How Important Is Phosphate in the Pathogenesis of Renal Osteodystrophy?

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Abstract
Renal osteodystrophy is a universal complication of ' chronic renal disease characterized histologically by several alterations in bone structure. The pathological changes seen in the skeleton of uremic patients include osteitis fibrosa cystica, which reflects the resorptive effect of increased osteoclastic activity owing to secondary hyperparathyroidism, and osteomalacia, which is a defect in bone mineralization secondary, at least in part, to alterations in the metabolism of vitamin D and characterized by a widening of the osteoid seam and absence of or abnormal mineralization front. Less commonly, osteosclerosis and osteoporosis are also seen in patients with renal insufficiency. The pathogenetic mechanisms responsible for the development of renal osteodystrophy in patients with renal failure are multifactorial and poorly understood. However, in the past decade some of the factors involved in the development of renal osteodystrophy have been clarified. The manifestations of deranged mineral metabolism in uremia include hypocalcemia, hyperphosphatemia, hypermagnesemia, hyperplasia of the