Skip to main content
PMC home page
Journal of Clinical Pathology logoLink to Journal of Clinical Pathology
. 1973 Feb;26(2):83–101. doi: 10.1136/jcp.26.2.83

Azotaemic renal osteodystrophy: a quantitative study on iliac bone

H A Ellis 1, Kathleen M Peart 1
PMCID: PMC477662  PMID: 4696838

Abstract

The histopathology of bone is described in 60 patients with chronic renal failure due to a variety of renal diseases. Changes of azotaemic renal osteodystrophy included osteitis fibrosa, osteomalacia, and osteosclerosis. Quantitative histology using a point-counting technique revealed a significant increase in total bone, mineralized bone, and osteoid in comparison with a control group of 68 individuals. Osteitis fibrosa due to secondary hyperparathyroidism occurred in 93%, osteomalacia in 40%, and osteosclerosis in 30% of patients. Woven bone formation was a characteristic feature and was related to the severity of osteitis fibrosa. There were significant correlations between the weights of parathyroid glands and the number of osteoclasts, amounts of woven bone, and marrow fibrosis in the ilium. Hyperparathyroidism caused degradation of mineralized bone but the loss was balanced or exceeded by the aggradation of woven mineralized bone. Woven bone formation together with excess osteoid gave rise to osteosclerosis. The histological findings indicate that hyperparathyroidism and osteitis fibrosa usually occur early in chronic renal failure and that osteomalacia develops subsequently.

