Musculoskeletal Changes Associated with Renal Disease

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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

Renal Osteodystrophy
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

X-ray:
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

Renal Transplant:
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.

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