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. 2017 Dec;33(4):603-610.
doi: 10.1007/s12288-016-0754-z. Epub 2016 Nov 28.

Bone Histo-Morphology in Chronic Kidney Disease Mineral Bone Disorder

Khuraijam Bembem  1 , Tejinder Singh  1 , Narinder Pal Singh  2 , Alpana Saxena  3 , Shyama Lata Jain  1
Affiliations

Bone Histo-Morphology in Chronic Kidney Disease Mineral Bone Disorder

Khuraijam Bembem et al. Indian J Hematol Blood Transfus. 2017 Dec.

Abstract

Chronic Kidney Disease-Mineral Bone Disorder(CKD-MBD) is a systemic disorder of the mineral and bone metabolism seen in patients with Chronic Kidney Disease(CKD). It is manifested by either one or a combination of the following: (a) Abnormalities of calcium, phosphorus, PTH, or vitamin D metabolism. (b) Abnormalities in bone turnover, mineralization, volume, linear growth, or strength. (c) Vascular or other soft- tissue calcification. Renal osteodystrophy measures the skeletal component of CKD-MBD. To study the histomorphology of bone marrow biopsy in patients with CKD-MBD and correlate the histological features of bone biopsy with the clinicobiochemical parameters. 32 cases of diagnosed CKD-MBD formed the study group. Detailed clinical history and biochemical analysis was done for them. Bone marrow trephine biopsies were conducted and the histology was studied. The clinicobiochemical and the histomorphological findings were correlated. Based on the bone biopsy findings, Hyperparathyroid bone disease consisted of-14 cases (44%), Mixed uremic osteodystrophy of-16 cases (50%) and one case (3%) each of Low turnover disease (Adynamic bone disease) and Normal histology. The mean blood urea, S. Creatinine, S Phosphate and the S. Vit D3 were found to be statistically significant between the two major subgroups. The area of the bone trabeculae and the osteoid percentage was found to be more in the MUO group and was found to be statistically significant.

Conclusion: A trephine biopsy helps us in understanding the skeletal symptoms of the CKD when the clinical and biochemical parameters are not conclusive. A biopsy in unexplained bone pain/fractures, unexplained hypercalcemia and elevated phosphate levels helps in guiding the proper management of the patient.

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Conflict of interest statement

Conflict of interest

There is no conflict of interest regarding the manuscript and the study was cleared by the ethical committee of the institute and was conducted under the guidance of the said co- authors.

Informed Consents

Informed consents were taken from the patients included in the study (A blank form enclosed along with the manuscript).

Figures

Fig. 1
Fig. 1
Masson Trichrome on decal section of bone marrow biopsy of a case of CKD showing variable thickness of bony trabeculae with area of lacunar and surface resorption
Fig. 2
Fig. 2
H & E section showing osteoblastic and osteoclastic proliferation along with tunnel resorption and moderate degree of fibrosis in the tunnel in a case of HPT
Fig. 3
Fig. 3
MT on decal section in a case of HPT showing peritrabecular fibrosis (Green arrow), hook resorption (Yellow arrow) and collagen being extruded into the marrow cavity (Red arrow)
Fig. 4
Fig. 4
MT on deal section of bone biopsy showing marked variablity of the bony trabeculae along with areas of tunnel resorption (Black arrow), surface resorption (Yellow arrow), hooked resorption (Green arrow) and marked peritrabecular fibrosos (Blue arrow) extending into the marrow spaces in a case of HPT
Fig. 5
Fig. 5
H & F section of a case of MUO showing marked variability of bony trabeculae. There are areas of osteoblastic proliferation (Blue arrow) and focal areas of peritrabecular fibrosis (Black arrow)
Fig. 6
Fig. 6
a Masson Trichrome and b Von Kossa on undecalcified sections showing increased osteoid in a case of MUO
See this image and copyright information in PMC

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