Full text

PDF
101

Images in this article

84Image
on p.84
91Image
on p.91
91Image
on p.91
92Image
on p.92
98Image
on p.98

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ball J., Garner A. Mineralisation of woven bone in osteomalacia. J Pathol Bacteriol. 1966 Apr;91(2):563–567. doi: 10.1002/path.1700910232. [DOI] [PubMed] [Google Scholar]
  2. Berson S. A., Yalow R. S. Parathyroid hormone in plasma in adenomatous hyperparathyroidism, uremia, and bronchogenic carcinoma. Science. 1966 Nov 18;154(3751):907–909. doi: 10.1126/science.154.3751.907. [DOI] [PubMed] [Google Scholar]
  3. Byers P. D., Smith R. Quantitative histology of bone in hyperparathyroidism. Its relation to clinical features, x-ray, and biochemistry. Q J Med. 1971 Oct;40(160):471–486. [PubMed] [Google Scholar]
  4. CRAWFORD T., DENT C. E., LUCAS P., MARTIN N. H., NASSIM J. R. Osteosclerosis associated with chronic renal failure. Lancet. 1954 Nov 13;267(6846):981–988. doi: 10.1016/s0140-6736(54)90540-1. [DOI] [PubMed] [Google Scholar]
  5. Castleman B., Mallory T. B. Parathyroid Hyperplasia in Chronic Renal Insufficiency. Am J Pathol. 1937 Jul;13(4):553–574.7. doi: 10.1097/00005053-193712000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Ellis H. A., Knight B. Parathyroids and cervical thymus in sudden unexpected death in infancy. Pediatrics. 1969 Aug;44(2):225–233. [PubMed] [Google Scholar]
  7. Ellis H. A., Peart K. M. Quantitative observations on mineralized and non-mineralized bone in the iliac crest. J Clin Pathol. 1972 Apr;25(4):277–286. doi: 10.1136/jcp.25.4.277. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Fournier A. E., Arnaud C. D., Johnson W. J., Taylor W. F., Goldsmith R. S. Etiology of hyperparathyroidism and bone disease during chronic hemodialysis. II. Factors affecting serum immunoreactive parathyroid hormone. J Clin Invest. 1971 Mar;50(3):599–605. doi: 10.1172/JCI106530. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Galante L., Colston K., MacAuley S., MacIntyre I. Effect of parathyroid extract on vitamin-D metabolism. Lancet. 1972 May 6;1(7758):985–988. doi: 10.1016/s0140-6736(72)91156-7. [DOI] [PubMed] [Google Scholar]
  10. Garner A., Ball J. Quantitative observations on mineralised and unmineralised bone in chronic renal azotaemia and intestinal malabsorption syndrome. J Pathol Bacteriol. 1966 Apr;91(2):545–561. doi: 10.1002/path.1700910231. [DOI] [PubMed] [Google Scholar]
  11. Ginzler A. M., Jaffe H. L. Osseous findings in chronic renal insufficiency in adults. Am J Pathol. 1941 May;17(3):293–302.3. [PMC free article] [PubMed] [Google Scholar]
  12. HAUST M. D., LANDING B. H., HOLMSTRAND K., CURRARINO G., SMITH B. S. OSTEOSCLEROSIS OF RENAL DISEASE IN CHILDREN. COMPARATIVE PATHOLOGIC AND RADIOGRAPHIC STUDIES. Am J Pathol. 1964 Jan;44:141–154. [PMC free article] [PubMed] [Google Scholar]
  13. IRVING J. T. A histological stain for newly calcified tissues. Nature. 1958 Mar 8;181(4610):704–705. doi: 10.1038/181704a0. [DOI] [PubMed] [Google Scholar]
  14. IRVING J. T. A histological staining method for sites of calcification in teeth and bone. Arch Oral Biol. 1959 Oct;1:89–96. doi: 10.1016/0003-9969(59)90001-9. [DOI] [PubMed] [Google Scholar]
  15. KAYE M., PRITCHARD J. E., HALPENNY G. W., LIGHT W. Bone disease in chronic renal failure with particular reference to osteosclerosis. Medicine (Baltimore) 1960 May;39:157–190. [PubMed] [Google Scholar]
  16. Kalu D. N., Doyle F. H., Pennock J., Foster G. V. Parathyroid hormone and experimental osteosclerosis. Lancet. 1970 Jun 27;1(7661):1363–1366. doi: 10.1016/s0140-6736(70)91271-7. [DOI] [PubMed] [Google Scholar]
  17. Leedham P. W., Pollock D. J. Intrafollicular amyloid in primary hyperparathyroidism. J Clin Pathol. 1970 Dec;23(9):811–817. doi: 10.1136/jcp.23.9.811. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Matrajt H., Hioco D. Solochrome cyanine R as an indicator dye of bone morphology. Stain Technol. 1966 Mar;41(2):97–100. doi: 10.3109/10520296609116287. [DOI] [PubMed] [Google Scholar]
  19. O'Riordan J. L., Page J., Kerr D. N., Walls J., Moorhead J., Crockett R. E., Franz H., Ritz E. Hyperparathyroidism in chronic renal failure and dialysis osteodystrophy. Q J Med. 1970 Jul;39(155):359–376. [PubMed] [Google Scholar]
  20. Pappenheimer A. M., Wilens S. L. Enlargement of the Parathyroid Glands in Renal Disease. Am J Pathol. 1935 Jan;11(1):73–91. [PMC free article] [PubMed] [Google Scholar]
  21. RIGGS B. L., KELLY P. J., JOWSEY J., KEATING F. R., Jr SKELETAL ALTERATIONS IN HYPERPARATHYROIDISM: DETERMINATION OF BONE FORMATION, RESORPTION AND MORPHOLOGIC CHANGES BY MICRORADIOGRAPHY. J Clin Endocrinol Metab. 1965 Jun;25:777–783. doi: 10.1210/jcem-25-6-777. [DOI] [PubMed] [Google Scholar]
  22. Raina V. Normal osteoid tissue. J Clin Pathol. 1972 Mar;25(3):229–232. doi: 10.1136/jcp.25.3.229. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Reiss E., Canterbury J. M., Kanter A. Circulating parathyroid hormone concentration in chronic renal insufficiency. Arch Intern Med. 1969 Oct;124(4):417–422. [PubMed] [Google Scholar]
  24. Roth S. I., Marshall R. B. Pathology and ultrastructure of the human parathyroid glands in chronic renal failure. Arch Intern Med. 1969 Oct;124(4):397–407. [PubMed] [Google Scholar]
  25. SEDLIN E. D., VILLANUEVA A. R., FROST H. M. AGE VARIATIONS IN THE SPECIFIC SURFACE OF HOWSHIP'S LACUNAE AS AN INDEX OF HUMAN BONE RESORPTION. Anat Rec. 1963 Jul;146:201–207. doi: 10.1002/ar.1091460304. [DOI] [PubMed] [Google Scholar]
  26. STANBURY S. W. Azotaemic renal osteodystrophy. Br Med Bull. 1957 Jan;13(1):57–60. doi: 10.1093/oxfordjournals.bmb.a069572. [DOI] [PubMed] [Google Scholar]
  27. STANBURY S. W., LUMB G. A. Metabolic studies of renal osteodystrophy. I. Calcium, phosphorus and nitrogen metabolism in rickets, osteomalacia and hyperparathyroidism complicating chronic uremia and in the osteomalacia of the adult Fanconi syndrome. Medicine (Baltimore) 1962 Feb;41:1–34. [PubMed] [Google Scholar]
  28. STANBURY S. W., LUMB G. A., NICHOLSON W. F. Elective subtotal parathyroidectomy for renal hyperparathyroidism. Lancet. 1960 Apr 9;1(7128):793–799. doi: 10.1016/s0140-6736(60)90678-4. [DOI] [PubMed] [Google Scholar]
  29. Siddiqui J., Kerr D. N. Complications of renal failure and their response to dialysis. Br Med Bull. 1971 May;27(2):153–159. doi: 10.1093/oxfordjournals.bmb.a070839. [DOI] [PubMed] [Google Scholar]
  30. Stanbury S. W. Bone disease in uremia. Am J Med. 1968 May;44(5):714–724. doi: 10.1016/0002-9343(68)90253-2. [DOI] [PubMed] [Google Scholar]
  31. Stanbury S. W., Lumb G. A., Mawer E. B. Osteodystrophy developing spontaneously in the course of chronic renal failure. Arch Intern Med. 1969 Sep;124(3):274–281. [PubMed] [Google Scholar]
  32. Stanbury S. W., Lumb G. A. Parathyroid function in chronic renal failure. A statistical survey of the plasma biochemistry in azotaemic renal osteodystrophy. Q J Med. 1966 Jan;35(137):1–23. [PubMed] [Google Scholar]
  33. Taylor T. G., Belanger L. F. The mechanism of bone resorption in laying hens. Calcif Tissue Res. 1969;4(2):162–173. doi: 10.1007/BF02279117. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Clinical Pathology are provided here courtesy of BMJ Publishing Group

RESOURCES