Author/Authors :
Sanusi, AA Department of Medicine Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife , Arogundade, FA Department of Medicine Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife , Oladigbo, M Department of Orthopaedic Surgery - Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife , Ogini, LM Department of Orthopaedic Surgery - Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife , Akinsola, A Department of Orthopaedic Surgery - Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife
Abstract :
BACKGROUND: Information on renal bone disease (RBD) is
sparse in Nigeria. The prevalence of RBD in a dialysis
population worldwide ranges between 33% and 67% and it
increases with progression of renal insufficiency.
OBJECTIVE: To determine the prevalence and magnitude of
RBD in patients with end stage renal disease (ESRD).
METHODS: Thirty consecutive ESRD patients were recruited.
They had thorough clinical evaluation and investigations which
included serum calcium, phosphate, alkaline phosphatase,
albumin and skeletal survey. The serum iPTH, osteocalcin,
and 1,25 (OH2) D3 were assessed in 20 patients.
RESULTS: The patients were aged 18–72 years with a mean of
38.93±15.7 years. There was a male:female ratio of 4:1.
Uraemic symptoms were the major presenting complaints.
None of the patients complained of bone pain or fracture. The
mean values for serum creatinine, urea, creatinine clearance,
calcium, phosphate, albumin, alkaline phosphatase, iPTH,
osteocalcin and 1,25 (OH)2 Vit D3 were 1478.96 ± 771.12
μmol/L, 22.33 ± 7.42 mmol/L, 3.38 ± 2.22 mls/min, 1.8 ±
0.5mmol/L, 1.61 ± 0.65 mmol/L, 30.2 ± 6.1 g/L, 124.33 ±
63.37 IU/L, 22.66 ± 24.72, 45.14 ± 43.8, 37.7 ± 22.3
respectively. There were hypocalcaemia and hyperphosphataemia
in 80% and 60% of the patients respectively.
Alkaline phosphatase was elevated in 44% of the patients
while 11.8% had hyperparathyroidism. Level of 1,25 (OH)2
Vit D3 was low in 83.3% of the patients. There was a significant
negative correlation between serum calcium and iPTH levels
(r = –0.915, p=0.029). There was also significant negative
correlation between alkaline phosphatase and 1,25 (OH)2 Vit
D3 and serum albumin. Radiological evidence of RBD
occurred in only 16.7% of the patients.
CONCLUSION: Renal bone disease is common in our patients
with ESRD associated most commonly with low bone turnover
while occurrence of hyperparathyroid bone disease appears
low