BACKGROUND AND OBJECTIVES: The relationship between parathyroid hormone, fibroblast growth factor 23 (FGF-23), and indices of bone turnover and mineralization in children with early CKD is unknown; thus, this study characterizes the features of renal osteodystrophy and their relationship to biochemical markers of mineral metabolism. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Fifty-two patients 2-21 years of age with predialysis CKD underwent tetracycline-labeled bone biopsy. Anthropomorphic measurements and biochemical values were obtained at the time of biopsy. RESULTS: Serum phosphorus levels were increased in 4% of patients with stage 3 CKD and 43% of those with stage 4/5 CKD. Parathyroid hormone concentrations were elevated in 36% of patients with stage 2, 71% with stage 3, and 93% with stage 4/5 CKD, whereas FGF-23 values were elevated in 81% of all patients, regardless of CKD stage. Bone turnover was normal in all patients with stage 2, but was increased in 13% with stage 3 and 29% with stage 4/5 CKD. Defective mineralization was present in 29% of patients with stage 2, 42% with stage 3, and 79% with stage 4/5 CKD. Defective skeletal mineralization was associated with lower serum calcium levels and increased parathyroid hormone concentrations. CONCLUSIONS: Elevated circulating FGF-23 levels and defects in skeletal mineralization early in the course of CKD suggest that factors other than the traditional markers of mineral deficiency play a crucial role in the development of renal bone disease.
BACKGROUND AND OBJECTIVES: The relationship between parathyroid hormone, fibroblast growth factor 23 (FGF-23), and indices of bone turnover and mineralization in children with early CKD is unknown; thus, this study characterizes the features of renal osteodystrophy and their relationship to biochemical markers of mineral metabolism. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Fifty-two patients 2-21 years of age with predialysis CKD underwent tetracycline-labeled bone biopsy. Anthropomorphic measurements and biochemical values were obtained at the time of biopsy. RESULTS: Serum phosphorus levels were increased in 4% of patients with stage 3 CKD and 43% of those with stage 4/5 CKD. Parathyroid hormone concentrations were elevated in 36% of patients with stage 2, 71% with stage 3, and 93% with stage 4/5 CKD, whereas FGF-23 values were elevated in 81% of all patients, regardless of CKD stage. Bone turnover was normal in all patients with stage 2, but was increased in 13% with stage 3 and 29% with stage 4/5 CKD. Defective mineralization was present in 29% of patients with stage 2, 42% with stage 3, and 79% with stage 4/5 CKD. Defective skeletal mineralization was associated with lower serum calcium levels and increased parathyroid hormone concentrations. CONCLUSIONS: Elevated circulating FGF-23 levels and defects in skeletal mineralization early in the course of CKD suggest that factors other than the traditional markers of mineral deficiency play a crucial role in the development of renal bone disease.
Authors: A M Parfitt; M K Drezner; F H Glorieux; J A Kanis; H Malluche; P J Meunier; S M Ott; R R Recker Journal: J Bone Miner Res Date: 1987-12 Impact factor: 6.741
Authors: Natalie A van Venrooij; Renata C Pereira; Yin Tintut; Michael C Fishbein; Navdeep Tumber; Linda L Demer; Isidro B Salusky; Katherine Wesseling-Perry Journal: Nephrol Dial Transplant Date: 2014-01-23 Impact factor: 5.992
Authors: Inari S Tamminen; Helena Valta; Hannu Jalanko; Sari Salminen; Mervi K Mäyränpää; Hanna Isaksson; Heikki Kröger; Outi Mäkitie Journal: Pediatr Nephrol Date: 2014-02-23 Impact factor: 3.714
Authors: Toshifumi Sugatani; Olga A Agapova; Yifu Fang; Alycia G Berman; Joseph M Wallace; Hartmut H Malluche; Marie-Claude Faugere; William Smith; Victoria Sung; Keith A Hruska Journal: Kidney Int Date: 2016-09-22 Impact factor: 10.612
Authors: Renata C Pereira; Isidro B Salusky; Richard E Bowen; Earl G Freymiller; Katherine Wesseling-Perry Journal: Bone Date: 2019-08-01 Impact factor: 4.398
Authors: Yifu Fang; Charles Ginsberg; Michael Seifert; Olga Agapova; Toshifumi Sugatani; Thomas C Register; Barry I Freedman; Marie-Claude Monier-Faugere; Hartmut Malluche; Keith A Hruska Journal: J Am Soc Nephrol Date: 2014-02-27 Impact factor: 10.121