• Carlos Perez Gomes, Maria Inês Barreto Silva, DuarteMaria Eugênia LeiteME, David Dorigo, Carla Cavalheiro da Silva Lemos, and Rachel Bregman.
• Nephrology Division, Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rua Soares Cabral 71, Laranjeiras Rio de Janeiro, (RJ), Brazil, CEP 22240-070.
• Sao Paulo Med J. 2005 Mar 2; 123 (2): 838783-7.

Context And ObjectiveFew studies have focused on bone disease in patients with chronic kidney disease under conservative treatment. The objective was to evaluate bone disease in patients with chronic kidney disease.Design And SettingCase series, at the Nephrology Division, Hospital Universitário Pedro Ernesto.Methods131 patients with creatinine clearance from 10 to 60 ml/min/1.73 m(2) were followed up for at least one year. Serum creatinine, albumin, calcium, phosphorus, alkaline phosphatase, total CO2 (tCO2), intact parathyroid hormone (iPTH), and alkaline phosphatase were measured. Creatinine clearance was calculated from 24-hour urine creatinine measurements and protein ingestion estimates from urea assays.ResultsPatients presenting creatinine clearance < 30 ml/min/1.73 m(2) had higher iPTH values, but normal serum levels for calcium, phosphorus, alkaline phosphatase and tCO2. Patients presenting iPTH values of twice the normal upper limit (144 pg/ml) showed lower tCO2 values. Bone alkaline phosphatase was evaluated in 37 patients with creatinine clearance < 30 ml/min/1.73 m(2), showing correlation with alkaline phosphatase but not with parathyroid hormone. Bone biopsy on nine patients with creatinine clearance < 30 ml/min/1.73 m(2) and iPTH > 144 pg/ml showed osteitis fibrosa (4), mild lesion (4) and high turnover (1).ConclusionThe present data suggest the importance of early control for iPTH and metabolic acidosis, among patients under conservative management for chronic kidney disease, in order to prevent complications related to bone disease.

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