renal osteodystrophy

renal osteodystrophy, complex bone disorder that occurs as a complication of chronic kidney disease (CKD), particularly in individuals with end-stage renal disease. Renal osteodystrophy is one of the manifestations of a broader condition known as chronic kidney disease–mineral and bone disorder (CKD-MBD). Common symptoms of renal osteodystrophy include bone pain, muscle weakness, and an increased risk of fractures due to poor bone mineralization and high bone turnover, which weakens bone structure. Patients may also experience skeletal deformities, growth retardation (in children), and soft tissue or vascular calcifications (abnormal buildup of calcium deposits in blood vessel walls).

Genetic and environmental factors influence the development of renal osteodystrophy. Numerous genetic variations, for instance, are associated with alterations in kidney function, and specific varations in several genes involved in bone remodeling, calcium regulation, and vitamin D metabolism potentially contribute to renal osteodystrophy. Environmental factors, including exposure to heavy metals (e.g., cadmium and lead), excessive fluoride intake, and exposure to air pollution and certain agrochemicals can also significantly contribute to the development and progression of kidney disease and its bone-related complications.

Of particular relevance to renal osteodystrophy is parathyroid hormone (PTH; also called parathormone). PTH helps regulate calcium and phosphate levels in the body by stimulating bone resorption, enhancing calcium reabsorption in the kidneys, promoting phosphate excretion, and activating vitamin D to increase calcium absorption from the intestinal tract. However, in CKD, the kidneys lose their ability to excrete phosphate and to effectively activate vitamin D, leading to high phosphate levels and low calcium levels. This imbalance triggers secondary hyperparathyroidism—an overproduction of PTH—which attempts to correct the calcium deficiency but ultimately results in excessive bone breakdown. Over time, healthy bone tissue may be replaced by fibrous tissue, increasing the risk of fractures and skeletal deformities.

Discover how ordinary objects work, and expand your understanding of the familiar.

SIGN UP

" height="20" alt="HEW Logo">

Thank you for signing up!"

Back to homepage

By clicking "Sign Up", you consent to the Britannica Privacy Policy and Terms of Use.

Britannica Quiz

Diseases, Disorders, and More: A Medical Quiz

Renal osteodystrophy is managed by the use of phosphate-binding agents to reduce phosphate levels, calcium supplements and vitamin D medications (e.g., calcitriol) to restore calcium and vitamin D levels, and agents such as calcimimetics that suppress PTH. In severe cases, parathyroidectomy (surgical removal of one or more of the parathyroid glands) may be necessary. Kidney transplant has been successful in some cases involving severe kidney disease.