Severe bone disease and low bone mineral density after juvenile renal failure

Kidney Int. 2003 Jan;63(1):266-75. doi: 10.1046/j.1523-1755.2003.00727.x.


Background: Little is known about the late effects of juvenile end-stage renal disease (ESRD) on bone integrity. To establish clinical manifestations of metabolic bone disease and bone mineral density (BMD) in young adult patients with juvenile ESRD, we performed a long-term outcome study.

Methods: A cohort was formed of all Dutch patients with onset of ESRD between 1972 and 1992 at age 0 to 14 years, born before 1979. Data were collected by review of medical charts, current history, physical examination, and performing dual energy x-ray absorptiometry (DEXA) of the lumbar spine and the femoral neck.

Results: Clinical information was retrieved in 247 out of 249 patients. Of all of these patients, 61.4% had severe growth retardation (<-2 SD), 36.8% had clinical symptoms of bone disease, and 17.8% were disabled by bone disease. Growth retardation and clinical bone disease were associated with a long duration of dialysis. DEXA was performed in 140 out of 187 living patients. Mean BMD +/- SD corrected for gender and age (Z score) of the lumbar spine was -2.12 +/- 1.4 and of the femoral neck was -1.77 +/- 1.4. A low lean body mass was associated with a low lumbar spine and a low femoral neck BMD; male gender, physical inactivity and aseptic bone necrosis were associated with a low lumbar spine BMD.

Conclusion: Bone disease is a major clinical problem in young adults with pediatric ESRD. Further follow-up is needed to establish the impact of the low bone mineral densities found in these patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Absorptiometry, Photon
  • Adolescent
  • Bone Density*
  • Bone Diseases, Metabolic / diagnostic imaging
  • Bone Diseases, Metabolic / epidemiology*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Cross-Sectional Studies
  • Female
  • Femur Neck / diagnostic imaging
  • Follow-Up Studies
  • Fractures, Bone / epidemiology
  • Humans
  • Incidence
  • Infant
  • Infant, Newborn
  • Kidney Failure, Chronic / epidemiology*
  • Lumbar Vertebrae / diagnostic imaging
  • Male
  • Retrospective Studies
  • Risk Factors