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Wikipedia preview
出典(authority):フリー百科事典『ウィキペディア(Wikipedia)』「2015/08/14 02:06:30」(JST)
[Wiki en表示]
Renal osteodystrophy |
Classification and external resources |
Specialty |
urology |
ICD-10 |
N25.0 |
ICD-9-CM |
588.0 |
eMedicine |
radio/500 |
MeSH |
D012080 |
Renal osteodystrophy or chronic kidney disease-mineral and bone disorder (CKD-MBD)[1] is a bone pathology, characterized by bone mineralization deficiency, that is a direct result of the electrolyte and endocrine derangements that accompany chronic kidney disease. Renal osteodystrophy can be further divided into metabolic states associated with either high or low bone turnover.
Contents
- 1 Signs and symptoms
- 2 Diagnosis
- 3 Pathogenesis
- 4 Differential diagnosis
- 5 Treatment
- 6 Prognosis
- 7 References
- 8 External links
Signs and symptoms
Renal osteodystrophy may exhibit no symptoms; if it does show symptoms, they include:
- Bone pain
- Joint pain
- Bone deformation
- Bone fracture
Diagnosis
Renal osteodystrophy is usually diagnosed after treatment for end-stage renal disease begins. Blood tests will indicate decreased calcium and calcitriol (vitamin D) and increased phosphate and parathyroid hormone. X-rays will also show bone features of renal osteodystrophy (chondrocalcinosis at the knees and pubic symphysis, osteopenia and bone fractures) but may be difficult to differentiate from other conditions.
Pathogenesis
Renal osteodystrophy is thought to be the result of hyperparathyroidism secondary to hyperphosphatemia combined with hypocalcaemia, both of which are due to decreased excretion of phosphate by the damaged kidney. Low activated vitamin D3 levels are a result of the damaged kidneys' inability to convert vitamin D3 into its active form, calcitriol, and result in further hypocalcaemia.
Differential diagnosis
To confirm the diagnosis, renal osteodystrophy must be distinguished from the following:
- osteoporosis
- osteopenia
- osteomalacia
Treatment
Treatment for renal osteodystrophy includes the following:
- calcium and vitamin D supplementation
- restriction of dietary phosphate
- phosphate binders such as calcium carbonate, calcium acetate, sevelamer hydrochloride, or lanthanum carbonate
- cinacalcet
- renal transplantation
- hemodialysis five times a week is thought to be of benefit[2]
Prognosis
Recovery from renal osteodystrophy has been observed post renal transplantation. Renal osteodystrophy is a chronic condition with a conventional hemodialysis schedule.[2]
References
- ^ Svára F (March 2009). "Chronic kidney disease-mineral and bone disorder (CKD-MBD): a new term for a complex approach". J Ren Care. 35 Suppl 1: 3–6. doi:10.1111/j.1755-6686.2009.00067.x. PMID 19222724.
- ^ a b Bonomini V, Mioli V, Albertazzi A, Scolari P (1998). "Daily-dialysis programme: indications and results". Nephrol. Dial. Transplant. 13 (11): 2774–7; discussion 2777–8. doi:10.1093/ndt/13.11.2774. PMID 9829478.
External links
- Renal Osteodystrophy - NKUDIC, NIH
Bone and joint disease (M80–M94, 730–733)
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|
Bone |
Inflammation |
endocrine: |
|
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infection: |
- Osteomyelitis
- Sesamoiditis
- Brodie abscess
- Periostitis
- Vertebral osteomyelitis
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Metabolic |
- Bone density
- Osteoporosis
- Osteopenia
- Osteomalacia
- Paget's disease of bone
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Bone resorption |
- Osteolysis
- Hajdu-Cheney syndrome
- Ainhum
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Other |
- Ischaemia
- Avascular necrosis
- Osteonecrosis of the jaw
- Algoneurodystrophy
- Hypertrophic pulmonary osteoarthropathy
- Nonossifying fibroma
- Pseudarthrosis
- Stress fracture
- Fibrous dysplasia
- Skeletal fluorosis
- bone cyst
- Hyperostosis
- Infantile cortical hyperostosis
- Osteosclerosis
- Pycnodysostosis
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|
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Joint |
|
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Combined |
Osteochondritis |
- Osteochondritis dissecans
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Child |
leg: |
- hip
- Legg–Calvé–Perthes syndrome
- tibia
- Osgood-Schlatter disease
- Blount's disease
- foot
- Köhler disease
- Sever's disease
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spine |
|
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arm: |
|
|
|
|
Index of bones and cartilage
|
|
Description |
- Anatomy
- bones
- skull
- face
- neurocranium
- compound structures
- foramina
- upper extremity
- torso
- pelvis
- lower extremity
- Physiology
- Development
- Cells
|
|
Disease |
- Congenital
- Neoplasms and cancer
- Trauma
- Other
- Symptoms and signs
|
|
Treatment |
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|
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- Urinary system
- Pathology
- Urologic disease / Uropathy (N00–N39, 580–599)
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Abdominal |
Nephropathy/
(nephritis+
nephrosis) |
Glomerulopathy/
glomerulitis/
(glomerulonephritis+
glomerulonephrosis) |
Primarily
nephrotic |
Non-proliferative |
- Minimal change
- Focal segmental
- Membranous
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Proliferative |
- Mesangial proliferative
- Endocapillary proliferative
- Membranoproliferative/mesangiocapillary
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By condition |
|
|
|
Primarily
nephritic,
RPG |
Type I RPG/Type II hypersensitivity |
|
|
Type II RPG/Type III hypersensitivity |
- Post-streptococcal
- Lupus
- IgA/Berger's
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Type III RPG/Pauci-immune |
- Granulomatosis with polyangiitis
- Microscopic polyangiitis
- Churg–Strauss syndrome
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|
