**4.9.1 Conclusion**

68 Chronic Kidney Disease

Hodsons et al, (1981) that there is a disparity between the radiological and histological evidence of ROD. In a study in Germany, Hodsons et al found only 7(41%) patients with radiological evidence of ROD out of 17 with histological evidence of ROD. Micheal et al

There are some reasons for the low prevalence of ROD using x-rays. Firstly, the conventional techniques for x-ray contribute. Meama et al (1972) noted the phalanges to be normal in 67% if uremic patients using conventional techniques for X-ray films, and only 8% showed subperiosteal erosion. With the introduction of better films and the use of magnification techniques, only 26% appeared normal while 29% for exhibited subperiosteal erosion. There is no facility for magnification technique in the center where the study was done. Secondly, it has been reported that more than 50% of bone can be lost without any evidence in a radiograph, because only the cortical bone is clearly noted, and an important loss of cancellous bone should occur before radiological feature of ROD can be appreciated (Poznanki, 1993). Perhaps the fact that CRF patients in our environment have infrequent haemodialysis and do not live long enough for these changes to be detected on x-ray studies

(1998) found radiological features of ROD in 35% of CRF patients in ESRD.

may be contributory to the low yield of ROD using radiological examination.

**4.6 ROD may be more prevalent in males** 

**evidence** 

**4.5 Radiological and biochemical evidence of rod is more prevalent in esrd patients**  In our study, the only patient who had radiological evidence of ROD had a creatinine clearance of 6mls/min. 90% of the CRF patients had creatinine clearance <15mls/min (ESRD). The entire patients who had creatinine clearance <15mls/min had elevated serum alkaline phosphatase levels. Theses finding agree with the findings of Coen et al (1996) that adynamic bone disease is commoner n early stages of renal failure, while Osteomalacia and Osteitis Fibrosa cystica tend to occur as resistance to PTH develops, a situation which occurs in ESRD.

In this study, the one patient who had radiological evidence of ROD was a male. Also, of the 9 patients that had histological evidence of ROD, 6(66%) were males, while 3(34%) were females, with a male- female ratio of 2:1, this finding is in contrast to the finding of Odenigbo et al (2003) in a study carried out at Enugu where ROD was found to be more prevalent in females. The finding also contradicts that of Couttenye et al (1997) who showed that women seem to develop hyperparathyroidism whereas men seems to more frequently develop aplastic bone disease. The reason why men in this study showed evidence of ROD more than women may be due to the fact that there were more men in this study, particularly in the group of 10 patients that had postmortem biopsy. However, the number of patients studied was small for a general statement to be made on gender difference.

**4.7 There is no correlation between symptoms of rod and biochemical or radiological** 

In the study, 7 (14%) of the CRF subjects had symptoms suggestive of ROD. Of these, 5(71%) had bone pain while 2 (29%) had radiological evidence of ROD ('Rugger Jersey" spine), while 3 (80%) had radiological features of osteoarthritis. This agrees with the finding of Odenigbo, who reported that out of the 11 patients who had bone pain, none had radiological evidence of ROD, but all patients who had radiological evidence of The findings of this study suggest that ROD which is a complication of chronic renal failure does exist in our environment. The study has also shown that Osteitis Fibrosa is the commonest type of ROD, and that ROD may be commoner in males. The study showed that in majority of patients with ESRD there is biochemical evidence. This finding may possibly be pointing to the fact that clinical features are a poor guide to the presence of ROD. Before now, it was thought that ROD hardly existed in our chronic renal failure patients, because they did not live long enough to manifest it. Though the findings of this study they agree with that, going by the low incidence of ROD using clinical symptoms and radiological methods, it is possible that in the nearest future, ROD may become more prevalent in on society. This is because there is now an increase in the availability of dialysis in many centers across the Nation, with possibility that many CRF patients may live long enough to develop ROD. The findings of this study suggest that serum alkaline phosphatase assay, a surrogate of parathyroid hormone, may be a good guide to the presence of ROD in our CRF patients. Majority of patients had hypocalcaemia and hyperphosphataemia.

## **4.9.2 Recommendations**

It is hereby recommended that:


### **4.9.3 Limitation of the study**

This study was faced with some limitations. It was not possible to carry out bone biopsies for live patients because of lack of consent from the patients. However, postmortem bone

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#### **5. References**


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**5**

**Relationships Among Renal Function,**

Akihiro Yoshihara and Lisdrianto Hanindriyo

*Graduate School of Medical and Dental Sciences,* 

*Division of Preventive Dentistry, Department of Oral Health Science,* 

*Niigata University,* 

*Japan* 

**Bone Turnover and Periodontal Disease** 

Chronic renal failure (CRF) is defined as a progressive decline in renal function associated with a reduced glomerular filtration rate. The most common causes are diabetes mellitus,

The clinical signs and symptoms of renal failure are collectively termed 'uremia'. CRF affects most body systems, and the clinical features are dependent upon the stage of renal

Gingival enlargement secondary to drug therapy is the most commonly reported oral manifestation of renal disease. It can be induced by cyclosporine and/or calcium

The oral hygiene of individuals receiving hemodialysis can be poor. Deposits of calculus may be increased (Epstein et al*.*, 1980; Gavalda et al*.*, 1999). There is no good evidence of an increased risk of periodontitis (Brown et al*.*, 1989; Thorstensson et al*.*, 1996; Naugle et al*.*, 1998), although premature bone loss has been reported (Locsey et al*.*, 1986). Localized suppurative osteomyelitis, secondary to periodontitis, was

Symptoms of xerostomia can arise in many individuals receiving hemodialysis (Kho et al*.*, 1999; Klassen and Krasko, 2002). Possible causes include restricted fluid intake, side-

Uremic patients may have an ammonia-like oral odor (Kho et al*.*, 1999), which also occurs in about one third of individuals receiving hemodialysis. CRF can give rise to altered taste sensation, and some patients complain of an unpleasant and/or metallic

channel blockers (Somacarrera et al*.*, 1994; Kennedy and Linden 2000).

observed in individuals receiving hemodialysis (Tomaselli et al*.*, 1993).

effects of drug therapy and/or mouth breathing (Porter et al*.*, 2004).

taste or a sensation of an enlarged tongue (Kho et al*.*, 1999).

glomerulonephritis and chronic hypertension (Proctor et al., 2004).

**1. Introduction** 

failure and the systems involved.

a. Gingival enlargement

c. Xerostomia

Oral manifestations of CRF and related therapies:

b. Oral hygiene and periodontal disease

d. Oral malodor/bad taste/halitosis

