Medical and Surgical Treatment of Azotemic Osteodystrophy
Authors: JOHN H. FELTS
Journal: Annals of Internal Medicine (1965)

Case Studies1 June 1965Medical and Surgical Treatment of Azotemic OsteodystrophyJOHN H. FELTS, M.D., F.A.C.P., J. E. WHITLEY, M.D., D. D. ANDERSON, M.D., H. M. CARPENTER, M.D., H. H. BRADSHAW, M.D.JOHN H. FELTS, M.D., F.A.C.P.Search for more papers by this author, J. E. WHITLEY, M.D.Search for more papers by this author, D. D. ANDERSON, M.D.Search for more papers by this author, H. M. CARPENTER, M.D.Search for more papers by this author, H. H. BRADSHAW, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-62-6-1272 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptAlthough osteomalacia and osteitis fibrosa resulting from primary kidney disease are found relatively frequently at autopsy (1), symptomatic bone disease during the course of renal insufficiency is recognized much less often, perhaps because the more prominent aspects of uremia draw attention away from less obvious manifestations of the syndrome. Some patients will, however, complain of bone pain, suffer spontaneous fractures, develop immobilizing skeletal deformity, and deposit calcium about joints, subcutaneously, and in blood vessel walls. For some of these patients, the underlying renal disease is so advanced that little can be done, but others, in reasonably good condition except for...References1. FOLLISJACKSON RHDA: Renal osteomalacia and osteitis fibrosa in adults. Bull. Hopkins Hosp. 72: 232, 1943. Google Scholar2. ALBRIGHTREIFENSTEIN FEC: The Parathyroid Glands and Metabolic Bone Disease. The Williams and Wilkins Co., Baltimore, 1948. Google Scholar3. FLETCHERJONESMORGAN RFJHDB: Bone disease in chronic renal failure. Quart. J. Med. 32: 321, 1963. MedlineGoogle Scholar4. STANBURYLUMB SWGA: Metabolic studies of renal osteodystrophy. I. Calcium, phosphorus and nitrogen metabolism in rickets, osteomalacia and hyperparathyroidism complicating uremia and in the osteomalacia of the adult Fanconi syndrome. Medicine (Balt.) 41: 1, 1962. CrossrefMedlineGoogle Scholar5. DENTHARPERPHILPOT CECMGR: The treatment of renal-glomerular osteodystrophy. Quart. J. Med. 30: 1, 1961. MedlineGoogle Scholar6. KAYEPRITCHARDHALPENNYLIGHT MJEGWW: Bone disease in chronic renal failure with particular reference to osteosclerosis. Medicine (Balt.) 39: 157, 1960. CrossrefMedlineGoogle Scholar7. POLLACKSIEGAL HS: Parathyroid hyperplasia and calcinosis associated with renal disease. J. Mount Sinai Hosp. NY 2: 270, 1936. Google Scholar8. DRESKINFOX EATA: Adult renal osteitis fibrosa with metastatic calcification and hyperplasia of one parathyroid gland. Arch. Intern. Med. (Chicago) 86: 533, 1950. CrossrefGoogle Scholar9. STANBURYLUMBNICHOLSON SWGAWF: Elective subtotal parathyroidectomy for renal hyperparathyroidism. Lancet 1: 793, 1960. CrossrefMedlineGoogle Scholar10. FINDLEYMOOREBRACKNEY TJDEL: Subtotal parathyroidectomy for renal hyperparathyroidism. Lancet 2: 1150, 1961. CrossrefGoogle Scholar11. WALSER M: The separate effects of hyperparathyroidism, hypercalcemia of malignancy, renal failure and acidosis on the state of calcium, phosphate, and other ions in plasma. J. Clin. Invest. 41: 1454, 1962. CrossrefMedlineGoogle Scholar12. ANDERSONMANNKENYONFARRELLHILLS WWJBNJJAG: Subtotal parathyroidectomy in azotemic renal osteodystrophy. New Eng. J. Med. 268: 575, 1963. CrossrefMedlineGoogle Scholar13. FORDHAMWILLIAMS CCTF: Brown tumor and secondary hyperparathyroidism. New Eng. J. Med. 269: 129, 1963. CrossrefMedlineGoogle Scholar14. STABLESLEVINRUBENSTEINBERKABRAHAMS DBNWAHMEC: Parathyroidectomy for hypercalcemic crisis in renal osteodystrophy. Ann. Intern. Med. 61: 531, 1964. LinkGoogle Scholar15. ALBRIGHT F: Renal osteitis fibrosa cystica: report of a case with discussion of metabolic aspects. Trans. Ass. Amer. Physicians 51: 199, 1936. Google Scholar16. LIUCHU SHHI: Studies of calcium and phosphorus metabolism with special reference to pathogenesis and effects of dihydrotachysterol (AT 10) and iron. Medicine (Balt.) 22: 103, 1943. CrossrefGoogle Scholar17. COHENGONICKCOBURNRUBINI MBHCJWME: Calcium metabolism in chronic renal failure. Clin. Res. 12: 122, 1964. Google Scholar18. RESSNEREPSTEIN DMFH: The effect of uremia on the gastrointestinal transport of calcium. Clin. Res. 11: 245, 1963. Google Scholar19. RASMUSSEN H: Parathyroid hormone. Nature and mechanism of action. Amer. J. Med. 30: 112, 1961. CrossrefMedlineGoogle Scholar20. YENDTCONNORHOWARD ERTBJE: In vitro calcification of rachitic rat cartilage in normal and pathological human sera with some observations on the pathogenesis of renal rickets. Bull. Hopkins Hosp. 96: 1, 1955. MedlineGoogle Scholar21. KAYE M: Mineral analysis of the fourth lumbar vertebra in health and renal failure. J. Clin. Invest. 