E1177. The Musculoskeletal Manifestations of Renal Osteodystrophy
Polish Mother’s Memorial Hospital Research Institute
King's College Hospital NHS Foundation Trust
Chronic renal failure is a condition with multiple musculoskeletal manifestations. Renal osteodystrophy is a term applied to the bone changes that are apparent in these patients. Musculoskeletal findings are mainly due to secondary hyperparathyroidism, osteomalacia, osteoporosis, and osteosclerosis.
Educational Goals / Teaching Points
• To illustrate musculoskeletal manifestation caused by renal osteodystrophy.
• To describe and explain the characteristics of these lesions on plain x-ray films and MRI.
• To present differential diagnoses for these findings.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Osseous abnormalities of renal osteodystrophy can be divided into:
• Rickets and osteomalacia
• Soft tissue and vascular calcification
• Miscellaneous alterations
Each category has its own pathophysiology and imaging findings. A detailed explanation will be provided for hyperparathyroidism, as the main complication of renal osteodystrophy.
Hyperparathyroidism is a general term indicating an increased level of parathyroid hormone. This disease can present with musculoskeletal manifestations, including:
• Bone resorption
• Bone sclerosis
• Chondrocalcinosis (Calcium Pyrophosphate Dihydrate Crystal Deposition Disease)
• Additional Rheumatic Manifestations
Finally, post-treatment (hemodialysis, peritoneal dialysis and kidney transplant) related complications such as osteonecrosis are discussed.
An understanding of most frequently detected musculoskeletal lesion patterns in renal osteodystrophy allows for the recognition of possible lesion patterns and early diagnosis of disease. This understanding can help us prevent serious complications such as hip fractures in these patients.