|
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Tubulopathy/
tubulitis |
Proximal |
|
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Thick ascending |
|
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Distal convoluted |
|
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Collecting duct |
- Liddle's syndrome
- RTA
- Diabetes insipidus
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Renal papilla |
|
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Major calyx/pelvis |
- Hydronephrosis
- Pyonephrosis
- Reflux nephropathy
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Any/all |
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|
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Interstitium |
- Interstitial nephritis
- Pyelonephritis
- Danubian endemic familial nephropathy
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Any/all |
General syndromes |
- Renal failure
- Acute renal failure
- Chronic kidney disease
- Uremic pericarditis
- Uremia
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Vascular |
- Renal artery stenosis
- Renal ischemia
- Hypertensive nephropathy
- Renovascular hypertension
- Renal cortical necrosis
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Other |
- Analgesic nephropathy
- Renal osteodystrophy
- Nephroptosis
- Abderhalden–Kaufmann–Lignac syndrome
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|
|
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Ureter |
- Ureteritis
- Ureterocele
- Megaureter
|
|
|
Pelvic |
Bladder |
- Cystitis
- Interstitial cystitis
- Hunner's ulcer
- Trigonitis
- Hemorrhagic cystitis
- Neurogenic bladder dysfunction
- Bladder sphincter dyssynergia
- Vesicointestinal fistula
- Vesicoureteral reflux
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Urethra |
- Urethritis
- Non-gonococcal urethritis
- Urethral syndrome
- Urethral stricture/Meatal stenosis
- Urethral caruncle
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|
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Any/all |
- Obstructive uropathy
- Urinary tract infection
- Retroperitoneal fibrosis
- Urolithiasis
- Bladder stone
- Kidney stone
- Renal colic
- Malakoplakia
- Urinary incontinence
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Index of the urinary system
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Description |
- Anatomy
- Physiology
- Development
- Cells
|
|
Disease |
- Electrolyte and acid-base
- Congenital
- Neoplasms and cancer
- Other
- Symptoms and signs
- Urine tests
- Blood tests
|
|
Treatment |
- Procedures
- Drugs
- Intravenous fluids
|
|
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UpToDate Contents
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English Journal
- High inorganic phosphate concentration inhibits osteoclastogenesis by modulating miR-223.
- M'Baya-Moutoula E1, Louvet L1, Metzinger-Le Meuth V2, Massy ZA3, Metzinger L4.
- Biochimica et biophysica acta.Biochim Biophys Acta.2015 Oct;1852(10 Pt A):2202-12. doi: 10.1016/j.bbadis.2015.08.003. Epub 2015 Aug 6.
- Chronic kidney disease-mineral and bone disorder (CKD-MBD) is a common complication of CKD, and uremic toxins have been shown to be instrumental in this process. We have previously shown that miR-223 is increased in smooth muscle cells subjected to the uremic toxin inorganic phosphate (Pi). In the p
- PMID 26255635
- The Kidney-Vascular-Bone Axis in the Chronic Kidney Disease-Mineral Bone Disorder.
- Seifert ME1, Hruska KA.
- Transplantation.Transplantation.2015 Sep 9. [Epub ahead of print]
- The last 25 years have been characterized by dramatic improvements in short-term patient and allograft survival after kidney transplantation. Long-term patient and allograft survival remains limited by cardiovascular disease and chronic allograft injury, among other factors. Cardiovascular disease r
- PMID 26356179
- Bone Disorders in Chronic Kidney Disease: An Update in Diagnosis and Management.
- Babayev R1, Nickolas TL1.
- Seminars in dialysis.Semin Dial.2015 Sep 2. doi: 10.1111/sdi.12423. [Epub ahead of print]
- Renal osteodystrophy (ROD) is a bone disorder that occurs in chronic kidney disease (CKD) patients and is associated with 2- to 14-fold increased fracture risk compared to the general population. Risk of fractures is also increased in kidney transplant recipients especially within the first 5 years
- PMID 26332760
Japanese Journal
- 上田 善彦,佐藤 英一,植田 初江
- 日本アフェレシス学会雑誌 32(1), 7-14, 2013-02-28
- … Arteriosclerosis is common in patients with chronic kidney disease (CKD), and cardiovascular disease (CVD) represents a major cause of death in these patients, especially those with end-stage renal disease (ESRD). … The important risk factors for CVD in ESRD patients are hypertension, dyslipidemia and CKD bone and mineral disorder (CKD-MBD). …
- NAID 110009580161
- Results of a survey on practice patterns at the end of a study involving CKD-MBD management at dialysis facilities:: As a part of MBD-5D study
- 横山 啓太郎,福原 俊一,深川 雅史,秋澤 忠男,黒川 清
- 日本透析医学会雑誌 46(2), 193-200, 2013
- … MBD-5D (Mineral and Bone Disorders Outcomes Study for Japanese Chronic Kidney Disease stage 5D patients) is a prospective, multicenter, observational study on hemodialysis patients with secondary hyperparathyroidism (SHPT). … The survey results show the change in practice patterns and treatment for CKD-MBD management and wide acceptance of the guidelines. …
- NAID 130003372763
- CKDに伴う骨・ミネラル代謝異常 : その病態と治療 (第1土曜特集 CKD診療ガイド2012 ガイドブック) -- (管理法各論)
Related Links
- 2009年8月29日 ... 以上のような背景から、「慢性腎臓病(CKD)」に伴う異常を、骨の病気ではなく、全身の 病気としてとらえようとするパラダイムシフト(発想の転換)が起き、この考え方の変化を 示すために、全身疾患としての「CKD-MBD(chronic kidney ...
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★リンクテーブル★
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クレアチンキナーゼ creatine kinase
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