Mineral and bone disorder in children with chronic kidney disease / 中华实用儿科临床杂志

ABSTRACT

Childhood is a critical time for the development of healthy skeleton.With the development of chronic kidney disease (CKD), there are disorders of mineral and bone metabolism, such as bone transformation, bone mineralization, volume bone and bone strength disorders.The manifestations are bone pain, fracture, growth and development disorders, vascular and soft tissue calcification, which may increase the incidence and mortality of cardiovascular diseases.The decrease of renal 1α-hydroxylase activity leads to the decrease of intestinal calcium absorption, the increase of serum parathyroid hormone (PTH) level and the high transport renal osteopathy.Phosphorus retention aggravates secondary hyperparathyroidism, and high phosphorus can lead to cardiovascular disease.Treatment of hyperphosphatemia and secondary hyperparathyroidism is helpful to improve growth disorders and high transport osteopathy, and to maintain serum calcium, phosphorus and PTH levels within the target normal range of different stages of CKD.Overtreatment can also lead to progression of nonmotile osteopathy, growth failure, hypercalcemia and cardiovascular calcification.Some new drugs, such as calcium-free phosphorus binders and new vitamin D analogues, can effectively inhibit serum PTH levels, providing a choice for the treatment of CKD in children.