Chapter

Chronic kidney disease-mineral and bone disorder (CKD-MBD) in children

Sevcan A. Bakkaloglu, Katherine Wesseling-Perry and Isidro B. Salusky

in The Spectrum of Mineral and Bone Disorders in Chronic Kidney Disease

Second edition

Published on behalf of Oxford University Press

Published in print June 2010 | ISBN: 9780199559176
Published online November 2012 | e-ISBN: 9780191753350 | DOI: http://dx.doi.org/10.1093/med/9780199559176.003.028

Series: Oxford Clinical Nephrology Series

Chronic kidney disease-mineral and bone disorder (CKD-MBD) in children

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Abnormalities in mineral metabolism and bone structure are an almost universal finding in chronic kidney disease (CKD) in childhood,1 and result in significant complications. Many are similar to those seen in adults with CKD (e.g. fractures, bone pain, and avascular necrosis), but others are unique to children (e.g. growth failure and skeletal deformities), which may result in significant physical disability when left untreated. Such skeletal changes reflect disturbances in endochondral bone formation at the level of the epiphyseal growth plate as well as the alterations in bone turnover, mineralization and volume common to the adult population.

Accordingly, treatment and prevention of renal bone diseases is of critical importance in managing the alterations in bone and growth plate that occur early in the course of CKD and are accompanied by the development of cardiovascular complications. A growing body of evidence demonstrates that cardiovascular disease is the leading cause of morbidity and mortality in adult and pediatric patients with CKD, and that therapies designed to treat the skeletal consequences of CKD affect the progression of vascular pathology. Such findings led to a reclassification of the biochemical, skeletal, and vascular complications associated with progressive kidney disease. Together, these alterations are termed ‘CKD mineral and bone disorder’ (‘CKD-MBD’), while the term ‘renal osteodystrophy’ exclusively defines bone morphology and is therefore one aspect of the CKD-MBD. This chapter summarizes the specific aspects related to normal skeletal development, and the major aspects of the pathogenesis, clinical manifestations, histological features, and therapeutic interventions currently used in the management of CKD-MBD. Particular emphasis has been placed on the clinical manifestations and treatment strategies that distinguish pediatric patients from their adult counterparts, and on the differences in the management of CKD-MBD across the spectrum of CKD.

Chapter.  9607 words.  Illustrated.

Subjects: Rheumatology ; Nephrology

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