Oral manifestations of renal osteodystrophy: case report and review of the literature

Abstract

Renal osteodystrophy, characterized by uneven bone growth and demineralization, is described. Oral manifestations of the disorder are described, and the value of dental radiographs in early detection of renal osteodystrophy is noted. A case report of a patient with severe oral complications, which resulted from long-standing end-stage renal disease and secondary hyperparathyroidism, is presented. Giant cell lesions of hyperparathyroidism, referred to as brown tumors (which may be associated with pain and swelling), are the key clinical oral manifestations and are the most dramatic dental radiographic finding in patients with renal osteodystrophy. Bone changes may include loss of lamina dura, giant cell lesions of hyperparathyroidism, and bone demineralization. The dentist's role in detection, assessment, and treatment is stressed.

Severe maxillofacial renal osteodystrophy in two patients with chronic kidney disease

“…In the meantime, the reduction of glomerular filtration also leads to impaired phosphate excretion, elevating the serum concentration of phosphate. Hyperphosphatemia can act by directly stimulating PTH synthesis and parathyroid hyperplasia and indirectly promoting HPT-II by decreasing the serum calcium level [1,2,10]. Excess of PTH acts in the transformation of the inactive form of vitamin D to 1,25-dihydroxyvitamin D 3 in the kidney and influences the development and activity of osteoclasts, osteoblasts, and osteocytes, thereby affecting bone turnover [1,4].…”

“…Those features were present in patient 2, justifying the diagnosis of osteitis fibrosa. On the other hand, osteomalacia is characterized by defective mineralization and increased osteoid production mainly caused by the decrease of 1,25-dihydroxyvitamin D 3 concentrations, usually causing osseous pain and musculoskeletal disability and making the patient at risk of osteopenia, bone deformity, and fracture [1,4,5]. Adynamic bone disease…”

“…Chronic kidney disease (CKD) is the progressive and irreversible loss of renal function, usually leading to end-stage renal disease, a potentially fatal condition, requiring chronic hemodialysis or kidney transplantation for survival [1,2]. One of the complications that can arise in patients with CKD is the clinical syndrome chronic kidney disease-mineral and bone disorder (CKD-MBD), which involves changes in laboratory tests such as serum calcium, organic phosphate, parathyroid hormone (PTH), and concentrations of vitamin D derivatives; changes in bone turnover; and extraskeletal calcifications [3,4].…”

“…ROD associated with HPT-II can be improved with the correction of calcium and vitamin D levels and a decrease in phosphate levels. This can be accomplished by conservative treatment, such as the use of phosphate-binding agents, treatment with calcitriol and other active vitamin D sterols, and following a phosphate-restricted diet [1,2,9]. Despite medical therapy, in several patients, the altered PTH levels persist, requiring surgical intervention with total parathyroidectomy with or without autotransplantation or subtotal parathyroidectomy.…”

Spectrum of Orofacial Manifestations in Renal Diseases

“…The patients are at increased risk of fracture during dental treatments, such as extractions. 17 Diffuse involvements of the jaws occur with significant frequency and radiographic alterations of the facial skeleton may represent one of the earliest signs of the disease. 16 In some patients, marked jaw enlargement and malocclusion may occur.…”