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Update on the role of bone biopsy in the management of patients with CKD–MBD

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Abstract

Patients with chronic kidney disease (CKD) are at increased risk of fractures. The fracture risk steadily increases along with the progression of renal disease to become several-fold higher in end-stage renal disease (ESRD) patients as compared to age and sex-matched controls. Renal osteodystrophy (ROD) is a heterogeneous group of metabolic bone diseases complicating progressive chronic kidney disease. Bone biomarkers and bone imaging techniques may help to assess bone health and predict fractures in CKD, but do have important inherent limitations. The gold standard for the diagnosis and specific classification of renal osteodystrophy (ROD) remains the (quantitative) histomorphometric analysis of the bone biopsy. By informing on bone turnover and mineralization, a bone biopsy may help guide prevention and treatment of ROD and its consequences. This review aims to present an update on epidemiological and procedural aspects, clinical indications, and histomorphometric analysis of bone biopsies and to define the role of bone biopsy in current CKD–MBD care.

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Fig. 1

Adapted from Behets [18]

Fig. 2

Adapted from Behets [18]

Fig. 3

Adapted from Behets [18]

Fig. 4

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Authors and Affiliations

  1. Department of Immunology and Microbiology, Laboratory of Nephrology, KU Leuven-University of Leuven, Leuven, Belgium

    P. Evenepoel

  2. Department of Nephrology and Renal Transplantation, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium

    P. Evenepoel

  3. Department of Biomedical Sciences, Laboratory of Pathophysiology, Antwerp University, 2610, Wilrijk, Belgium

    G. J. S. Behets & P. C. D’Haese

  4. Centre for Metabolic Bone Diseases, University Hospitals Leuven, Leuven, Belgium

    M. R. Laurent

  5. Department of Clinical and Experimental Medicine, Gerontology and Geriatrics Section, KU Leuven, 3000, Leuven, Belgium

    M. R. Laurent

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  1. P. Evenepoel
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  2. G. J. S. Behets
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  3. M. R. Laurent
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  4. P. C. D’Haese
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Correspondence to P. Evenepoel.

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Evenepoel, P., Behets, G.J.S., Laurent, M.R. et al. Update on the role of bone biopsy in the management of patients with CKD–MBD. J Nephrol 30, 645–652 (2017). https://doi.org/10.1007/s40620-017-0424-8

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  • DOI: https://doi.org/10.1007/s40620-017-0424-8

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