Clin Osteol 2008; 13(4): 144-151

Chronic kidney disease - mineral and bone disorder - a reviewReview articles

S. Dusilová-Sulková

The article summarizes current approaches to the diagnosis of impaired calcium-phosphate metabolism in renal failure. Phosphorus retention and decreased calcitriol level are crucial to the pathogenesis of secondary hyperparathyroidism, the basic form of this meta­ bolic disorder from the point of view of pathogenesis. Parathyroid gland hyperactivity is influenced by both functional stimuli and the amount of tissue. Parathyroid gland hyperplasia is characterized by variations in quality - decreased receptor density, which makes the advanced forms difficult to treat. Understanding the relationship between calcium-phosphate metabolism and cardiovascular com­ plications in renal failure has led to stricter requirements for the target acceptable serum phosphorus concentration. It has also promp­ ted a more complex approach, new definition and classification. In 2006, chronic kidney disease - mineral and bone disorder (CKDMBD) was defined. It comprises three components: laboratory abnormalities, bone histomorphometry changes and extraosseous calcification. All the three areas should be considered in prevention and treatment. Recent years have witnessed new pharmacotherapeutic options as well. As for parathormone concentration control, beneficial laboratory effects have been confirmed in vitamin D ac­ tivators and calcimimetics. There is evidence concerning the effects both calcium- and non-calcium-based binders have on blood levels of phosphorus. Moreover, the quality of life is improved and, as seen from retrospective studies, mortality and morbidity rates decre­ ase. Currently, renal osteopathy is viewed as one component of chronic kidney disease - mineral and bone disorder. Treatment of the condition is characterized by relatively strict laboratory target values and the requirement for minimal confirmed cardiovascular ef­ fects.

Keywords: chronic kidney disease, renal osteopathy, vitamin D receptor, parathyroid hormone, parathyroid gland, calcification, hyperphosphataemia

Published: December 11, 2008  Show citation

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Dusilová-Sulková S. Chronic kidney disease - mineral and bone disorder - a review. Osteologický bulletin. 2008;13(4):144-151.
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