When, How, and Why a Bone Biopsy Should Be Performed in Patients With Chronic Kidney Disease
Por:
Torres, PU, Boyer, J, Mazzaferro, S, de Vemejoul, MC, Cohen-Soal, M
Publicada:
1 nov 2014
Resumen:
In chronic kidney disease the excessive production of parathyroid hormone increases the bone resorption rate and leads to histologic bone signs of secondary hyperparathyroidism. However, in other situations, the initial increase in parathyroid hormone and bone remodeling may be slowed down excessively by a multitude of factors including age, ethnic origin, sex, and treatments such as vitamin D, calcium salts, calcimimetics, steroids, and so forth, leading to low bone turnover or adynamic bone disease. Both high and low bone turnover diseases actually are observed equally in chronic kidney disease patients treated by dialysis, and all types of renal osteodystrophy are associated with an increased risk of skeletal fractures, reduced quality of life, and poor clinical outcomes. Unfortunately, the diagnosis of these bone abnormalities cannot be obtained correctly by current clinical, biochemical, and imaging methods. Therefore, bone biopsy has been, and still remains, the gold standard analysis for assessing the exact type of renal osteodystrophy. It is also the unique way to assess the mechanisms of action, safety, and efficacy of new bone-targeting therapies. (C) 2014 Elsevier Inc. All rights reserved.
Filiaciones:
Torres, PU:
Clin Landy, Serv Nephrol & Dialysis, Paris, France
Univ Paris 05, Dept Renal Physiol, Necker Hosp, Paris, France
Boyer, J:
RedinRen, IIB St Pau, Fundacio Puigvert, Dept Nephrol, Barcelona, Catalonia, Spain
Mazzaferro, S:
Univ Roma La Sapienza, Dept Cardiovasc Resp Nephrol & Geriatr Sci, I-00185 Rome, Italy
de Vemejoul, MC:
Lariboisiere Hosp, Ctr Viggo Petersen, Serv Rheumatol, Paris, France
Cohen-Soal, M:
Lariboisiere Hosp, Ctr Viggo Petersen, Serv Rheumatol, Paris, France
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