodystrophy and dialysis encephalopathy.
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PMID:Effect of water deionisers on 'fracturing osteodystrophy' and dialysis encephalopathy in Plymouth. 732 79

Plasma aluminum (pAl) was measured in 58 patients coming from three centers using different preparation of dialysis water: deionizer (29 patients), softener (16 patients) and reverse osmosis (13 patients). Twenty five healthy subjects were used as controls. A deferoxamine test was performed to 11 of 19 patients with pAl between 40 and 200 micrograms/dl and a bone biopsy with double tetracycline staining was executed to 15 patients with pAl over 40 micrograms/dl. Mean pAl was 9.5 +/- 1.7 micrograms/dl in controls and 34.3 +/- 6.1 169 +/- 27.8 and 50.8 +/- 10.3 micrograms/dl in patients coming form centers using deionizers, softeners and reverse osmosis respectively. Seventy six percent of patients coming from centers using deionizers and 85% of patients coming from centers with reverse osmosis had pAl below 40 micrograms/dl and all had values below 200 micrograms/dl. Plasma aluminum had a increase of over 200 micrograms/dl in 6 of 11 patients in which the deferoxamine test was performed. Six patients had a positive staining for aluminum in bone biopsies (three with basal pAl over 200 micrograms/dl and one with a increase in pAL after deferoxamine < 200 micrograms/dl). Of these, 2 patients had a mixed osteodystrophy and 4 a low turnover bone disease. Centers with deionizers and reverse osmosis had very low aluminum levels in dialysis water and five of six patients with aluminum levels related bone disease came from the center using softener.
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PMID:[Aluminum-related bone disease in chronic hemodialysis patients]. 829 81

Correlation between renal disease and trace elements includes following two types; 1) Renal failure due to excess of trace element intake into the body, such as itai-itai disease or heavy metal intoxication. 2) Disturbances of trace elements in patients with chronic renal failure, such as aluminum dementia and aluminum-related bone disease. Itai-itai disease occurred by water pollution with cadmium. Cadmium causes Fanconi syndrome in the kidney and osteomalasia in person, especially in old women, who were living near the riverside. Recently, we have shown that an itai-itai disease model can be made using rats by long-term intravenous injection of cadmium chloride. In patients with chronic renal failure, aluminum dementia and aluminum related bone disease were reported. However, aluminum dementia has disappeared by using reverse osmosis system for making dialysate. Fluoride should be one of ions which must be paid attention, because excess of fluoride cause mottled tooth and osteosclerosis. It may be dangerous to add fluoride into tap water system for the purpose of preventing decayed tooth, because fluoride retention in the serum may occur in patients with chronic renal failure.
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PMID:[Renal disease and trace elements]. 858 12


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