Spasovski Goce B
Department of Nephrology, Clinical Centre, Skopje, Republic of Macedonia.
Prilozi. 2004;25(1-2):83-93.
When renal disease develops, mineral and vitamin D homeostasis is disrupted, resulting in diverse manifestations in bone cells and structure as well as the rate of bone turnover. In ESRF when patients require chronic maintenance dialysis, nearly all of them have abnormal bone histology named renal osteodystrophy (ROD). On the other hand, survival rates of patients on dialysis have increased with improved dialytic therapy and the resultant increased duration of dialysis has led to a rise in renal osteodystrophy. Because this metabolic bone disease can produce fractures, bone pain, and deformities late in the course of the disease, prevention and early treatment are essential. Serum PTH levels are commonly used to assess bone turnover in dialyzed patients. However, it is found that serum PTH levels between 65 and 450 pg/ml seen in the majority of dialysis patients are not predictive of the underlying bone disease. To date, bone biopsy is the most powerful and informative diagnostic tool to provide important information on precisely the type of renal osteodystrophy affecting patients, the degree of severity of the lesions, and the presence and amount of aluminum and strontium deposition in bone. Bone biopsy is not only useful in clinical settings but also in research to assess the effects of therapies on bone. Although considered as an invasive procedure, bone biopsy has been proven as safe and free from major complications besides pain, haematoma or wound infections, but the operator's experience and skill is important in minimizing morbidity. Alternatives to bone biopsy continue to be pursued, but the non-invasive bone markers have not been proven to hold sufficient diagnostic performance related to the bone turnover, mineralization process and bone cell abnormality. At present however, the transiliac bone biopsy remains the golden standard in the diagnosis of renal osteodystrophy.
当肾脏疾病发生时，矿物质和维生素D的内环境稳定被破坏，导致骨细胞、骨结构以及骨转换率出现多种表现。在终末期肾衰竭（ESRF）患者需要长期维持性透析时，几乎所有人都有异常的骨组织学表现，即肾性骨营养不良（ROD）。另一方面，随着透析治疗的改善，透析患者的生存率有所提高，而随之延长的透析时间导致肾性骨营养不良的发生率上升。由于这种代谢性骨病在疾病后期会导致骨折、骨痛和畸形，预防和早期治疗至关重要。血清甲状旁腺激素（PTH）水平通常用于评估透析患者的骨转换情况。然而，发现大多数透析患者血清PTH水平在65至450 pg/ml之间并不能预测潜在的骨病。迄今为止，骨活检是最有力且信息丰富的诊断工具，能够提供关于影响患者的肾性骨营养不良的确切类型、病变的严重程度以及骨中铝和锶沉积的存在及含量等重要信息。骨活检不仅在临床环境中有用，在评估治疗对骨骼的影响的研究中也很有用。尽管骨活检被认为是一种侵入性操作，但除了疼痛、血肿或伤口感染外，已被证明是安全的，且无重大并发症，但操作人员的经验和技能对于将发病率降至最低很重要重要。人们一直在寻求骨活检的替代方法，但尚未证明非侵入性骨标志物在骨转换、矿化过程和骨细胞异常方面具有足够的诊断性能。然而目前髂骨活检仍然是肾性骨营养不良诊断的金标准。
