Clinical, radiological and biochemical evidence of renal osteodystrophy in patients with chronic renal failure at the Kenyatta National Hospital

Abstract

Between May 1988 and January 1989 40 patients with established diagnosis of chronic renal failure (CRF) on either maintenance dialysis or conservative management were studied to determine the incidence and ..the nature of renal osteodystrophy. Serum immunoreactive parathyroid hormone (iPTH), magnesium (Mg) and 1,25 dihydroxycilolecalciferol (1, 25DHCC) were assayed, as welI as serum alkaline phosphatase, inorganic phosphate (inP) and calcium (Ca). Clinical features suggestive of renal osteodystrophy were present in 80 percent of the patients. 75 percent were symptomatic. Signs suggestive of renal bone disease were seen in 62.5 percent. Radiologica changes suggestive of renal osteodystrophy were found in only 7.5 percent of the patients only 60 percent of the patients had conclusive biochemical features of renal bone disease, that is, a raised serum inP, iPTH and alkaline phosphatase levels. Serum Ca levels were normal when compared to the control group of individuals. There was no correlation between clinical features and biochemical parameters of renal osteodystrophy with the exception of pruritus which was correlated with iPTH levels. Serum 1,25DHCC levels were reduced in the patients and were positively correlated with the duration of renal failure.

Serum alkaline phosphatase levels were positively correlated with the duration.of renal failure. Serum biochemical changes were not significantly altered by the severity of renal failure and the duration of hemodialysis.