43: 1367, 1964. CrossrefMedlineGoogle Scholar22. CARLSSON A: Tracer experiments on the effect of vitamin D on the skeletal metabolism of calcium and phosphorus. Acta Physiol. Scand. 26: 212, 1952. CrossrefMedlineGoogle Scholar23. CARLSSONLINDQUIST AB: Comparison of intestinal and skeletal effects of vitamin D in relation to dosage. Acta Physiol. Scand. 35: 53, 1955. CrossrefMedlineGoogle Scholar24. DYMLING J: Calcium kinetics in osteopenia and parathyroid disease. Acta Med. Scand. 175: Suppl. 408, 1964. Google Scholar25. RASMUSSENDELUCAARNAUDHAWKERVON STEDINGK HHCCM: The relationship between vitamin D and parathyroid hormone. J. Clin. Invest. 42: 1940, 1963. CrossrefMedlineGoogle Scholar26. Case records of the Massachusetts General Hospital, Case No. 29-1963. New Eng. J. Med. 268: 943, 1963. CrossrefGoogle Scholar27. ST. GOAR WT: Personal communication. Google Scholar28. DULLHENNEMAN TAPH: Urinary hydroxyproline as an index of collagen turn-over in bone. New Eng. J. Med. 268: 132, 1963. CrossrefGoogle Scholar29. KLEINALBERTSENCURTISS LKPH: Urinary hydroxyproline in hyperparathyroidism: a study of three cases with and without bone disease. Metabolism 11: 1023, 1962. Google Scholar30. STANBURY SW: Azotemic renal osteodystrophy. Brit. Med. Bull. 13: 57, 1957. CrossrefMedlineGoogle Scholar31. STANBURY SW: Bony complications of renal disease, in Renal Disease, edited by BLACK, D. A. K., F. A. Davis Company, Philadelphia, 1962, p. 508. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Winston-Salem, North CarolinaFrom the Departments of Medicine, Radiology, Surgery, and Pathology, Bowman Gray School of Medicine of Wake Forest College, and the North Carolina Baptist Hospital, Winston-Salem, N. C.This study was supported in part by a grant from the John A. Hartford Foundation, Inc., New York, N. Y.Portions of this study were presented at the Forty-fifth Annual Session of the American College of Physicians, Atlantic City, N. J., April 6, 1964.Requests for reprints should be addressed to John H. Felts, M.D., Department of Medicine, Bowman Gray School of Medicine of Wake Forest College, Winston-Salem, N. C. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByNebenschilddrüsenTotal parathyroidectomy without autotransplantation after renal transplantation for tertiary hyperparathyroidism: long-term follow-upMineral and bone disorder after renal transplantation: a reviewNebenschilddrüsenParathyroid Surgery in Renal Failure: A ReviewElective total parathyroidectomy without autotransplant in end-stage renal diseaseRepeat parathyroid operation associated with renal diseaseEvaluation of Parathyroid Autograft Growth and Function in Hemodialysis PatientsArterial Calcifications in Patients Undergoing Chronic Peritoneal Dialysis: Incidence, Progression and RegressionRenale OsteopathienRenale OsteopathienHypoparathyroidismEssential features of the treatment of chronic renal failure in the dog*EFFECTS OF MAGNESIUM ON PARATHYROID HORMONE SECRETION DURING CHRONIC HÆMODIALYSISTotal parathyroidectomy in the treatment of renal osteodystrophyPhysiologic studies in renal osteodystrophy treated by subtotal parathyroidectomyThe Renal Excretion of Nitrogen Containing MetabolitesBiochemical consequences of chronic renal failure: a review.Medical management of chronic renal failureRecent Progress in Osteomalacia and RicketsA. ROBERT ARNSTEIN, M.D., BOY FRAME, M.D., F.A.C.P., HAROLD M. FROST, M.D.Case 53-1965 1 June 1965Volume 62, Issue 6Page: 1272-1279KeywordsAutopsyBlood vesselsBoneCalciumDiagnostic radiologyFibrosisHospital medicineRenal diseasesSurgeryVitamin D Issue Published: 1 June 1965 PDF DownloadLoading ...