Preservation of bone mass in pediatric dialysis and transplant patients

Renal osteodystrophy continues to be a major challenge to the physician tre ating the child with end-stage renal disease (ESRD). The gold standard for the assessment of bone status is bone histomorphometry, which divides bone pathology into 3 main types; high-turnover, low-turnover, and mixed disease . The high-turnover disease, related to hyperparathyroidism, has been the o ne most extensively investigated; however, optimal therapy, especially in t he growing child, is yet unclear. Overzealous treatment might result in ady namic bone disease (an extreme example of low-turnover disease), and furthe r interference with statural growth. Pre-existent bone disease after kidney transplantation seems to worsen immediately, probably because of the high dose of corticosteroids used. In children who attain normal kidney function in the allograft, bone status seems to improve over time. Little is known about bone in transplanted patients with reduced glomerular filtration rate (GFR). The correlation between bone histology and its main surrogates, bon e remodeling markers and bone mineral density, is yet unclear, but it might serve to follow the progress of an individual patient. New therapeutic mod alities aimed at suppressing hyperparathyroidism, and consequently bone res orption, as well as agents directly attenuating bone resorption, should be further investigated for their effect on bone in patients with ESRD or afte r transplantation. Similarly, agents stimulating bone formation, particular ly growth hormone, require further attention for their potential to improve bone status. Bone health and the child's somatic growth at ESRD or after k idney transplantation are closely related, and therapy should be aimed at a chieving optimal results for both. (C) 2001 by the National Kidney Foundati on, Inc.