Aluminium bone deposits in normal renal function patients after long-term treatment by plasma exchange.

The accumulation of aluminium (Al) can cause Al bone deposits, osteomalacia and encephalopathy. As albumin solutions used as replacement fluid in plasma exchange (PE) are contaminated with Al, we studied Al overload in two symptomless patients with normal renal function, treated by long-term plasma exchange (PE). Total Al loading was calculated at 1750 mumol in patient 1 (178 PE sessions) and 2100 mumol in patient 2 (153 PE sessions).

Evidence for a toxic effect of aluminum on osteoblasts: a histomorphometric study in hemodialysis patients with aplastic bone disease.

To evaluate the potential role of aluminum (Al) in a subset of dialysis patients with aplastic bone disease, we have studied tetracycline-labeled bone biopsies of 32 patients (22 males and 10 females, 45-73 years) on maintenance hemodialysis. Selection criteria included normal resorption surfaces (RS) and osteoid thickness. Eleven patients (Group I) had no stainable bone Al (Al-; 61.

Protection from progressive renal failure and hyperparathyroid bone remodeling by WR-2721.

In chronic renal failure (CRF), secondary hyperparathyroidism (sHPT) plays a major role in skeletal lesions and also probably in the deterioration of renal functions consecutive to nephrocalcinosis. In this study we tested whether WR-2721 [S-,2-(3-aminopropylamino)-ethylphosphorothioic acid], an inhibitor of parathyroid hormone (PTH) secretion, could prevent the deleterious effects of sHPT at both the bone and kidney level in an animal model of CRF. Rats were either subtotally nephrectomized (NX) or sham-operated (SHAM).

Deferoxamine-induced bone changes in haemodialysis patients: a histomorphometric study.

1. The histological effects of deferoxamine therapy were assessed on transiliac bone biopsies taken after double tetracycline labelling from 16 uraemic patients undergoing chronic haemodialysis, all having aluminium deposits in bone. Eight patients had osteomalacia, five had an "aplastic" bone lesion and three a high bone turnover with a marked increase in osteoid volume.

Skeletal distribution and biochemical parameters of Paget's disease.

Quantitative bone scans were performed with 99mTc-EHDP in 170 untreated pagetic patients (93 men, 77 women; mean age, 65.4 years). The distribution of 863 pagetic skeletal locations was analyzed.

Intravenous disodium etidronate therapy in Paget's disease of bone and hypercalcemia of malignancy. Effects on biochemical parameters and bone histomorphometry.

Nineteen patients with Paget's disease and four patients with hypercalcemia of malignancy underwent hypocalcemic therapy with etidronate disodium (etidronate) administered intravenously. The dosage for patients with Paget's disease was 4.3 mg/kg/day, infused on each of seven consecutive days.

Serum bone Gla-protein in renal osteodystrophy: comparison with bone histomorphometry.

Serum bone Gla-protein (S-BGP) and other serum biochemical parameters, including alkaline phosphatase (S-AP) and immunoreactive PTH (S-iPTH), were measured in 42 patients undergoing chronic hemodialysis. Each patient also had a tetracycline-labeled transiliac bone biopsy, allowing correlations between the biochemical and trabecular bone histomorphometric parameters, S-BGP was markedly increased [64.0 +/- 74.

[Desferrioxamine treatment of osteomalacia caused by aluminum poisoning].

Three haemodialyzed chronic renal failure patients with histologically proven osteomalacia due to aluminium toxicity were treated with repeated injections of desferrioxamine, a potent chelator of aluminium. The drug, in doses of 3 or 6 g, was administered intravenously once a week for 5 to 11 months, at the end of a dialysis session. Treatment was well tolerated.

High bone turnover associated with an aluminum-induced impairment of bone mineralization.

