Vnitr Lek 2003, 49(5):403-408

[Renal bone disease].

S Sulková, M Fortová, M Válek, F Svára: Interní oddĕlení Strahov 1. lékarské fakulty UK a VFN, Praha.

Renal bone disease is a serious complication associated with chronic renal failure. The pathogenetic mechanisms are very complicated. The disorder develops as a result of hypophosphataemia, hypocalcaemia and calcitrol deficiency already during the period when renal functions decline below 50%. Formerly the form with an excessive bone turnover predominated, nowadays we encounter ever more frequently so-called a dynamic bone disease. A serious manifestation are extraosseous calcifications. In treatment phosphate binding substances in the gastrointestinal tract are involved (along with other provisions, correcting hypophosphataemia), supplementation of calcium in case of hypocalcaemia correction of metabolic acidosis and administration of the active vitamin D metabolite (continuously as supplementation in deficient endogenous production, in a pulsatile pattern with the aim to suppress the activity of parathyroid bodies). In case of "resistant" hyperparathyroidism surgery is indicated (parathyroidectomy). Treatment of the dynamic form is not known, prevention of suppression of excessive parathyroid activity is important. New trends in the treatment of renal bone disease are non-calcium phosphate binding substances in the gastrointestinal tract, vitamin D analogues (with a lower hypercalcaemic potential) and calcium mimetics.