Khuraijam Bembem1, Tejinder Singh1, Narinder Pal Singh2, Alpana Saxena3, Shyama Lata Jain1. 1. Department of Pathology, Maulana Azad Medical College, 64 Kala Vihar Apt, Mayur Vihar Phase 1 extn, New Delhi, 91 India. 2. Department of Medicine, Maulana Azad Medical College, New Delhi, India. 3. Department of Biochemistry, Maulana Azad Medical College, New Delhi, India.
Abstract
Chronic Kidney Disease-Mineral Bone Disorder(CKD-MBD) is a systemic disorder of the mineral and bone metabolism seen in patients with Chronic Kidney Disease(CKD). It is manifested by either one or a combination of the following: (a) Abnormalities of calcium, phosphorus, PTH, or vitamin D metabolism. (b) Abnormalities in bone turnover, mineralization, volume, linear growth, or strength. (c) Vascular or other soft- tissue calcification. Renal osteodystrophy measures the skeletal component of CKD-MBD. To study the histomorphology of bone marrow biopsy in patients with CKD-MBD and correlate the histological features of bone biopsy with the clinicobiochemical parameters. 32 cases of diagnosed CKD-MBD formed the study group. Detailed clinical history and biochemical analysis was done for them. Bone marrow trephine biopsies were conducted and the histology was studied. The clinicobiochemical and the histomorphological findings were correlated. Based on the bone biopsy findings, Hyperparathyroid bone disease consisted of-14 cases (44%), Mixed uremic osteodystrophy of-16 cases (50%) and one case (3%) each of Low turnover disease (Adynamic bone disease) and Normal histology. The mean blood urea, S. Creatinine, S Phosphate and the S. Vit D3 were found to be statistically significant between the two major subgroups. The area of the bone trabeculae and the osteoid percentage was found to be more in the MUO group and was found to be statistically significant. CONCLUSION: A trephine biopsy helps us in understanding the skeletal symptoms of the CKD when the clinical and biochemical parameters are not conclusive. A biopsy in unexplained bone pain/fractures, unexplained hypercalcemia and elevated phosphate levels helps in guiding the proper management of the patient.
Chronic Kidney Disease-Mineral Bone Disorder(CKD-MBD) is a systemic disorder of the mineral and bone metabolism seen in patients with Chronic Kidney Disease(CKD). It is manifested by either one or a combination of the following: (a) Abnormalities of calcium, phosphorus, PTH, or vitamin D metabolism. (b) Abnormalities in bone turnover, mineralization, volume, linear growth, or strength. (c) Vascular or other soft- tissue calcification. Renal osteodystrophy measures the skeletal component of CKD-MBD. To study the histomorphology of bone marrow biopsy in patients with CKD-MBD and correlate the histological features of bone biopsy with the clinicobiochemical parameters. 32 cases of diagnosed CKD-MBD formed the study group. Detailed clinical history and biochemical analysis was done for them. Bone marrow trephine biopsies were conducted and the histology was studied. The clinicobiochemical and the histomorphological findings were correlated. Based on the bone biopsy findings, Hyperparathyroid bone disease consisted of-14 cases (44%), Mixed uremic osteodystrophy of-16 cases (50%) and one case (3%) each of Low turnover disease (Adynamic bone disease) and Normal histology. The mean blood urea, S. Creatinine, S Phosphate and the S. Vit D3 were found to be statistically significant between the two major subgroups. The area of the bone trabeculae and the osteoid percentage was found to be more in the MUO group and was found to be statistically significant. CONCLUSION: A trephine biopsy helps us in understanding the skeletal symptoms of the CKD when the clinical and biochemical parameters are not conclusive. A biopsy in unexplained bone pain/fractures, unexplained hypercalcemia and elevated phosphate levels helps in guiding the proper management of the patient.
Authors: M E Cohen-Solal; J L Sebert; B Boudailliez; P F Westeel; P H Morinière; A Marie; M Garabedian; A Fournier Journal: Bone Date: 1992 Impact factor: 4.398
Authors: G Coen; S Mazzaferro; P Ballanti; D Sardella; S Chicca; M Manni; E Bonucci; F Taggi Journal: Nephrol Dial Transplant Date: 1996-05 Impact factor: 5.992
Authors: B Peter Sawaya; Rezkalla Butros; Shehzab Naqvi; Zhaopo Geng; Hanna Mawad; Robert Friedler; Paolo Fanti; Marie-Claude Monier-Faugere; Hartmut H Malluche Journal: Kidney Int Date: 2003-08 Impact factor: 10.612
Authors: Goce B Spasovski; An R J Bervoets; Geert J S Behets; Ninoslav Ivanovski; Aleksander Sikole; Geert Dams; Marie-M Couttenye; Marc E De Broe; Patrick C D'Haese Journal: Nephrol Dial Transplant Date: 2003-06 Impact factor: 5.992
Authors: A J Hutchison; R W Whitehouse; H F Boulton; J E Adams; E B Mawer; T J Freemont; R Gokal Journal: Kidney Int Date: 1993-11 Impact factor: 10.612
Authors: N A Hamdy; J A Kanis; M N Beneton; C B Brown; J R Juttmann; J G Jordans; S Josse; A Meyrier; R L Lins; I T Fairey Journal: BMJ Date: 1995-02-11