1. Dr. Wehid Sheikhi is a professor of pediatrics at the Faculty of Medical Sciences. 2. The document discusses renal osteodystrophy which is a bone disease caused by chronic kidney disease and disrupted mineral metabolism. 3. Management of renal osteodystrophy and mineral bone disorder in CKD involves controlling serum levels of calcium, phosphorus, PTH and vitamin D through dietary modifications and pharmaceutical interventions.

1. ‫شیخی‬‫وحید‬ ‫دکتر‬
‫اهدان‬‫ز‬‫پزشکی‬‫علوم‬‫دانشگاه‬‫یار‬‫استاد‬
‫کودکان‬‫یست‬‫ز‬‫لو‬‫و‬‫نفر‬

2. RENAL OSTEODYSTROPHY
CKD-BMD

3. Renal Osteodystrophy
CKD
Causes disordered regulation of
mineral metabolism with
subsequent alterations in bone
modeling ,remodeling, and growth.

4. CKD STAGES
1 ABOVE 90
2 60 -90
3 30---60
4 15 ---30
5 BELOW 15
CKD-BMD

5. CKD-MBD
CARDIOV
ASCULAR
DISEASES

Is the leading causes of
mortality in adults and
children with CKD .

And abnormal mineral
metabolism , bone disease
and it therapies are closly
linked to cardiovascular
pathologic processes.

6. CKD-MBDis defined as a
systemic disorder of mineral and
bone metabolism resulting from
CKD that manifest as either one or
a combination of the following

7. 2.Abnormalityies in bone
histology ,linear growth ,or
sternght.
3.Vascular or other soft tissue
calcification.

8. Renal osteodystrophy
 Is the specific term used to describe the bone
pathologic process that occurs as a complication of
CKD and is therfore one aspect of the CKD-MBD .
 Although the definitive evaluation of renal O D
requires a bone biopsy ,this procedure is not rutinely
performed in the clinical setting.

9. CKD-MBD
Bone
histomorp
hometry
Is the gold standard
for assessment three essential
aspects of bone histology
 Turnover
 Mineralization
 Volume

10. Phatogenesis of secondary hyper
parathyroidism
 FGF23
 As early as STAGE2 CKD FGF23 SERUM LEVEL begin
to rise due to decrease renal exertion and is the
earliest serologic indication of osteocyte dysfuntion
 FGF23 is a kay phosphaturic agent like PTH
 FGF23is kay regulator of mineral metabolism and
cardio vascular disease in CKD patients.

11. Role of 1,25 DIHYDROXYVITAMINE D
 Roles of
 25-hydroxy d3
 Phosphore
 Ca Sensing receptor
 Skeletal resistance to PTH

12. WHEN CKD PROGERESS to STAGE 4
 PHOSPHATURIC EFFECTE OF PTH
LOST AND
HYPERPHOSPHATEMIA
APPEARE

13. MANAGEMENT OF CKD AND
MINERAL AND BONE DISORDER
 DIETARY MANIPULATION OF CALCIUM AND
PHOSPHORUS
 THE TOTAL AMOUNT OF CALCIUM
SUPLEMEMENT MONITORED CAREFULLY
 BELOW 1.5 GRAM PER DAY
 TREATMENT GOALS INCLUDE PHOSPHOR LEVEL
WITHIN NORMAL RANGE
 AVOIDING A CALCIUM PHOSPHORUS ABOVE 55
 DIETARY PHOSPHATE RESTRICTION

14. LEVEL OF VITD
 BELOW 5
 5 15
 16 30
 8000
‫تا‬‫انه‬‫ز‬‫و‬‫ر‬‫واحد‬
4
‫سپس‬‫و‬ ‫هفته‬
4000
‫تا‬‫واحد‬
8
‫هفته‬
 4000
‫هفته‬‫دو‬‫هر‬‫انه‬‫ز‬‫و‬‫ر‬‫واحد‬
 2000
‫انه‬‫ز‬‫و‬‫ر‬‫واحد‬

