Diamond Terrence, Elder Grahame J
Department of Endocrinology, St George Hospital, University of NSW, Sydney, Australia.
Department of Renal Medicine, Westmead Hospital, Westmead, Australia.
Nephrology (Carlton). 2017 Mar;22 Suppl 2:22-26. doi: 10.1111/nep.13017.
Bone biopsy is currently the only means to accurately assess renal osteodystrophy and responses to therapeutic interventions. With sedation, the technique is relatively painless, and complications are uncommon. Bone biopsy should be considered when the aetiology of symptoms or biochemical abnormalities is in question, and results may lead to changes in therapy. Although it remains prudent to use antiresorptive drugs cautiously in patients with chronic kidney disease (CKD) stages 3a-4 and low bone mineral density, bone biopsy may not be warranted before commencing therapy in these patients. Histomorphometric indices adopted for bone biopsy assessment are turnover (T), mineralisation (M) and volume (V). Often, only measurements of trabecular bone are reported; however, marked cortical changes are common in CKD and may be critical to bone structure and integrity. MicroCT of bone biopsies can rapidly assess static parameters and provides information on the cortical and trabecular compartments that may influence management. Limitations of bone biopsy include the time required for pre-biopsy tetracycline labelling and sample processing, and a paucity of facilities to process and report samples. Patients with CKD may not respond predictably to treatments, and because the biopsy sample is illustrative of activity at only one skeletal site and one point in time, assessment of real-time laboratory trends is always required. Optimally, we need a non-invasive 'virtual bone biopsy' that provides information for initiating and monitoring therapy. However, bone biopsy is the current standard by which the accuracy of investigational imaging techniques, hormonal values and biochemical turnover markers are judged.
骨活检是目前准确评估肾性骨营养不良及治疗干预反应的唯一方法。在镇静状态下，该技术相对无痛，且并发症并不常见。当症状或生化异常的病因存疑且结果可能导致治疗方案改变时，应考虑进行骨活检。尽管对于3a - 4期慢性肾脏病（CKD）且骨密度低的患者谨慎使用抗吸收药物仍属审慎之举，但在这些患者开始治疗前可能无需进行骨活检。用于骨活检评估的组织形态计量学指标包括骨转换（T）、矿化（M）和骨体积（V）。通常，报告的仅为小梁骨的测量结果；然而，CKD患者中皮质骨的明显改变很常见，且可能对骨结构和完整性至关重要。骨活检的显微CT可快速评估静态参数，并提供可能影响治疗管理的皮质骨和小梁骨区域的信息。骨活检的局限性包括活检前四环素标记和样本处理所需的时间，以及处理和报告样本的设施不足。CKD患者对治疗的反应可能无法预测，而且由于活检样本仅代表一个骨骼部位和一个时间点的活性，因此始终需要评估实时实验室指标变化趋势。理想情况下，我们需要一种非侵入性的“虚拟骨活检”，为启动和监测治疗提供信息。然而，骨活检是目前判断研究性成像技术、激素值和生化转换标志物准确性的标准。
