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Pediatric chronic kidney disease-mineral and bone disorder (CKD-MBD)

Tarak Srivastava, MD
Bradley A Warady, MD
Section Editor
Tej K Mattoo, MD, DCH, FRCP
Deputy Editor
Melanie S Kim, MD


Abnormalities in mineral metabolism and bone structure are an almost universal finding with progressive chronic kidney disease (CKD) [1]. Disorder regulation of mineral metabolism in children with CKD results in significant complications similar to those seen in adult patients (eg, fractures, bone pain, and avascular necrosis), and others that are unique to children (eg, growth failure and skeletal deformities).

The prevention and management of pediatric CKD-mineral and bone disorder (CKD-MBD) will be reviewed here.


KDIGO definitions — The Kidney Disease: Improving Global Outcomes (KDIGO) initiative is a collaboration of internationally recognized nephrology experts who have developed guidelines based on standardized definitions to improve the care of patients with CKD. This group proposed the term CKD-MBD, which has been broadly accepted, to define the broad clinical syndrome that develops as a systemic bone disorder due to mineral, skeletal, and vascular abnormalities that occur in association with CKD [2]. Renal osteodystrophy is one aspect of CKD-MBD that refers to the bone pathology alone. Changes that occur in the homeostatic mechanisms that regulate serum concentrations of calcium, phosphate, vitamin D, and parathyroid hormone (PTH) lead to the development of CKD-MBD and renal osteodystrophy. (See "Regulation of calcium and phosphate balance" and "Parathyroid hormone secretion and action".)

This review and its recommendations are consistent with the Kidney Disease Outcome Quality Initiative (KDOQI) clinical practice guidelines for CKD-MBD [1,3]. The KDOQI clinical practice guidelines for bone metabolism and disease in children with CKD, as well as other KDOQI guidelines, can be accessed through the National Kidney Foundation's website at www.kidney.org/professionals/kdoqi/guidelines.cfm.

Stages of chronic kidney disease — Many of the complications of CKD, including renal osteodystrophy, can be prevented or delayed through early detection and treatment. As a result, several societies have advocated developing a staging system to identify patients in whom interventions might delay CKD progression. In 2012, the KDIGO pediatric working group revised the 2002 classification of pediatric CKD by the KDOQI Clinical Practice Guideline for Chronic Kidney Disease [3,4]. (See "Epidemiology, etiology, and course of chronic kidney disease in children", section on 'Definitions and classifications'.)


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Literature review current through: Sep 2016. | This topic last updated: Mar 10, 2016.
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