Prevention and treatment of renal osteodystrophy in children on chronic renal failure: European guidelines

G Klaus, A Watson, A Edefonti, M Fischbach, K Rönnholm, F Schaefer, E Simkova, C J Stefanidis, V Strazdins, J Vande Walle, C Schröder, A Zurowska, M Ekim, European Pediatric Dialysis Working Group (EPDWG), G Klaus, A Watson, A Edefonti, M Fischbach, K Rönnholm, F Schaefer, E Simkova, C J Stefanidis, V Strazdins, J Vande Walle, C Schröder, A Zurowska, M Ekim, European Pediatric Dialysis Working Group (EPDWG)

Abstract

Childhood renal osteodystrophy (ROD) is the consequence of disturbances of the calcium-regulating hormones vitamin D and parathyroid hormone (PTH) as well as of the somatotroph hormone axis associated with local modulation of bone and growth cartilage function. The resulting growth retardation and the potentially rapid onset of ROD in children are different from ROD in adults. The biochemical changes of ROD as well as its prevention and treatment affect calcium and phosphorus homeostasis and are directly associated with the development of cardiovascular disease in pediatric renal patients. The aims of the clinical and biochemical surveillance of pediatric patients with CRF or on dialysis are prevention of hyperphosphatemia, avoidance of hypercalcemia and keeping the calcium phosphorus product below 5 mmol(2)/l(2). The PTH levels should be within the normal range in chronic renal failure (CRF) and up to 2-3 times the upper limit of normal levels in dialysed children. Prevention of ROD is expected to result in improved growth and less vascular calcification.

Figures

Fig. 1
Fig. 1
Clinical algorithm for treatment of elevated calcium phosphorus product in children with CRF. Ca-cont calcium containing; Ca-free calcium-free; phos-binder phosphate binder; vit D vitamin D; ADBD adynamic bone disease

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