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Renal Osteodystrophy

Renal Osteodystrophy Abstract In this issue of the Journal (p 901), Talwalkar and his colleagues describe two young children with renal osteodystrophy resistant to phosphate restriction, calcium supplementation, and vitamin D therapy. After parathyroidectomy and partial autotransplantation, bone lesions healed promptly. After 20 months, roentgenograms and the serum immunoreactive parathyroid hormone (iPTH) level were normal. Three points of general interest derive from this article: (1) Medical management of renal osteodystrophy is sometimes unsatisfactory. (2) Partial parathyroidectomy may have gratifying clinical and biochemical results. (3) Autotransplantation, with convenient relocation of parathyroid remnants, facilitates evaluation of function and, if necessary, reoperation. The latter two points have been extensively discussed,1.2 and consensus favors the procedure so successfully used for the first time in children by Talwalkar's group. Pediatricians, however, will continue to be more concerned with the indications for parathyroid ablation than with the choice of procedure. The reasons for the occasional failure of References 1. Wells SA, Ellis GJ, Gunnels JC, et al: Parathyroid autotransplantation in primary parathyroid hyperplasia . N Engl J Med 295:57-62, 1976.Crossref 2. Management of primary parathyroid hyperplasia, correspondence . N Engl J Med 295:1202-1204, 1976. 3. Balsan S: Renal osteodystrophy , in Lieberman E (ed): Clinical Pediatric Nephrology . Philadelphia, JB Lippincott Co, 1976, pp 424-438. 4. Avioli LV, Teitelbaum S: Renal osteodystrophy , in Edelmann CM (ed): Pediatric Kidney Disease . Boston, Little Brown & Co, 1978, pp 366-401. 5. David DS: Mineral and bone homeostasis in renal failure: Pathophysiology and management , in David DS (ed): Calcium Metabolism in Renal Failure and Nephrolithiasis . New York, John Wiley & Sons Inc, 1977, pp 1-76. 6. Ritz E, Malluche HM, Krempien B, et al: Bone histology in renal insufficiency , in David DS (ed): Calcium Metabolism in Renal Failure and Nephrolithiasis . New York, John Wiley & Sons Inc, 1977, pp 197-233. 7. Freitag J, Martin KJ, Hruska KA, et al: Impaired parathyroid hormone metabolism in patients with chronic renal failure . N Engl J Med 298:29-32, 1978.Crossref 8. Roof BS, Piel CF: 1 α,25-vitamin D for osteodystrophy in children . N Engl J Med 298:1424-1425, 1978. 9. Coburn JW, Brickman AS, Sherrard DV, et al: Clinical efficacy of 1-25-dihydroxy-vitamin D in renal osteodystrophy , in Normam AW, Schaefer K, Coburn JW, et al (eds): Vitamin D: Biochemical, Chemical and Clinical Aspects Related to Calcium Metabolism . New York, de Gruyter, 1977, pp 657-666. 10. Christiansen C, Rodbro P, Christiansen MS, et al: Deterioration of renal function during treatment of chronic renal failure with 1,25-dihydroxycholecalciferol . Lancet 2:700-703, 1978.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1979 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1979.02130090019002
Publisher site
See Article on Publisher Site

Abstract

Abstract In this issue of the Journal (p 901), Talwalkar and his colleagues describe two young children with renal osteodystrophy resistant to phosphate restriction, calcium supplementation, and vitamin D therapy. After parathyroidectomy and partial autotransplantation, bone lesions healed promptly. After 20 months, roentgenograms and the serum immunoreactive parathyroid hormone (iPTH) level were normal. Three points of general interest derive from this article: (1) Medical management of renal osteodystrophy is sometimes unsatisfactory. (2) Partial parathyroidectomy may have gratifying clinical and biochemical results. (3) Autotransplantation, with convenient relocation of parathyroid remnants, facilitates evaluation of function and, if necessary, reoperation. The latter two points have been extensively discussed,1.2 and consensus favors the procedure so successfully used for the first time in children by Talwalkar's group. Pediatricians, however, will continue to be more concerned with the indications for parathyroid ablation than with the choice of procedure. The reasons for the occasional failure of References 1. Wells SA, Ellis GJ, Gunnels JC, et al: Parathyroid autotransplantation in primary parathyroid hyperplasia . N Engl J Med 295:57-62, 1976.Crossref 2. Management of primary parathyroid hyperplasia, correspondence . N Engl J Med 295:1202-1204, 1976. 3. Balsan S: Renal osteodystrophy , in Lieberman E (ed): Clinical Pediatric Nephrology . Philadelphia, JB Lippincott Co, 1976, pp 424-438. 4. Avioli LV, Teitelbaum S: Renal osteodystrophy , in Edelmann CM (ed): Pediatric Kidney Disease . Boston, Little Brown & Co, 1978, pp 366-401. 5. David DS: Mineral and bone homeostasis in renal failure: Pathophysiology and management , in David DS (ed): Calcium Metabolism in Renal Failure and Nephrolithiasis . New York, John Wiley & Sons Inc, 1977, pp 1-76. 6. Ritz E, Malluche HM, Krempien B, et al: Bone histology in renal insufficiency , in David DS (ed): Calcium Metabolism in Renal Failure and Nephrolithiasis . New York, John Wiley & Sons Inc, 1977, pp 197-233. 7. Freitag J, Martin KJ, Hruska KA, et al: Impaired parathyroid hormone metabolism in patients with chronic renal failure . N Engl J Med 298:29-32, 1978.Crossref 8. Roof BS, Piel CF: 1 α,25-vitamin D for osteodystrophy in children . N Engl J Med 298:1424-1425, 1978. 9. Coburn JW, Brickman AS, Sherrard DV, et al: Clinical efficacy of 1-25-dihydroxy-vitamin D in renal osteodystrophy , in Normam AW, Schaefer K, Coburn JW, et al (eds): Vitamin D: Biochemical, Chemical and Clinical Aspects Related to Calcium Metabolism . New York, de Gruyter, 1977, pp 657-666. 10. Christiansen C, Rodbro P, Christiansen MS, et al: Deterioration of renal function during treatment of chronic renal failure with 1,25-dihydroxycholecalciferol . Lancet 2:700-703, 1978.Crossref

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Sep 1, 1979

References