Hernández AYY, Puello CCA, Duque SFL, Vallejo OJV

Language: Spanish
References: 15
Page:
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ABSTRACT

Introduction: Renal osteodystrophy is a diffuse metabolic osteopathy, related to chronic renal failure, which includes various pathologies in the musculoskeletal system. It occurs in response to metabolic disorders generated by electrolyte changes, chronic inflammation and hormonal alteration. These variations modify the process of bone remodeling. Clinical manifestations include alteration in the parenchyma and bone stroma, and range from expansive lesions, producing deformity, to pathological fractures of the bone.
Objective: Relate the clinical, imaging and histological manifestations in the skull-facial bone component for the diagnosis of renal osteodystrophy.
Case Presentation: Two clinical cases of patients with chronic kidney disease and secondary underlying hyperparathyroidism are presented, with multiple masses in the jaws that cause facial asymmetry and functional alteration. Tomographic images reveal alteration in cortical and trabecular bone morphology. Both individuals showed alterations in levels of parathyroid hormone, alkaline phosphatase, phosphorus and serum calcium. Histopathology verified fibro-bone tissue with neoformed bone and great vascularization, with multinucleated osteoclast-like cells without the presence of hemosiderin. Patients were attended in an interdisciplinary way between internal medicine, endocrinology and maxillofacial surgery.
Conclusions: Patients with advanced chronic kidney disease present alteration of the structure and bone and mineral metabolism. Such a situation can compromise the craniofacial bone complex. Severe cases of renal osteodystrophy are characterized by a marked expansion of the jaws, which generates asymmetry and traits of leonthiasis. The tomographic images associated with renal osteodystrophy present trabecular bones with cortical expansion, which evidences the immature bone turnover present. Histopathology is not specific and may be similar to cases of craniofacial bone dysplasia. Given the above, it is essential to relate these findings to the clinic to define an adequate diagnosis.

REFERENCES

1. Cannata J, Gomez-Alonso C, Grosso S, Altadill A, Díaz-Lopez J. Osteodistrofia renal: clasificación y concepto actual. Nefrología. 1995; 15(S1):61-6 [15/07/ 2020]. Disponible en: https://www.revistanefrologia.com/es-osteodistrofia-renal-clasificacion-concepto-actual--articulo-X02116995950227561.

2. Astudillo J, Cocio R, Ríos D. Osteodistrofia renal y trastornos del metabolismo y la mineralización ósea asociados a enfermedad renal crónica: manifestaciones en radiología. Revista Chilena de Radiología. 2016;22(1):27-34. DOI:10.1016/j.rchira.2016.02.002

3. Moe S, Drüeke T, Cunningham J, Goodman W, Martin K, Olgaard K, et al3. . Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int. 2006; 69(11):1945-53. DOI: 10.1038/sj.ki.5000414

4. Lorenzo V, Rodriguez Portillo M, Perez Garcia R, Cannata-Andía JB. De la Osteodistrofia Renal a las Alteraciones del Metabolismo Óseo y Mineral asociado a la Enfermedad Renal Crónica: Evolución de un concepto. Nefrología. 2007; 27(5):527-33 [15/07/2020]. Disponible en: https://revistanefrologia.com/es-de-osteodistrofia-renal-las-alteraciones-del-metabolismo-seo-mineral-asociado-articulo-X02116995070218674.

5. Bover J, Ureña P, Torregrosa J, Rodríguez G, Castro C, Górriz J, et al5. . Osteoporosis, densidad mineral ósea y complejo CKD-MBD (I): consideraciones diagnósticas. Nefrología. 2018;38(5):476-90. DOI: 10.1016/j.nefro.2017.12.006

6. Bakkaloglu SA, Wesseling PK, Pereira RC, Gales B, Wang HJ, Elashoff RM, et al6. . Value of the new bone classification system in pediatric renal osteodystrophy. Clin J Am Soc Nephrol. 2010; 5(10):1860-6. DOI: 10.2215/CJN.01330210

7. Lopes ML, Albuquerque AF, Germano AR, Queiroz LM, Miguel MC, da Silveira ÉJ. Severe maxillofacial renal osteodystrophy in two patients with chronic kidney disease. Oral Maxillofac Surg. 2015; 19(3):321-7. DOI: 10.1007/s10006-015-0490-9

8. Kaushik A, Kaushik M. Maxillofacial radiographic changes in renal osteodystrophy. J Parathyr Dis. 2016; 4:13-6 [15/07/2020]. Disponible en: http://www.jparathyroid.com/Article/JPD_201604101044478.

9. Raubenheimer EJ, Noffke CE, Mohamed A. Expansive jaw lesions in chronic kidney disease: review of the literature and a report of two cases. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015; 119(3):340-5. DOI: 10.1016/j.oooo.2014.11.002

10. Pontes FSC, Lopes MA, de Souza LL, Dos Santos da Mata Rezende D, Santos-Silva AR, Jorge J, et al10. . Oral and maxillofacial manifestations of chronic kidney disease-mineral and bone disorder: a multicenter retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol. 2018; 125(1):31-43. DOI: 10.1016/j.oooo.2017.09.011

11. Davis EM. Oral Manifestations of Chronic Kidney Disease and Renal Secondary Hyperparathyroidism: A Comparative Review. J Vet Dent. 2015;32(2):87-98. DOI: 10.1177/089875641503200202

12. James BC, Hwang JL, Grogan RH, Kaplan EL, Sarne D, Angelos P. Leontiasis ossea caused by long-standing hyperparathyroidism secondary to chronic renal failure. Surgery. 2014; 156(6):1644-6. DOI: 10.1016/j.surg.2014.08.082

13. Haroyan H, Bos A, Ginat DT. Uremic leontiasis ossea. Am J Otolaryngol. 2015; 36(1):74-6. DOI: 10.1016/j.amjoto.2014.08.007

14. Donoso H, Gunther W, Romero R, Pezoa O, Fernández T, Ortega P. Uremic leontiasis ossea, a rare presentation of severe renal osteodystrophy secondary to hyperparathyroidism. J Stomatol Oral Maxillofac Surg. 2018; 119(1):56-60. DOI: 10.1016/j.jormas.2017.10.006

15. Moorthi RN, Moe SM. Recent advances in the noninvasive diagnosis of renal osteodystrophy. Kidney Int. 2013; 84(5):886-94. DOI: 10.1038/ki.2013.254