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Bone biopsy and the diagnosis of renal osteodystrophy

INTRODUCTION

There are four major types of bone disease that occur in patients with advanced chronic renal failure [1-4]:

  • Predominant hyperparathyroid bone disease (osteitis fibrosa)
  • Low turnover osteomalacia (defective mineralization in association with low osteoclast and osteoblast activities)
  • Mixed uremic osteodystrophy (hyperparathyroid bone disease with a superimposed mineralization defect)
  • Adynamic or aplastic bone (diminished bone formation and resorption)

They are collectively called renal osteodystrophy.

The pathogenesis of these disorders is discussed elsewhere. (See "Pathogenesis of renal osteodystrophy".)

In a 2006 position statement from KDIGO (Kidney Disease: Improving Global Outcomes), it was stated that the term, renal osteodystrophy, should be exclusively used to define bone morphology alterations observed in chronic kidney disease [5]. These alterations can be assessed further by histomorphometry, including aspects of bone turnover, mineralization, and volume. (See 'TMV classification system' below.)
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