Mehls O, Salusky I B
Department of Pediatrics, University Children's Hospital, Heidelberg, Federal Republic of Germany.
Pediatr Nephrol. 1987 Apr;1(2):212-23. doi: 10.1007/BF00849295.
Renal osteodystrophy starts very early in chronic renal failure. Although vitamin D levels are normal in patients with 70-80% function, the levels are not appropriate to the prevailing biochemical milieu. Renal osteodystrophy may contribute to renal growth failure but a correlation between the degree of renal osteodystrophy and growth failure is not observed. Catch-up growth cannot be obtained over a longer period of time with vitamin D. The main reason for osteomalacia is Al intoxication. Aluminium osteopathy is more common in pediatric renal patients than anticipated. The mechanism whereby Al produces its effect on bone is uncertain. Guidelines for the diagnosis and therapy of renal osteopathy are presented. Prophylaxis of renal osteopathy can be attempted by phosphate restriction and/or vitamin D and by avoiding Al-containing drugs. All vitamin D compounds can be used for treatment and all have their advantages and disadvantages.
肾性骨营养不良在慢性肾衰竭早期就会出现。虽然肾功能在70%-80%的患者中维生素D水平正常，但这些水平与当时的生化环境不相适应。肾性骨营养不良可能导致肾脏生长衰竭，但未观察到肾性骨营养不良程度与生长衰竭之间的相关性。长期使用维生素D无法实现追赶生长。骨软化的主要原因是铝中毒。铝骨病在儿童肾病患者中比预期更为常见。铝对骨骼产生作用的机制尚不清楚。本文介绍了肾性骨病的诊断和治疗指南。可通过限制磷和/或维生素D以及避免使用含铝药物来尝试预防肾性骨病。所有维生素D化合物都可用于治疗，且各有优缺点。
