Osteosclerosis in Chronic Uremia

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Abstract
The osseous changes in chronic renal disease are well known. The type of change depends upon the site of kidney involvement (glomerulus, tubules, or mixed), the character of the disease, the age of the patient when it appears, and the duration of the process. The generally accepted classification of the types is as follows (Pugh, 16): a. Glomerular insufficiency with retention of phosphorus producing the changes of secondary hyperparathyroidism in adults and renal rickets in children b. Glomerular insufficiency with acidosis without a significant elevation of the serum phosphorus but producing osteomalacia c. Tubular insufficiency with acidosis producing osteomalacia d. Fanconi's syndrome producing osteomalacia. Sporadic cases of increased density of the bone in chronic renal disease have been described by several authors. The original histological observations were made by Ginzler and Jaffe (10) in 1941. They divided the osseous changes in chronic renal disease into three phases: a. Mild: Scattered resorption of lacunae on the surface of the spongy trabeculae and on the walls of the vascular canals. There is no bone formation b. Moderate: Perforation of the trabeculae by tracts of connective tissue, erosion of the cortex, and enlargement of the haversian canals. There are minimal reparative changes consisting of new bone side by side with the other changes c. Advanced: The spongiosa is a close mesh with thick and distorted trabeculae by reason of accretion of the bone. Since 1953 sporadic reports of radiologically observed cases of osteosclerosis associated with chronic renal disease are found in the literature. In a recent article Zimmerman (25) reviewed the previous accounts and added a personal contribution of 4 cases. There were no recognized cases of osteosclerosis in chronic renal disease at The University of Chicago Hospitals when this study was undertaken. A review has been made of the records of all cases of renal disease admitted to these hospitals from 1948 through 1959 searching for cases with osteosclerosis. The purpose of this review was to try to clarify (a) frequency of osteosclerosis in chronic renal disease in a large group of patients; (b) correlation between this and other osseous changes seen in chronic renal disease; (c) pathogenesis. During the twelve-year period of this survey, a total of 987 patients were admitted with renal disease. Of this group, all cases with an abnormal nitrogen retention some time during the course of the illness were selected. An elevated blood urea nitrogen was present in all cases reported in the literature. This abnormal finding is not necessarily constant because of periods of remission and compensation experienced throughout the course of the disease. Of the 987 cases, there were 380 with an elevated blood urea nitrogen or nonprotein nitrogen but without associated disease which might alter the osseous findings.

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