Internal Medicine

0521779407-18 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 8:1

Renal Masses and Tumors Renal Osteodystrophy 1289

Tumor Grade

■Grade I:∼69%

■Grade II:∼42%

■Grade III:∼27%

RENAL OSTEODYSTROPHY

KENNETH CHEN, MD; TIMOTHY MEYER, MD; and YIMING LIT, MD

history & physical

History

■Chronic renal failure

■Bone pain, fractures

■Muscle weakness

■Dialysis

■Kidney transplant

Signs & Symptoms

■Asymptomatic until irreparable damage

■Musculoskeletal:

■Fractures: mineralization defects, impaired new bone formation,

excess bone resorption

➣Bone pain in lower back, hips, legs

➣Proximal muscle aching, weakness (with high PTH)

■Ectopic calcification in arteries, cardiac conduction system, cornea

with high values for Ca×PO4 product (>65):

➣Arrhythmia

➣Accelerated atherosclerosis

➣Calciphylaxis: ischemic necrosis of the skin, muscles, digits

tests

Laboratory

■Early disease:

➣Elevated PO4, low Ca (correct for albumin)

➣Elevated PTH, alkaline phosphatase

■Advanced disease:

➣Hypercalcemia from tertiary hyperparathyroidism

➣Alternatively low PTH from oversuppression by vitamin D and

Ca