Medical and Surgical Treatment of Azotemic Osteodystrophy

Abstract

Azotemic osteodystrophy refers to the bone changes during chronic renal failure. Osteomalacia results from vitamin-D resistance secondary to uremia while osteitis-fibrosa is due to parathyroid hyperplasia provoked by hypocalcemia. The nature of osteosclerosis which is less clearly defined is apparently asymptomatic. Calciferol or dihydrotachysterol orally in large doses reverses negative Ca balance, relieves bone pain and promotes skeletal recalcification. Although such therapy is usually adequate, disabling metastatic calcifications, serious fractures and skeletal deformities leading to immobilization are indications for consideration of parathyroidectomy. A case is presented in which subjective and objective improvement followed administration of vitamin-D. Despite frequent determinations of serum Ca and P concentrations, hypercal-cemic nephropathy supervened necessitating omission of the vitamin; symptoms recurred and brown tumors of the femurs were found. Vitamin-D was again given but femoral fractures occurred prompting parathyroidectomy before skeletal disease could be suppressed. Subsequent bone healing was rapid; the underlying renal disease was not affected.