DIAGNOSIS AND TREATMENT OF ALUMINUM BONE-DISEASE

Aluminium accumulation in serum and tissues is a well-known complicati on in patients with chronic renal failure, and retention of the elemen t in bone has been implicated in the pathogenesis of the so-called alu minium-related bone disease (ARBD). Regular serum aluminium monitoring remains mandatory to detect patients and centres at risk for aluminiu m intoxication. Early recognition of ARBD however requires a desferrio xamine (DFO) test in combination with a serum iPTH measurement. Defini te diagnosis of ARBD is made by histological examination of a bone bio psy. Once ARBD has been identified DFO treatment should be initiated a nd all potential sources of aluminium exposure eliminated. In order to minimize the risk for DFO-related cerebral, auditory and visual side- effects, and siderophore-mediated opportunistic infections the chelato r should be used at low doses (5 mg/kg) and administered widely spaced (once weekly) following well-defined strategies of administration.