Renal damage does not only lead to disorders of mineral metabolism. Hormonal balance is also out of balance. This excessively produces parathyroid hormones. Too much hormone promotes bone loss. The level of phosphates in the blood also increases, which can contribute to the storage of calcium in the blood vessels. These factors mean that almost no calcium is built into the bones and the bones are also affected by increased demineralization. The bones are getting softer and are losing stability.
What does renal osteopathy do with bones?
Not only does the risk of – sometimes spontaneous – bone fractures increase. Bone softening (osteomalacia), bone loss (osteoporosis) and muscle weakness are also possible consequences of sick kidneys. “Limited kidney function and the associated decreased absorption of calcium from the blood into the bones can also lead to increased formation of calcium deposits around the joints. These can cause pain in the affected and lead to reduced movement and deformities,” says Ketteler.
Diseased kidneys weaken not only the bones
And weak kidneys carry another risk: In the case of advanced kidney failure, calcium deposits can form in the arteries and joints. These are based on calcium phosphate crystals. In patients with severe renal weakness, there is a high risk of developing arteriosclerosis, ie hardening of the arteries. Calcified arteries are, among other things, a significant risk factor for heart attack, myocardial insufficiency, narrowing of the heart valves and stroke.
Prof. Dr. medical Markus KettelerChief Physician for General Internal Medicine and Nephrology / Geriatrics at Robert Bosch Hospital in Stuttgart and Chairman of the Commission of the German Society for Nephrology (DgfN).
Treatment of renal osteopathy: Balancing mineral metabolism
Because weakening bones do not give any warning signals, blood levels in case of kidney failure are regularly checked and high doses of vitamin D3 are given preventively. “This can delay the development of renal osteopathy or slow down progression,” says the nephrologist. “Drugs that inhibit parathyroid hormone production can also be used. There are also drugs that bind dietary phosphate.” Subsequent diseases of bones and joints are treated separately. Among other things, some painkillers and anti-inflammatory drugs are used.
Can a kidney transplant cure renal osteopathy?
For many patients with dialysis-dependent kidneys, kidney transplantation is a great hope. How renal osteopathy develops with a new kidney is unpredictable. According to the expert, significant osteopathy usually persists even after a kidney transplant. On the other hand, if renal osteopathy was well controlled before transplantation, significant improvement can be hoped for. However, after the transplant, the bones are at risk again: cortisone is given to prevent organ rejection. Cortisone significantly increases the risk of osteoporosis.