Role of bone biopsy in renal osteodystrophy.
Role of bone biopsy in renal osteodystrophy.
复制标题
骨活检在肾性骨营养不良中的作用。
DOI：
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发表时间：
2009
影响因子：
0.5
通讯作者：
K. Martin
中科院分区：
文献类型：
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作者：
Wisam Al Badr;K. Martin
肾性骨营养不良（ROD）是一种异常的骨组织，发生在肾脏疾病的背景下，是一种疾病谱系，而不是统一的进行性骨病。它是与慢性肾脏疾病（CKD）相关的骨和矿物质代谢广泛紊乱的重要组成部分。有多种致病因素可导致骨活检所见的组织学异常。ROD患者在CKD早期很少有症状。同样值得注意的是，临床表现通常在生化变化之前，这些变化是阴险和微妙的。这使得临床医生在没有直接检测的情况下很难怀疑骨骼和矿物质代谢异常的存在。血清钙、磷和碱性磷酸酶水平通常正常，直到慢性肾病病程晚期。骨和矿物质代谢异常的主要筛查试验是甲状旁腺激素的测定，这也有些延迟。临床体征和症状也很难解释，因为它们的缓慢和非特异性，可能包括模糊、不明确、骨痛和肌肉无力。诊断ROD的金标准是双四环素标记、铁染色、铝染色后矿化骨组织的骨活检。目前使用的骨组织学的组织形态计量学描述没有很好地整合临床，并提出了一个新的命名法，临床上更相关和有用。在目前的治疗时代，需要进一步的研究来定义ROD的谱，并找到临床有用的非侵入性生物标志物，以改善CKD背景下异常骨的治疗和监测。
Renal osteodystrophy (ROD), the abnormal bone histology that occurs in the context of kidney disease, is a disease spectrum and not a uniform progressive bone disease. It is an important component of the broad disturbances of bone and mineral metabolism associated with chronic kidney disease (CKD). There are multiple pathogenetic factors which contribute to the histological abnormalities seen on bone biopsy. The patients with ROD are rarely symp-tomatic in the early stages of CKD. It is also noteworthy that the clinical manifestations are usually preceded by biochemical changes that are insidious and subtle. This makes it difficult for the clinician to suspect the presence of bone and mineral metabolism abnormalities without direct testing. The serum calcium, phosphorus, and alkaline phosphatase levels are usually normal until late in the course of CKD. The main screening test for abnormal bone and mineral metabolism is the measurement of parathyroid hormone which is also somewhat delayed. The clinical signs and symptoms are also challenging to interpret because of their slow and non-specific nature which may include vague, ill-defined, bone aches and pains, and muscle weakness. The gold standard for diagnosis of ROD is bone biopsy with mineralized bone histology after double tetracycline labeling, iron staining and aluminum staining. The currently used histomorphometric descriptions of bone histology are not well integrated clinically and a new nomenclature that is clinically more relevant and useful has been proposed. Additional studies are required to define the spectrum of ROD in the current therapeutic era, and to find clinically useful non-invasive biomarkers to improve the treatment and monitoring of the abnormal bone in the setting of CKD.