Sharma Ashish K, Toussaint Nigel D
Department of Nephrology, The Royal Melbourne Hospital, Parkville, Victoria, Australia.
Department of Medicine (RMH), The University of Melbourne, Melbourne, Australia.
Nephrology (Carlton). 2017 Mar;22 Suppl 2:27-30. doi: 10.1111/nep.13018.
Renal osteodystrophy (ROD) refers to alterations in bone turnover, mineralisation, mass and microarchitecture in patients with chronic kidney disease (CKD) and represents the skeletal component of 'CKD-mineral and bone disorder'. Changes in bone structure lead to impaired bone quality, compromised bone strength and increased susceptibility to fractures with associated significant morbidity, mortality and financial cost. Diagnosis and management of ROD is hindered by the inadequacy of currently available diagnostic methods to interpret the complex pathophysiology. Bone biopsy, the perceived gold standard test to assess ROD, is invasive and suboptimal for disease screening and management in routine clinical practice. High-resolution imaging, such as high-resolution peripheral quantitative computed tomography and high-resolution magnetic resonance imaging provide accurate non-invasive quantification of bone microarchitecture and facilitate assessment of mechanical competence of bone, correlating with skeletal fragility. We discuss the potential for these imaging techniques in patients with CKD to provide quantification and assessment of bone structure and strength. When used in conjunction with serum biomarkers, these investigative tools may provide a non-invasive diagnostic virtual bone biopsy.
肾性骨营养不良（ROD）指慢性肾脏病（CKD）患者骨转换、矿化、骨量和骨微结构的改变，是“CKD - 矿物质和骨异常”的骨骼表现。骨结构变化导致骨质量受损、骨强度下降以及骨折易感性增加，伴有显著的发病率、死亡率和经济成本。目前可用的诊断方法不足以解释复杂的病理生理学，这阻碍了ROD的诊断和管理。骨活检被视为评估ROD的金标准检测方法，但具有侵入性，在常规临床实践中用于疾病筛查和管理并不理想。高分辨率成像，如高分辨率外周定量计算机断层扫描和高分辨率磁共振成像，可对骨微结构进行准确的非侵入性定量，并有助于评估骨的力学性能，与骨骼脆性相关。我们讨论了这些成像技术在CKD患者中对骨结构和强度进行定量和评估的潜力。当与血清生物标志物联合使用时，这些检测工具可能提供一种非侵入性的诊断性虚拟骨活检。
