Ingham J P, Stewart J H, Posen S
Br Med J. 1973 Jun 30;2(5869):745-8. doi: 10.1136/bmj.2.5869.745.
Forty-six patients with end-stage renal failure were subjected to iliac crest biopsy before the initiation of a dialysis programme and regardless of the presence of skeletal symptoms. Quantitative studies of undecalcified sections showed osteoporosis in 11 patients, osteosclerosis in 10, and osteomalacia (alone or in combination with other lesions) in 14. Semiquantitative studies showed osteitis fibrosa (alone or in combination with other lesions) in 29. The various abnormalities occurred alone or in combination with one another and, to a large extent, independently of serum biochemistry.Radiological examination failed to diagnose the histological abnormality in 12 of 13 patients with osteomalacia and in 10 of 25 patients with osteitis fibrosa. These abnormalities were commoner in women, in patients with pyelonephritis, and in patients with documented renal failure of long standing. Bone volume changes could not be correlated with any clinical parameters.Skeletal findings in untreated patients should be taken into account when the effects of chronic dialysis or renal transplantation or both are being considered.
46例终末期肾衰竭患者在开始透析治疗前接受了髂嵴活检，且不论是否存在骨骼症状。对未脱钙切片的定量研究显示，11例患者有骨质疏松，10例有骨硬化，14例有骨软化（单独或与其他病变合并）。半定量研究显示，29例有纤维性骨炎（单独或与其他病变合并）。各种异常单独出现或相互合并出现，且在很大程度上与血清生化指标无关。13例骨软化患者中有12例、25例纤维性骨炎患者中有10例，放射学检查未能诊断出组织学异常。这些异常在女性、肾盂肾炎患者以及有长期记录的肾衰竭患者中更为常见。骨量变化与任何临床参数均无相关性。在考虑慢性透析或肾移植或两者的效果时，应考虑未治疗患者的骨骼检查结果。