15. PHOSPHATE BINDING AGENTS
TO AVOID Aluminium related
bone diseases ,the use of AL –FREE
Phosphate binder has been
advocated.
Calcium Carbonate
VITAMIN D THERAPY

16. TARGET RANGE OF PTH

By Stage of CKD

STAGE 3 35-70pg/ml

STAGE 4 70-110

STAGE5 200-300

17. CALCIMIMETICS
Cinacalcet Activator Calcium
sensing receptor
For the treatment of secondary
Hyperpara
And reduce PTH level

18. PARATHYROIDECTOMY

‫و‬‫اتتیرویید‬‫ر‬‫پا‬‫غده‬‫فی‬‫و‬‫هیپرتر‬‫یا‬‫ی‬‫هیپرپالز‬‫وجود‬

‫یافته‬‫باشد‬‫ی‬‫ر‬‫و‬‫ضر‬‫اگر‬
OsteitisFibrosaCystica
‫استخوان‬‫ی‬ ‫بیوپس‬ ‫در‬

‫د‬‫ویتامین‬‫با‬‫مان‬‫ر‬‫د‬‫علیرغم‬‫باال‬‫اتیرویید‬‫ر‬‫پا‬‫سرمی‬ ‫سطح‬

‫پایدار‬‫کلسمی‬‫هیپر‬

‫طبی‬‫های‬‫مان‬‫ر‬‫د‬‫یا‬‫و‬‫دیالیز‬‫به‬‫مقاوم‬‫ش‬‫ر‬‫خا‬

‫استخوانی‬‫نده‬‫و‬‫پیشر‬‫ن‬‫کلسیفیکاسیو‬

‫استخوان‬‫شدید‬‫شکستگی‬‫یا‬‫د‬‫ر‬‫د‬

‫ی‬ ‫کلسیفیالکس‬

19. CALCIPHYLAXIS

‫پوست‬‫ایسکمیک‬‫ز‬‫و‬‫نکر‬ ‫با‬‫مشخص‬‫م‬‫ر‬‫سند‬ ‫یک‬ ‫ی‬ ‫فیالکس‬‫ی‬ ‫کلس‬

‫جلدی‬‫یر‬‫ز‬‫چربی‬

‫میشود‬‫مشخص‬ ‫عضله‬‫و‬

‫کودک‬‫یا‬‫دیالیز‬‫ن‬‫بدو‬‫سایی‬‫ر‬‫نا‬‫با‬ ‫کودکان‬‫در‬‫هست‬‫شایع‬‫غیر‬ ‫کودکان‬‫در‬‫هرچند‬
‫ی‬‫دیالیز‬ ‫ان‬
‫است‬ ‫شده‬‫دیده‬‫هم‬‫مناسب‬‫عملکرد‬‫ای‬‫ر‬‫دا‬‫کلیه‬ ‫پیوند‬‫با‬ ‫کودکان‬‫و‬

20. ‫در‬ ‫الومینیوم‬ ‫اب‬ ‫تبط‬‫ر‬‫م‬ ‫ان‬‫و‬‫استخ‬ ‫بیماری‬
‫ب‬
‫ان‬‫ر‬‫یما‬
‫هی‬ ‫و‬ ‫د‬ ‫ویتامنی‬ ‫کننده‬‫ایفت‬‫ر‬‫د‬
‫کلسمی‬
‫پر‬
‫ابشد‬ ‫شده‬ ‫رد‬ ‫ابید‬ ‫اپیدار‬

21. ‫ابالی‬ ‫اپیدار‬ ‫کلسمی‬‫هیپر‬ ‫هم‬ ‫پیوندی‬ ‫ان‬‫ر‬‫بیما‬ ‫در‬
12
‫اتریوییدک‬‫ر‬‫اپ‬ ‫اندیکاسیون‬ ‫سال‬ ‫یک‬ ‫مبدت‬ ‫ونیم‬
‫تومی‬
‫هست‬