Chronic Kidney Disease

The prevalence of both chronic kidney disease (CKD) and metabolic bone diseases increases with age. Given the aging of the population as a prevailing demographic trend in the Western world, these medical conditions represent a significant challenge.
Moreover, CKD in its advanced stages (from CKD grade 3) is associated with changes of calcium-phosphate metabolism, which, together with the lack of active di-hydroxylated vitamin D, constitute mineral and bone disease that is connected with CKD (CKD-MBD). The bone component of CKD-MBD (renal osteopathy) affects the vast majority of patients with advanced or end stage renal disease (ESRD) and represents a heterogenic group of bone impairment. Furthermore, the occurrence (or co-occurrence) of other metabolic bone diseases, particularly osteoporosis, is very probable in the generally elderly CKD population. More attention has recently focused on the presence of osteoporosis in patients with advanced CKD, and at the same time, on the non-invasive diagnostic methods as laboratory markers of bone turnover, densitometry (DXA) and parameters mirroring bone microarchitecture. Still, the former two methods face some limitations, of which clinicians should be aware. All these metabolic bone diseases including osteoporosis are connected with increased fracture rates, and indeed, fractures occur earlier and more frequently in CKD patients in comparison with non-CKD population, thus contributing to their significant morbidity and mortality. Approved therapeutic options targeted to decrease the fracture risk, particularly in patients with advanced CKD, are very sparse, although some of the drugs routinely used in patients with normal or slightly decreased renal function have been successfully tested in this population.

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Marcy A
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Journal of Medical and surgical pathology
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