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. 2012 Jan;7(1):146-52.
doi: 10.2215/CJN.05940611. Epub 2011 Nov 3.

Early skeletal and biochemical alterations in pediatric chronic kidney disease

Katherine Wesseling-Perry  1 , Renata C Pereira, Chi-Hong Tseng, Robert Elashoff, Joshua J Zaritsky, Ora Yadin, Shobha Sahney, Barbara Gales, Harald Jüppner, Isidro B Salusky
Affiliations

Early skeletal and biochemical alterations in pediatric chronic kidney disease

Katherine Wesseling-Perry et al. Clin J Am Soc Nephrol. 2012 Jan.

Abstract

Background and objectives: The relationship between parathyroid hormone, fibroblast growth factor 23 (FGF-23), and indices of bone turnover and mineralization in children with early CKD is unknown; thus, this study characterizes the features of renal osteodystrophy and their relationship to biochemical markers of mineral metabolism.

Design, setting, participants, & measurements: Fifty-two patients 2-21 years of age with predialysis CKD underwent tetracycline-labeled bone biopsy. Anthropomorphic measurements and biochemical values were obtained at the time of biopsy.

Results: Serum phosphorus levels were increased in 4% of patients with stage 3 CKD and 43% of those with stage 4/5 CKD. Parathyroid hormone concentrations were elevated in 36% of patients with stage 2, 71% with stage 3, and 93% with stage 4/5 CKD, whereas FGF-23 values were elevated in 81% of all patients, regardless of CKD stage. Bone turnover was normal in all patients with stage 2, but was increased in 13% with stage 3 and 29% with stage 4/5 CKD. Defective mineralization was present in 29% of patients with stage 2, 42% with stage 3, and 79% with stage 4/5 CKD. Defective skeletal mineralization was associated with lower serum calcium levels and increased parathyroid hormone concentrations.

Conclusions: Elevated circulating FGF-23 levels and defects in skeletal mineralization early in the course of CKD suggest that factors other than the traditional markers of mineral deficiency play a crucial role in the development of renal bone disease.

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Figures

Figure 1.
Figure 1.
Prevalence of increased bone formation rates (black bars), mineralization defects (white bars), increased PTH levels (striped bars), and increased FGF-23 values (black polka-dotted bars) in pediatric patients with CKD. The mineralization defect was defined as an abnormal accumulation of osteoid (osteoid volume) in combination with a delay osteoid maturation time. Increased PTH values and FGF-23 values were defined as values above the range determined in healthy individuals.
See this image and copyright information in PMC

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