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                              Renal osteodystrophy

Renal osteodystrophy (ROD), also known as uremic osteopathy, is a constellation of musculoskeletal abnormalities that occur in patients with chronic renal failure, due to concurrent and superimposed: osteomalacia (adults)/rickets (children) secondary hyperparathyroidism: abnormal calcium and phosphate metabolism.Renal osteodystrophy is one of the main complications of end-stage renal disease that leads to skeletal and extraskeletal manifestations. Although it may be unavoidable in patients undergoing hemodialysis, appropriate and timely interventions can help alleviate the symptoms experienced by the patients and also reduce the osteodystrophy-related comorbidities. This activity reviews the evaluation and management of renal osteodystrophy and explains the role of the interprofessional team in improving the care of patients with this condition

Renal osteodystrophy (ROD), also known as uremic osteopathy, is a constellation of musculoskeletal abnormalities that occur in patients with chronic renal failure, due to concurrent and superimposed:

• osteomalacia (adults)/rickets (children)
• secondary hyperparathyroidism: abnormal calcium and phosphate metabolism
  • bone resorption
  • osteosclerosis
  • soft tissue and vascular calcifications
  • brown tumors
• aluminum intoxication, e.g. if the patient is on dialysis

Radiographic features

Imaging findings are many and varied:

• osteopenia: (often seen early) thinning of cortices and trabeculae
• salt and pepper skull
• demineralization: usually subperiosteal, however, it may also involve joint margins, endosteal, subchondral, subligamentous areas, cortical bone, or trabeculae 5 
• subperiosteal resorption: characteristic subperiosteal resorption may be seen on radial aspects of middle phalanges of the index and long fingers
• bone sclerosis ​ ​
  • diffuse bony sclerosis
  • rugger jersey spine: sclerosis of the vertebral body endplates
• soft tissue calcification
• amyloid deposition: erosion in and around joint
• insufficiency fractures
• Looser zone
• brown tumors

Differential diagnosis

General imaging differential considerations include

• osteomalacia
• rheumatoid arthritis
• seronegative spondyloarthropathies
• neoplasms: multiple myeloma, metastases; brown tumors can mimic primary malignant tumor of bone; amyloid deposition may mimic PVNS or synovial chondromatosis
• osteomyelitis

Chronic renal insufficiency, hemodialysis, peritoneal dialysis, renal transplantation and administration of different medications provoke complex biochemical disturbances of the calcium-phosphate metabolism with wide spectrum of bone and soft tissue abnormalities termed renal osteodystrophy. Clinically most important manifestation of renal bone disease includes secondary hyperparathyroidism, osteomalacia/rickets, osteoporosis, adynamic bone disease and soft tissue calcification. As a complication of long-term hemodialysis and renal transplantation amyloid deposition, destructive spondyloarthropathy, osteonecrosis, and musculoskeletal infections may occur. Due to more sophisticated diagnostic methods and more efficient treatment classical radiographic features of secondary hyperparathyroidism and osteomalacia/rickets are now less frequently seen. Radiological investigations play an important role in early diagnosis and follow-up of the renal bone disease. Although numerous new imaging modalities have been introduced in clinical practice (scintigraphy, CT, MRI, quantitative imaging), plain film radiography, especially fine quality hand radiograph, still represents most widely used examination.

National Institute Of Medical Coding

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