Issues

The syndrom of renal osteopathy – pathogenesis, clinic, diagnostic and therapy

Journal: Osteologie
ISSN: 1019-1291
Issue: Issues of 2008 (Vol. 17): Issue 3 2008 (103-190)
Pages: 125-134

The syndrom of renal osteopathy – pathogenesis, clinic, diagnostic and therapy

P. M. Jehle
Ev. Krankenhaus der Paul-Gerhardt-Stiftung, Lutherstadt Wittenberg, Klinik für Innere Medizin und KfH-Nierenzentrum (Chefarzt bzw. leitender Arzt: Prof. Dr. Peter M. Jehle)

Keywords

Osteoporosis, vitamin D, calcimimetics, Renal osteopathy, secondary hyperparathyreoidism, calciphylaxis, cardiovascular calcification, phosphate binders

Summary

Renal osteopathy is a complex syndrome which leads to a considerable increase in morbidity and mortality of patients with chronic kidney disease (CKD). Prevention of secondary hyperparathyroidism (sHPT) should be considered in all CKD patients. Vitamin D deficiency should be corrected. With declining renal function (GFR below 60 ml/min) active vitamin D metabolites should additionally be applied. Hyperphosphatemia should also be corrected. Vitamin D therapy exerts pleiotropic effects and antiatherogenic effects and should be therefore considered as a longterm therapy. Therapy of renal osteopathy had considerably improved by new drugs such as the calcimimetic cinacalcet, the active vitamin D analogue paricalcitol and the calciumfree phosphate binders sevelamer and lanthanum with more patients achieving the recommended target values of PTH, serum calcium and phosphate. The frequency of parathyroidectomy which is still indicated in autonomous HPT will decline in the future years.

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