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Nephrol Dial Transplant (2003) 18: III94-III96
© 2003 European Renal Association-European Dialysis and Transplant Association

Original Article

Role of osteoclastic dysfunction in the development of renal bone disease

Junichiro James Kazama1,2,, Fumitake Gejyo1, Takeshi Kurosawa3 and Masafumi Fukagawa4

1 Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences, 2 Division of Intensive Care Medicine, Niigata University Medical Hospital, 3 Sumiyoshi Clinic Hospital and 4 Division of Nephrology and Dialysis Center, Kobe University School of Medicine, Japan

A 47-year-old-man was referred for treatment for end-stage renal failure. He had been diagnosed with type II adult onset osteopetrosis before the deterioration of his renal function. He presented with anaemia, severe hypocalcaemia, secondary hyperparathyroidism and azotaemia. An iliac bone biopsy revealed increased bone volume, disturbed osteoid calcification, active osteoclastic bone resorption and fibrous transformation in the bone marrow space. Incomplete osteoclastic dysfunction strongly suggested hypocalcaemia and secondary hyperparathyroidism, and the osteoclastic bone resorption also indicated secondary hyperparathyroidism, even though bone resorption was potentially suppressed. The present case shows that evidence of the involvement of osteoclastic dysfunction in the development of renal bone disease can be found in bone histology.

Keywords: adult onset type II osteopetrosis; end-stage renal failure; iliac bone biopsy; secondary hyperparathyroidism

Correspondence and offprint requests to: J. James Kazama MD, PhD, Division of Intensive Care Medicine, Niigata University Medical Hospital, 1-754 Asahimachi-Dori, Niigata, Niigata 951-8510 Japan. Email: jjkaz{at}med.niigata-u.ac.jp


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