Renal Osteodystrophy in the First Decade of the New Millennium: Analysis of 630 Bone Biopsies in Black and White Patients
Renal Osteodystrophy in the First Decade of the New Millennium: Analysis of 630 Bone Biopsies in Black and White Patients
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DOI：
10.1002/jbmr.309
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发表时间：
2011-06-01
影响因子：
6.2
通讯作者：
Monier-Faugere, Marie-Claude
中科院分区：
文献类型：
--
作者：
Malluche, Hartmut H.;Mawad, Hanna W.;Monier-Faugere, Marie-Claude
肾性骨营养不良发生在肾功能丧失的早期。美国有2600万慢性肾脏疾病（CKD）患者，几乎所有CKD 5期患者都有骨组织学异常。通过组织形态计量学评估成人CKD-5透析患者的630份骨活检，并使用周转(T)，矿化(M)和体积(V)分类进行分析。存在种族差异；白人主要表现为低流动率（62%），而黑人主要表现为正常或高流动率（68%）。仅有3%的患者出现矿化缺陷。在白人中，大致相同数量的患者松质骨体积低、正常或高，而在黑人中，三分之二的患者松质骨体积高。松质骨体积低的黑人和白人中，由于骨形成少，80%以上的人骨小梁较薄。一半的白人大脑皮层厚度较低，而四分之三的黑人大脑皮层厚度正常。50%的白人皮质孔隙度高，而四分之三的黑人皮质孔隙度高。综上所述，TMV系统提供了相关信息。它应该扩展到包括松质骨和皮质骨的结构。种族差异是存在的。低骨体积和低骨转换比以前认识到的更常见，而矿化缺陷现在很少在成人中观察到。这些发现呼吁对当前的治疗模式进行调整，考虑种族和低骨体积和转换的风险。后者已被证明与血管钙化增加有关。(C) 2011年美国骨与矿物研究学会。
Renal osteodystrophy occurs early during loss of kidney function. There are 26 million American patients with chronic kidney disease (CKD), and almost all patients with CKD stage 5 have abnormal bone histology. Six hundred and thirty bone biopsies from adult CKD-5 patients on dialysis were evaluated by histomorphometry and analyzed using the turnover (T), mineralization (M), and volume (V) classification. There were racial differences; whites exhibited predominantly low turnover (62%), whereas blacks showed mostly normal or high turnover (68%). A mineralization defect was observed in only 3% of patients. In whites, cancellous bone volume was low, normal, or high in approximately the same number of patients, whereas in blacks, cancellous bone volume was high in two-thirds of the patients. More than 80% of blacks and whites with low cancellous bone volume had thin trabeculae owing to low bone formation. Cortical thickness was low in half the whites, whereas it was normal in three-quarters of blacks. Cortical porosity was high in 50% of whites, whereas three-quarters of blacks had high porosity. In summary, the TMV system gives relevant information. It should be expanded to include the architecture of cancellous and cortical bone. There are racial differences. Low bone volume and low bone turnover are more frequent than heretofore appreciated, whereas mineralization defects nowadays are observed rarely in adults. These findings call for an adjustment of the current therapeutic paradigm that takes into consideration race and risk of low bone volume and turnover. The latter have been shown to be associated with increased vascular calcifications. (C) 2011 American Society for Bone and Mineral Research.