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Year : 2007  |  Volume : 17  |  Issue : 4  |  Page : 150-159

Pathogenesis and management of renal osteodystrophy


1 Department of Medicine, Armed Forces Medical College, Pune, India
2 Command Hospital (CC), Lucknow, India
3 Command Hospital (SC), Pune, India

Correspondence Address:
A S Narula
Department of Medicine, Armed Forces Medical College, Pune
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-4065.39168

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Renal osteodystrophy is a common complication of chronic kidney disease (CKD). It is the part of a broad spectrum of disorders of mineral and bone metabolism that develop in this clinical setting and result in both skeletal and extraskeletal consequences. Insights into the mechanisms of bone remodeling, mineral metabolism and vascular calcification have shed light on the systemic nature of the disorder. Central to the assessment of disturbances in the bone and mineral metabolism is the ability to assess the bone disease accurately by noninvasive means. Recent emphasis is on the requirement to begin the therapy early in the course of CKD. Guidelines on a 'step care' approach to the detection and management of alterations in calcium, phosphorus and parathyroid hormone metabolism in various stages of CKD are now available. Although constant improvements in the technicalities of the parathyroid hormone assays have improved the diagnostic capability, controversies regarding this aspect still exist. Noncalcium, nonaluminum-based phosphate binders hold promise for the future developments in the management of calcium-phosphate metabolism. Further research and progress in this area continue to evaluate the appropriate interventions to address both the skeletal and extraskeletal consequences targeted toward improving patient outcomes.






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Indian Journal of Nephrology
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Online since 20th Sept '07