Specific bone and mineral disorders in patients with chronic kidney disease

Bone lesions, collectively known as renal osteodystrophy (ROD), are a common complication of chronic kidney disease (CKD). Besides osteitis fibrosa and mixed lesions, other bone and mineral disorders such as adynamic bone disease, osteomalacia, osteoporosis, dialysis-related amyloidosis, and calcific uremic arteriolopathy are increasingly recognized in patients with CKD. Although bone lesions usually begin early in the course of CKD and are progressive, symptoms and signs such as bone pain and fractures may not occur until the patient is already on maintenance dialysis. More importantly, these disorders are associated with increased risk of cardiovascular disease and mortality in patients with CKD. The term ROD does not reflect the full spectrum of bone pathology or clinical manifestations of bone and mineral disorders in patients with CKD. Accordingly, the National Kidney Foundation and, more recently the Kidney Disease: Improving Global Outcomes, now consider ROD to represent only one measure of the skeletal component of the broader syndrome of chronic kidney disease-mineral and bone disorders in which abnormalities in bone and mineral metabolism or extraskeletal calcification are observed. In this review, we will discuss, in detail, the epidemiology, pathogenesis, histopathology, clinical manifestation, diagnosis, and treatment of these disorders.