Imaging Pearls ❯ Musculoskeletal ❯ Renal Osteodystrophy
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- Renal Osteodystrophy
Renal osteodystrophy (ROD) starts early with loss of kidney function (approximately 50% loss of glomerular infiltration rates. Virtually all patients with advanced chronic kidney disease (CKD) have ROD, and an association between histologic changes in bone turnover and vascular calcifications has been described. This association underlines the importance of treatment of ROD. - "The main abnormalities of ROD encompass changes in turnover, mineralization, and bone volume; therefore, effects of treatment modalities should be analyzed with respect to these three abnormalities. Three major therapeutic groups are available for the management of ROD: phosphate binders (P-binders), vitamin D or vitamin D analogues, and calcimimetics."
Effects of Treatment of Renal Osteodystrophy on Bone Histology
Hartmut H. Malluche et al.
Clin J Am Soc Nephrol. 2008 Nov; 3(Suppl 3): S157–S163. - "Chronic renal insufficiency, hemodialysis, peritoneal dialysis, renal transplantation and administration of different medications provoke complex biochemical disturbances of the calcium–phosphate metabolism with wide spectrum of bone and soft tissue abnormalities termed renal osteodystrophy. Clinically most important manifestation of renal bone disease includes secondary hyperparathyroidism, osteomalacia/rickets, osteoporosis, adynamic bone disease and soft tissue calcification."
Imaging of renal osteodystrophy
V. Jevtic
European Journal of Radiology , Volume 46 , Issue 2 , 85 - 95 - "As a complication of long-term hemodialysis and renal transplantation amyloid deposition, destructive spondyloarthropathy, osteonecrosis, and musculoskeletal infections may occur. Due to more sophisticated diagnostic methods and more efficient treatment classical radiographic features of secondary hyperparathyroidism and osteomalacia/rickets are now less frequently seen."
Imaging of renal osteodystrophy
V. Jevtic
European Journal of Radiology , Volume 46 , Issue 2 , 85 - 95 - Non-traumatic abnormalities:
METABOLIC DISEASES
• Gout - Gouty tophi composed of monosodium urate crystals can present as soft-tissue masses with mean attenuation values of approximately 160 H , and metastatic or dystrophic calcification within these tophi are best seen on CT .
• Dual-energy CT may be used to differentiate uric acid from calcium, allowing gouty urate crystals to be distinguished from dystrophic calcifications.
• Both radiography and conventional diagnostic CT show increased attenuation in both settings of urate crystals and calcium-containing mineralizations.
• Dual-energy CT may depict subclinical urate crystal deposition at other asymptomatic sites that have been included in the imaging field, this enables the clinician to treat before irreversible joint damage occurs . - Non-traumatic abnormalities:
METABOLIC DISEASES
• CT is useful for detecting mineralization in:
• Chondrocalcinosis (associated with many disorders including pseudogout)
• Periarticular deposits of calcium due to metastatic calcification are commonly seen in chronic renal failure
Hanlon R, King S.
Overview of the radiology of connective tissue disorders in children.
Eur J Radiol. 2000 Feb; 33(2):74-84. - Non-traumatic abnormalities:
AUTOIMMUNE DISEASE
• Autoimmune disease:
• Sheetlike patterns of calcification in the skin, subcutaneous tissue, and fascial planes (calcinosis universalis).
• can be seen in association with autoimmune connective tissue disorders, such as polymyositis or dermatomyositis.
Hanlon R, King S.
Overview of the radiology of connective tissue disorders in children.
Eur J Radiol. 2000 Feb; 33(2):74-84.
Olsen KM, Chew FS
Tumoral calcinosis: pearls, polemics, and alternative possibilities.
Radiographics. 2006 May-Jun; 26(3):871-85. - Non-traumatic abnormalities:
VASCULAR DISORDERS
• VASCULAR MALFORMATIONS:
• Low flow:
• Venous malformations, which are characterized by slow flow and the pooling of blood, show serpigenous vascular components that enhance after contrast administration
• High-flow vascular malformations
• Arteriovenous fistulas
• Arteriovenous malformations
• will show large feeding arteries in addition to draining vessels although these can occasionally be seen in large low-flow malformations or non-involuting hemangiomas as well