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Pediatric Drugs
Published in: Pediatric Drugs 4/2006

01-07-2006 | Therapy In Practice

Minimizing Bone Abnormalities in Children with Renal Failure

Author: Dr Helena Ziólkowska

Published in: Pediatric Drugs | Issue 4/2006

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Abstract

Renal osteodystrophy (ROD), a metabolic bone disease accompanying chronic renal failure (CRF), is a major clinical problem in pediatric nephrology. Growing and rapidly remodeling skeletal systems are particularly susceptible to the metabolic and endocrine disturbances in CRF. The pathogenesis of ROD is complex and multifactorial. Hypocalcemia, phosphate retention, and low levels of 1,25 dihydroxyvitamin D3 related to CRF result in disturbances of bone metabolism and ROD. Delayed diagnosis and treatment of bone lesions might result in severe disability.
Based on microscopic findings, renal bone disease is classified into two main categories: high- and low-turnover bone disease. High-turnover bone disease is associated with moderate and severe hyperparathyroidism. Low-turnover bone disease includes osteomalacia and adynamic bone disease.
The treatment of ROD involves controlling serum calcium and phosphate levels, and preventing parathyroid gland hyperplasia and extraskeletal calcifications. Serum calcium and phosphorus levels should be kept within the normal range. The calcium-phosphorus product has to be <5 mmol2/L2 (60 mg2/dL2). Parathyroid hormone (PTH) levels in children with CRF should be within the normal range, but in children with end-stage renal disease PTH levels should be two to three times the upper limit of the normal range. Drug treatment includes intestinal phosphate binding agents and active vitamin D metabolites. Phosphate binders should be administered with each meal. Calcium carbonate is the most widely used intestinal phosphate binder. In children with hypercalcemic episodes, sevelamer, a synthetic phosphate binder, should be introduced. In children with CRF, ergocalciferol (vitamin D2), colecalciferol (vitamin D3), and calcifediol (25-hydroxyvitamin D3) should be used as vitamin D analogs. In children undergoing dialysis, active vitamin D metabolites alfacalcidol (1α-hydroxyvitamin D3) and calcitriol (1,25 dihydroxyvitamin D3) are applied. In recent years, a number of new drugs have emerged that hold promise for a more effective treatment of bone lesions in CRF. This review describes the current approach to the diagnosis and treament of ROD.
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Metadata
Title
Minimizing Bone Abnormalities in Children with Renal Failure
Author
Dr Helena Ziólkowska
Publication date
01-07-2006
Publisher
Springer International Publishing
Published in
Pediatric Drugs / Issue 4/2006
Print ISSN: 1174-5878
Electronic ISSN: 1179-2019
DOI
https://doi.org/10.2165/00148581-200608040-00001

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