Please enter verification code
Confirm
Clinical Characteristics of Mineral Bone Disease Among Patients with Chronic Kidney Disease in Southern, Nigeria
American Journal of Internal Medicine
Volume 7, Issue 6, November 2019, Pages: 163-168
Received: Oct. 4, 2019; Accepted: Oct. 21, 2019; Published: Dec. 6, 2019
Views 522      Downloads 165
Authors
Ndu Victor Onyebuchi, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
Oko-Jaja Richard I., Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
Emem-Chioma Pedro, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
Wokoma Friday, Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
Article Tools
Follow on us
Abstract
Mineral bone disease (MBD) is a common complication in patients with chronic kidney disease (CKD). The objective of this study is to determine the characteristics of CKD-MBD among adult patients with CKD in South-South, Nigeria. One hundred and fifty consecutive consenting chronic kidney disease patients who fulfilled the inclusion criteria for this study were recruited. Patients had a detailed clinical assessment, biochemical and radiological evaluations for CKD-MBD. Biochemical investigations included serum calcium, phosphate, parathyroid hormone (PTH) and alkaline phosphatase while the radiological investigations included X-ray of the skull, spine, wrist and phalanges. The age range of the patients was 22-80 years, with a mean of 45.1 (±11.9) years. There were 90 males and 60 females with male to female ratio of 1.5:1. Symptoms suggestive of CKD-MBD in the study population were bone pain and pruritus occuring in 34.9% and 12.0% of the CKD-MBD patients. Other symptoms presented by the patients included leg swelling in 126 (84%), frothiness of urine in 123 (82%), vomiting in 109 (72.7%), facial puffiness in 102 (68%), haematuria in 18 (12%) and chest pain in 73 (48.7%) of the patients. The mean values for serum PTH, serum calcium, serum phosphate, alkaline phosphatase and caxpo4 product among the CKD-MBD patients were 205.06±112.6 pg/ml, 2.56±0.73mmol/l, 1.63±0.63mmol/l, 109.26±65.57IU/L and 4.07±1.28mmol2/l2 respectively. There was hypercalcaemia in 44.6%, hypocalcaemia in 26.0%, hypophosphataemia in 12.0% and hyperphosphataemia in 29.3% of the patients. High alkaline phosphatase was observed in 36.0% while 8.7% had low alkaline phosphatase. There was high calcium x phosphate product in 34.0% of the patients. Radiological features in keeping with CKD-MBD was present in only 6% of those with CKD-MBD. Hypercalcemia is the major biochemical abnormalilty in patients with CKD-MBD in our environment.
Keywords
CKD, MBD, Kidney Function, Calcium
To cite this article
Ndu Victor Onyebuchi, Oko-Jaja Richard I., Emem-Chioma Pedro, Wokoma Friday, Clinical Characteristics of Mineral Bone Disease Among Patients with Chronic Kidney Disease in Southern, Nigeria, American Journal of Internal Medicine. Vol. 7, No. 6, 2019, pp. 163-168. doi: 10.11648/j.ajim.20190706.15
Copyright
Copyright © 2019 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
[1]
Adelekun T A, Akinsola A. Hypertension induced chronic renal failure: clinical features, management and prognosis. West Afri J Med 1998; 17: 104-108.
[2]
Beaglehole R, Yach D. Globalization and the prevention and control of non-communicable disease. The neglected chronic kidney disease of adult. Lancet 2003; 362: 903-8.
[3]
Atkins RC. The changing patterns of chronic kidney disease: the need to develop strategies for prevention relevant to different regions and Countries. Kidney Int Suppl 2005; 98: 83-5.
[4]
K/DOQI clinical practice guideline for chronic kidney disease: evaluation, classification, stratification. Part IV: Definition and classification of stages of chronic kidney disease. Am J Kidney Dis. 2002; 39: 546-75.
[5]
Arogundade F A, Barsoum RS. CKD prevention in sub- Saharan Africa: a call for government, non-government and community support. Am J Kidney Dis. 2008; 51: 515-23.