A hemodialyzed patient showing x-ray and biochemical evidence of apparently pure severe hyperparathyroidism underwent a tetracycline-labeled transiliac bone biopsy. The bone biopsy not only confirmed the hyperparathyroid bone lesions but also revealed an impairment of bone mineralization induced by aluminum. This was demonstrated by a reduction of double-labeled osteoid surfaces, a significant increase in the osteoid seam thickness, and the presence of extensive aluminum deposits in bone.

Low rate of bone formation with or without histologic appearance of osteomalacia in patients with aluminum intoxication.

We analyzed transiliac bone biopsy specimens obtained after tetracycline double labeling from 24 patients with aluminum-related bone disease who had undergone long-term hemodialysis. The specimens were selected by the following criteria: Al deposits at the mineralization fronts, a dramatic reduction in double-labeled surfaces, reflecting a low mineralization rate, and a significant increase in osteoid volume and osteoid surfaces. The bone formation rate at the tissue level and at the basic multicellular unit level was decreased in all patients.

Serum aluminium concentration and aluminium deposits in bone in patients receiving haemodialysis.

Serum aluminium concentrations and biopsy specimens of bone were examined in 56 patients with end stage chronic renal failure receiving maintenance haemodialysis. Deposits of aluminium in bone specimens were often associated with low bone formation with or without osteomalacia. Serum aluminium concentrations of greater than 3.

Effects of parathyroidectomy on bone formation and mineralization in hemodialyzed patients.

Undecalcified sections of doubly tetracycline-labeled transiliac bone biopsy specimens obtained from ten hemodialyzed patients before and 10 to 16 months after parathyroidectomy (PTX) were analyzed. Before parathyroidectomy (total PTX with autotransplant in six patients and subtotal PTX in four patients), all the patients demonstrated histological evidence of hyperparathyroidism with increased resorption parameters. A high bone formation rate (BFR) was noted in all patients but one who had both an increase in the osteoid seam thickness and a low calcification rate characteristic of osteomalacia.

Predictive value of desferrioxamine infusion test for bone aluminium deposits in hemodialyzed patients.

A transiliac bone biopsy was performed in 16 hemodialyzed patients, and a staining procedure with Aluminon was used to reveal bone aluminium deposits. The baseline serum aluminium levels did not allow to predict the patients with aluminium deposits. In contrast, the peak of serum aluminium, 48 h after a desferrioxamine infusion, was much more reliable for the detection of patients with bone aluminium overload.

Parathyroid function and vitamin D status in patients with bone metastases of prostatic origin.

The biochemical parameters of calcium metabolism were measured in patients suffering from bone metastases of prostatic origin. In 14 patients with sclerotic bone lesions, serum calcium and serum phosphorus were significantly lower than in controls. Serum alkaline phosphatase levels, which reflect osteoclastic bone formation, and urinary hydroxyproline, which reflects osteoclastic bone resorption, were both increased.

[Myelomatous bone. Histomorphometric study and therapeutic effects].

In order to evaluate quantitatively the bony changes in multiple myeloma, 118 transiliac bone biopsies in non decalcified bone were made in patients with multiple myeloma and studied histologically. Areas of osteoclastic resorption were increased when compared to normal controls and the number of osteoclasts/mm2 in spongy bone was significantly more elevated in zones massively invaded by plasmocytes than in non-invaded zones. The binding of tetracycline to osteoid was increased, indicating active bone formation.

Iliac bone histomorphometry in adults and children with osteogenesis imperfecta.

Histomorphometric analysis was performed on transiliac undecalcified bone biopsies taken from eight adults and four children with osteogenesis imperfecta. Double tetracycline labelling done before the biopsy allowed measurement of the calcification rate in 11 patients. The adults, as well as the children, had thin iliac cortices and considerably decreased trabecular bone volume.

[Aluminum poisoning in renal dialysis patients: bone histology. Value of quantitative bone biopsy].

Four patients under maintenance dialysis for chronic renal failure were suffering from aluminium toxicity. One showed evidence of encephalopathy, two presented with fractures and one was asymptomatic. Hypercalcaemia was constant, whereas high serum aluminium levels were present in only 2 patients.