Musculoskeletal Changes Associated with Renal Disease
Kidneys paly a major role in mineral homeostasis, so renal disease consequences for the skeleton.
Mnemonic – VITAMINS ABCDE:
Vascular calcification; Infections (osteomyelitis, septic arthritis); Tumoral calcifications; Amyloid arthropathy; Metabolic bone disease (osteomalacia, osteoporosis); Infarction (osteonecrosis); Nodule (tophi); Secondary hyperparathyroidism
Aluminium toxicity; Bursitis (olecranon); Crystal arthropathy (gout, CPPD); Digital clubbing; Erosive spondyloarthropathy
Early stages of renal disease effects due to action of parathyroid hormone on the osteoclast-osteoblast system – probably due to decreased phosphate excretion by the kidney elevation of plasma phosphate increased PTH hormone increased bone turnover
Later stages serum phosphate increases mineralisation of osteomalacic bone osteosclerosis develops
End stage kidney cannot hydroxylate vitamin D decrease in intestinal calcium absorption inhibition of calcification of osteoid
Complications – pathologic fractures aseptic necrosis of bone (especially hips), bone pain
Osteosclerosis; osteoporosis; new bone formation
Dialysis Bone Disease/Renal Spondyloarthropathy:
Typically involves vertebrae and can be very destructive. Many are asymptomatic and only seen radiographically.
Bone loss and erosions increased risk for fractures
Most common and most successful type of organ transplant.
Alternative to dialysis for those with end-stage renal disease.
Tendonitis common following transplant – especially achilles
Acute gout arthritis is association with cyclosporine use following transplant. Cyclosporine blocks renal uric acid clearance. Because of immunosuppression need to careful rule out septic arthritis.