[6]
Pugsley D, Norris KC, Garcia-Garcia G, Agodoa L. Global approaches for understanding the disproportionate burden of chronic kidney disease. Ethn Dis 2009; 19: 1-2.
[7]
National Kidney Foundation. K/DOQI clinical practice guideline for chronic kidney disease: evaluation, classification and stratification. Am J Kid Dis. 2002; 39: 1-226.
[8]
Baker LRL. Renal Disease In: Kumar P, Clark M. Clinical medicine, 4th edn. W. B Saunders. Philadephia. 1999; 20: 572-73.
[9]
Kadiri S. Towards reducing the impact of chronic kidney disease. African Health 2001; 23: 9-10.
[10]
Kadiri S, Arijie A. Temporal variations and metrological factors in hospital admission of chronic renal failure in South-south Nigeria. West Afri J Med 1999; 18: 49-51.
[11]
EL Nahas M, Bello AK. Chronic Kidney Disease: the global challenge. Lancet 2005; 365: 331-40.
[12]
Barsoum RS, Francis MR. Spectrum of glomerulonephritis in Egypt. Saudi J Kidney Dis Transpl. 2000; 11: 421-9.
[13]
Barsoum RS. Chronic Kidney disease in the developing world. N Engl J Med. 2009; 354:997-9.
[14]
Akinsola W, Odesanmi WO, Oguniyi JO, Ladipo GOA. Diseases causing chronic renal failure in Nigeria: a prospective study of 100 cases. Afri J Med Sc. 1989; 18: 131-5.
[15]
Hartmut M, Maria-Claude F. Renal bone disease: an unmet challenge for the nephrologist: Kidney Int. 1990; 38: 193-205.
[16]
Palmer SC, Strippoli GF. Interventions for preventing bone disease in kidney transplant recepients: a systemic review of randomized controlled trials. Am J Kidney disease 2005; 45: 638-49.
[17]
Moe S, Drueke T. Definition, evaluation and classification of renal osteodystrophy: a position statement from kidney disease improving global outcome. Kidney Int. 2006; 69: 1945-53.
[18]
Onyemekeihia R. Renal osteodystrophy in Benin. A dissertation submitted to the National Postgraduate Medical College of Nigeria, faculty of internal medicine. November 2004.
[19]
Sanusi AA, Arogundade FA, Oladigbo M. Prevalence and pattern of renal bone disease in end stage renal disease patients in IIe-Ife, Nigeria. West Afri J Med 2010; 29: 75-80.
[20]
Osunkotun BO, Odeku EI, Adeloye R. Non-embolic cerebrovascular disease in Nigerians. J neuro. Sci 1969; 19: 361-388.
[21]
Agarwal SK. Assessment of renal bone mineral disorder in naïve CKD patients. A single centre prospective study. Indian J Nephrol 2007; 17: 96-100.
[22]
Kurz P, Monier Faugere M, Bougna B et al. Evidence for abnormal calcium hemostasis in patients with adynamic bone disease. Kidney Int 1994; 46: 855-861.
[23]
London GM, Pannier B, Marchias SJ, Guerin A. Calcification of aortic valve in dialysed patients. J Am Soc Nephrol 2000; 11: 778-783.
[24]
Odenigbo CU. The prevalence and radiological markers of ROD in patients with chronic renal failure in Enugu FMCP, National Postgraduate Medical College of Nigeria may 2003.
[25]
Harowin P, Lecomte-Houcke M, Flipo RM. Current aspects of osteoarticular pathology in patients undergoing haemodialysis. Study of 80 patients. Laboratory and pathologic analysis. Discussion of the pathologic mechanism. J Rheumatol. 1987; 14: 748-9.
[26]
Liach F. Secondary hyperparathyroidism in renal failure: The trade off hypothesis revisited. Am J Kidney Dis 1995; 25 (5): 663-79.
[27]
Poznanki AK. Radiological evaluation of bone mineral in children. In favus MJ (ed) primer on Metabolic bone disease and disorders of mineral metabolism. Raven press New York 1993: 115-20.
ADDRESS
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
U.S.A.
Tel: (001)347-983-5186