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Title
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Aluminum-related bone-disease in dialysis patients : pathophysiology, diagnosis and therapy
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Author
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Abstract
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| Accumulation of aluminum in tissues has become a well-known complication in patients with chronic renal failure and retention of the element in bone has been implicated in the pathogenesis of the so-called aluminum-related bone disease (ARBD). Distinctive features of ARBD include extensive deposition of aluminum on the mineralization front, a decreased number of osteoclasts, increased osteoid volume, low serum PTH levels and a strong decrease of double tetracycline-labeled surfaces. Apart from the classic vitamin-D resistant osteomalacia ARBD has been associated with the development of an >>adynamic bone disease<< characterized by a defect in matrix synthesis. The latter type of bone disease has also been observed in iron overloaded dialysis patients without aluminum overload. Regular monitoring of the serum aluminum levels combined with a desferrioxamine (DFO) test may provide a relatively sensitive and specific index for the diagnosis of ARBD. Definite diagnosis is made by chemical, histochemical and histological examination of a bone biopsy consisting in Aluminon, Perls' and Goldner's stainings. Until now, treatment of ARBD with DFO is the only available way. With regard to the limited response of tissue aluminum removal towards increased doses of DFO and in order to reduce the risk for side-effects, the chelator should be given in low amounts (i.e. less-than-or-equal-to 10 mg/kg). Several months of therapy may be necessary for patients with clinical symptoms to become asymptomatic. |
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Language
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English
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Source (journal)
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Nieren- und Hochdruckkrankheiten. - München
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Publication
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München
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1991
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ISSN
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0300-5224
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Volume/pages
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20
:7
(1991)
, p. 311-316
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ISI
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A1991FZ95200005
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