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Disorders of Bone & Mineral Metabolism - ECAB

Disorders of Bone & Mineral Metabolism - ECAB

Suresh C Tiwari

(2013)

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Book Details

Abstract

The skeleton is a metabolically active organ that undergoes continuous remodeling throughout life. This remodeling is necessary both to maintain the structural integrity of the skeleton and to fulfill its metabolic functions as a storehouse of calcium and phosphorus. Skeletal remodeling can be triggered by changes in mechanical forces or microdamage and by hormonal response to changes in circulating calcium and phosphorus levels. The skeleton also serves as the second line of defense against acidosis, and it is able to liberate buffers in the form of inorganic phosphates. Disorders of Bone and Mineral Metabolism is a multi-authored clinical update that covers all major aspects of bone and its mineral disorders. The first chapter is divided into different sections describing various minerals of clinical importance followed by regulation of mineral metabolism by parathyroid hormone, and vitamin D. There is a very good balance of basic information to act as a primer for the reader and the supporting experimental evidence. The complicated and often difficult topics of mineralization of bone and its regulation and other aspects of mineral metabolism are presented in a particularly clear and interesting manner. A long and useful bibliography follows every chapter. This update contains thorough discussions of the pathophysiology, diagnostic techniques, and therapy of mineral diseases with a wealth of detail. The book is a very useful reference for those interested in bone and mineral physiology and disease, be it a general physician or a nephrologist.


Table of Contents

Section Title Page Action Price
Font Cover Front Cover
Front Matter ia
Copyright id
ECAB Clinical Update:Nephrology ie
Disorders of Bone &Mineral Metabolism if
About the Authors ig
Contents ii
ECAB Clinical Update InformationDISORDERS OF BONE & MINERALMETABOLISM i
Introduction 2
Renal Osteodystrophy 2a
ABSTRACT 2a
KEYWORDS 2b
Introduction 2a
Regulation of Bone Resorption and Formation 3
Systemic Hormones 3
Calcitonin 4
1,25(OH)2 Dihydroxyvitamin D3 4
Estrogens 5
Glucocorticoids 6
Growth Factors and Cytokines 6
Transforming Growth Factor 6
Bone Morphogenetic Proteins 6
Fibroblast Growth Factors 7
Cytokines 7
Interleukin-6 7
Prostaglandins 7
Conclusion 7
Introduction 8
Histological Patterns of Renal Osteodystrophy 12
Osteitis Fibrosa (Predominant Hyperparathyroid Bone Disease) 13
Mild Lesion 13
Osteomalacia 14
Mixed Uremic Osteodystrophy 14
Adynamic Bone Disease (Low Turnover) 14
Osteoporosis in Chronic Kidney Disease 15
Bone Loss and Fracture in Chronic Kidney Disease 16
Risk Factors for Bone Loss and Fracture 16
Pathogenesis of Renal Osteodystrophy 17
Increased Renal Phosphate Retention 17
Decreased Renal Calcitriol Production 18
Decreased Vitamin D Action on Parathyroid Glands 19
Pathogenetic Factors in Osteomalacic Renal Osteodystrophy 20
Clinical Signs and Symptoms of Osteodystrophy 20
Clinical Features - Adults 20
Bone Pain 20
Myopathy 20
Pruritus 21
Calciphylaxis 21
Arthritis and Periarthritis 21
Spontaneous Tendon Rupture 22
Skeletal Deformities 22
Growth Retardation 22
Evaluation 22
Radiographic Features of ROD 22
Secondary Hyperparathyroid Bone Disease 22
Osteomalacia 23
Extraskeletal Calcifications 23
Bone Activity Markers 23
Alkaline Phosphatase 23
25(OH) Vitamin D 24
Serum Biomarkers 24
PTH 25
DEXA Scan 25
Bone Mineral Density 26
Biochemical Investigations 30
Bone Biopsy 30
Check List Prior to Bone Biopsy 30
Baseline Diagnosis and Biochemical Profile of Study Population 33
Bone Densitometry Analysis: Pattern of BMD in ESRD Study Group 34
Correlation of BMD with Demographic Profile 36
Correlation with Duration of Dialysis 36
Correlation with Sex 36
Correlation with Age 37
Correlation with BMI 38
Prevalence of Fracture 38
BMD of Control versus ESRD Study Group 38
Correlation of BMD with Biochemical Profile 39
Spectrum of Bone Histology in ESRD Group 39
Intimate Approach to Pathophysiology of Renal Osteodystrophy- High-turnover Bone Disease 59a
ABSTRACT 59a
KEYWORDS 59b
Introduction 59a
Calcium/Phosphate Homeostasis 60
Vitamin D 60
Parathyroid Hormone 60
Calcitonin 60
Bone Remodeling and Molecular Regulation 61
Behavior Of Disease 62
High-turnover Bone Disease 63
Molecular Pathophysiology 63
Histopathology 65
Histologic Hallmarks 66
Roentgenology 66
Roentgenologic Hallmarks 66
Conclusion 68
Adynamic Bone Disease 69a
ABSTRACT 69a
KEYWORDS 69b
Definition 69a
Prevalence of Adynamic Bone Disease 70
Pathogenesis 70
Clinical Features and Biochemical Profile 71
Long-Term Consequences of ABD 71
Management 73
Conclusion 74
Osteomalacia 76a
ABSTRACT 76a
KEYWORDS 76a
Causes 76a
Other Causes 76a
Symptoms 77
Diagnosis 77
Treatment 78
Ergocalciferol 78
Calcium Phosphate (Tribasic) 78
Calcium Lactate 78
Calcium Glubionate 79
Cholecalciferol 79
Tumor-Induced Osteomalacia (Oncogenic Osteomalacia) 82
Investigation 82
Diagnosis 82
Treatment 82
Case Study Disorders of Mineral Metabolism in a Case of Renal Transplant 83
Calcitriol in Chronic Kidney Disease 86a
ABSTRACT 86a
KEYWORDS 86a
Calcitriol on Nervous System 86a
Calcitriol in Cardiac Function 87
Calcitriol on Parathyroid Gland 87
Calcitriol on Carcinogenesis 87
Colon Carcinogenesis 87
Prostate Cancer 87
Pulmonary Cancer 88
Immunoregulatory Function of Calcitriol 88
Calcitriol in Chronic Renal Disease 88
Metabolism 88
Receptor Regulation 89
SHPT and Calcitriol 89
Conclusion 89
Nephrolithiasis 93a
ABSTRACT 93a
KEYWORDS 93b
Introduction 93a
Pathogenesis 93a
Signs and Symptoms 94
Evaluation 95
History and Examination 95
Laboratory Evaluation 96
Radiology 96
Etiology of Nephrolithiasis 98
Calcium Metabolism 98
Primary Hypercalciuria and Bone Disease 99
Management of Hypercalciuria 100
Oxalate Metabolism 101
Uric Acid 102
Hyperuricosuric Calcium Nephrolithiasis (HUCN) 102
Cystine 102
Infection Related Stones 103
Drug-Induced Nephrolithiasis 103
Summary 104
Management of Patients with Renal Bone Disease 108a
ABSTRACT 108a
KEYWORDS 108a
Dietary Phosphate Restriction 108a
Phosphate Binders 109
Aluminium 109
Calcium-based Binders 109
Non-aluminium, Calcium, Magnesium Binders 110
Sevelamer 110
Lanthanum Carbonate 110
Nicotinamide 111
Vitamin D and Analogs 114
25 Vitamin D 114
1,25-Vitamin D 114
Additional Benefits of Vitamin D 115
Calcimimetic Agents 116
Parathyroidectomy 116
Other Books in This Series 120