—— nn BONES ” 190 RENAL OSTEODYSTROPHY 141 PURULENT OSTEOMYELITIS 4 PAGET DISEASE OF THE BONE “* 253 OSTEOCHONDROMA 173 FIBROUS DYSPLASIA 193 GIANT CELL TUMOR 254 OSTEOGENIC SARCOMA ( OSTEOSARCOMA) 92 EWING'S TUMORBONES ————— 6 #190 RENAL OSTFODYSTROPHY / E | = incrased bone resorption and bone FoMmahon w/ the pomer dominahi ,- 2 a ° 1,25 (0M2-D/ manifestations : . V osteopenia /osteopomsis 1.25 - dihydroxy vitamin D V osteomalacia Vv secondary dyperparg thy widism Y growth retardation — porathyrid hormone (PTH) 1s sponsible For * ostecdast achvation snckasing bone sorphnon and calcium mebilization Though increased RANKL exprssicn on osteoblasts © INCRaSed UNNOY. excretion OF phasphates © increased resoiphon oF Calcium by the renal tubules © inceOxd synthesis of active vitamin D (1.25 COD) by the kidneys v vitamin D, in tum, enhances calcium absorption from the gut ond mobilizes bone calcium by inducing RANKL on osteoblasts v The net msult of the actions of PTH is an eleyatn in seum calcium, which, under remal cittumstances , inhibits Further PTH producton v in chronic mnal insufficiency, ther is inadequok 125~ dihydrry vitamin D ultimately agfechng gastrointestinal calcium absorphon )yperphosphatemia of aa) Failure Qlso suppresses rena) 4 = hydroxylase further impornng vitamin D synthesb- 3 major mechanisms of how renal diseaes cause stektal @ abnormalihes : @ Tweuiar DysFUuNCTION = rng) tubular acidosis ~ low pH dissolves hydroxyappante resulting | demineralizahon of the matnx ard osteomalaciq ® GENERALIZED RENAL FAILURE - agfecting giomenlar and tubular V tedured phosphak excretion V chronic >yperphosphatemi@ v hypocalcemia : V ultimately, secondary hyperparath yidism Which is not completely analogous t~ pamay >yperporothyrpidism © DECREASED PRODUCTION OF SECRETED FACTORS ~ kidneys * convert vitamin D—» 4,25 dihydroxy vitamin Dy * secrtte. the proteins BMP-# and Klotho — deceased vitamin Dz results in: V hypocalcemia V secondory byperparathy midiism — BMP-F © prdued by renal tubular cells * induces osteoblas) ditreentation / proliperation - FGF-23 « made by osteocytes * acts on Kidney t regulak phosphate homeostasis ond vitamin D production ° dependent on producton of membrone= bourc) Klotto i — Scell Wpes of the bone: @ OSTEOBLAST - bene Fomatin / matix deposition © OSTEOCITE - regulation of cakium © OSTEOCLAST - bone resorption Funchon Jeading te: