Abstract
The incidence, course and time of onset of skeletal abnormalities caused by chronic renal failure (CRF) are not clear in rapidly growing young children. To study these features we investigated the skeletal status of 12 children under 5 years of age (mean age 2.5 yrs) who had mild to moderate degrees of CRF (serum creatinine (S.Cr) 0.9 - 5.5 mg/dl). Seven patients had low growth velocity; 4 had obvious skeletal deformities. Major osseous derangements were detected on radiographs in 7 patients, and were present in the iliac crest bone biopsy specimens in all 12 patients. Radiographic evidence of rickets appeared early (within 1.9 yrs after detection of CRF, mean S.Cr 2.4 mg/dl). Normal plasma 25-OH vitamin D levels ruled out vitamin D deficiency. In contrast, X-ray signs of secondary hyperparathyroidism appeared later (mean duration of CRF 3.2 yrs, mean S.Cr 3.5 mg/dl). Rickets responded readily to vitamin D therapy (1600-5000 IU/day) but secondary hyperparathyroid lesions were refractory to conventional dietary and medical management, including large doses of vitamin D (up to 20,000 IU/day). Progressive bone disease constituted the reason for admitting 3 of our patients to the transplant program. We conclude that renal osteodystrophy is an unexpectedly common occurrence in very young children and may represent a major complication even before CRF becomes advanced.
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Hsu, A., Kooh, S., Fraser, D. et al. RENAL OSTEODYSTROPHY IN CHILDREN UNDER 5 YEARS OF AGE. Pediatr Res 11, 552 (1977). https://doi.org/10.1203/00006450-197704000-01092
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DOI: https://doi.org/10.1203/00006450-197704000-01092