Bone disease in pediatric chronic kidney disease.

Bone disease in pediatric chronic kidney disease.
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DOI:
10.1007/s00467-012-2324-4
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发表时间:
2013-04
影响因子:
3
通讯作者:
Wesseling-Perry, Katherine
Wesseling-Perry, Katherine
中科院分区:
医学3区
文献类型:
--
作者:
Wesseling-Perry, Katherine

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患有长期慢性肾病 (CKD) 的儿童会表现出骨病的临床症状,包括骨畸形和骨折,这会导致长期残疾。该人群中很大一部分人存在骨骼矿化异常,并可能导致慢性发病。为了强调骨转换以外的参数对 CKD 骨疾病的潜在贡献,肾性骨营养不良 (ROD) 的新定义强调评估三个关键组织学描述符,即骨转换 (T)、矿化 (M) 和体积 (V) (TMV),建议在所有 CKD 患者的评估中使用。尽管骨活检是评估骨组织学所有三个推荐领域的唯一可用方法,但这种侵入性手术并未在任何临床环境中常规使用;因此,对整个 CKD 病程中异常转换、矿化缺陷和骨量改变的发生率的真正了解是有限的。然而,最近的数据揭示了肾 ROD 在整个 CKD 病程中的进展,包括其早期阶段,以及伴随 ROD 的细胞生物学的变化。
Children with long-standing chronic kidney disease (CKD) display clinical symptoms of bone disease, including bony deformities and fractures, which contribute to long-standing disability. Abnormalities in skeletal mineralization occur in a substantial proportion of this population and may contribute to chronic morbidity. Underscoring the potential contribution of parameters other than bone turnover to bone disease in CKD, a new definition for renal osteodystrophy (ROD), emphasizing the assessment of three key histologic descriptors, i.e., bone turnover (T), mineralization (M), and volume (V) (TMV), has been recommended in the assessment of all patients with CKD. Although bone biopsy is the only available method for assessing all three recommended areas of bone histology, this invasive procedure is not routinely used in any clinical setting; thus, a true understanding of the prevalence of abnormal turnover, defective mineralization, and altered bone volume throughout the course of CKD is limited. Recent data, however, have shed light on the progression of renal ROD throughout the course of CKD, including its early stages, as well as on the alterations in cell biology that accompany ROD.
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