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Renal osteopathy has been known for many years now [1–3]. It is characterized by different histological features, which are due to disturbances in calcium (Ca), phosphate, aluminum, and vitamin D metabolism (Chapter 11). Three major types of histological changes exist, which do not represent separate disease entities, but may appear as mixed forms. Despite an agreement on the types of lesions, some differences in nomenclature exist.

Serum aluminium concentrations and biopsy specimens of bone were examined in 56 patients with end stage chronic renal failure receiving maintenance haemodialysis. Deposits of aluminium in bone specimens were often associated with low bone formation with or without osteomalacia. Serum aluminium concentrations of greater than 3.7 mumol/l (10 micrograms/100 ml) indicated a high probability of deposits of aluminium in bone specimens, although high serum concentrations did not predict the type of renal bone disease. Biopsy of the bone is the best method of detecting aluminium intoxication of bone. A serum aluminium concentration of 3.7 mumol/l should be the threshold beyond which bone biopsy should be performed to confirm an overload of aluminium and identify histological bone changes induced by aluminium.

To determine the prevalence of renal osteodystrophy 47 children, aged 1-17 yrs, with glomerular filtration rates(GFR) 30ml/min/1.73m2:16 children), 4 children had increased osteoid surfaces. Changes in other histological parameters were not seen. In group 2 (GFR 20-29ml/min/1.73m2), 3 children had HPD. In group 3 (GFR< 20ml/min/1.73m2:23 children), 12 children had HPD, 2 OM & 9 mixed disease(MD). X-rays & alkaline phosphatase levels were normal in 10 children with histological changes (HPD 6, OM 1, MD 3). Parathyroid hormone levels were elevated in 22 children with & 10 without histological changes. Serum calcium, phosphorus & bicarbonate did not correlate with any histological parameters. Thus renal bone disease was only seen in children with GFRs