The circulating 25(OH)D concentration is the most reliable measure of overall vitamin D status, even though it is biologically inactive. 25(OH)D is measured by commercially available immunoassays, preferably by automated…
The biochemical alterations in renal osteodystrophy can be summarized as follows: 1. Azotemia, hyperphosphatemia, and changes in acid-base balance and electrolytes that reflect the chronic acidotic state 2. Low serum…
Radiographic examination of the skull may show irregular rarefaction of the calvaria (“salt-and-pepper” skull) and loss of the dense white line cast by the lamina dura surrounding the roots of…
Treatment of rachitic and osteomalacic syndromes due to renal tubular acidosis should focus on the primary process rather than on the bone disease. Administration of alkali in the form of…
Rickets or osteomalacia of variable degrees is a common manifestation of all the diverse conditions associated with renal tubular acidosis. Some of the rachitic disorders are life threatening, such as…
All of the findings and chemical abnormalities are similar to those seen in the classic nutritional deficiency syndrome, with the exception of the concentrations of the polar metabolites of vitamin…
Three phosphate-wasting lesions in the proximal tubule have been identified. Type I, first described by Albright, is seen most frequently. It is transmitted as a sex-linked dominant trait and the…
ADULT OSTEOMALACIA Clinical Manifestations. The diagnosis of adult osteomalacia (see Plate 3-14) may be difficult to establish because the changes may be considerably more subtle than those seen in childhood…
Vitamin D has receptors throughout many tissues and acts as both an endocrine as well as an autocrine/paracrine hormone. The endocrine properties have direct effects on bone and muscle tissue…
CHILDHOOD RICKETS Clinical Manifestations. In severe childhood rickets (see Plate 3-13), growth is impaired and height is generally below the third quartile. However, unless there is concurrent severe nutritional disturbance,…
