Bone Biopsy for Histomorphometry in Chronic Kidney Disease (CKD): State-of-the-Art and New Perspectives

Journal of Clinical Medicine

Cristina Politi¹  Sandro Giannini²  Maurizio Gallieni³  Maria Fusaro⁴  Roberto Ciresa⁵  Luca Dalle Carbonare⁵  Francesca Stefani⁵  Maria Teresa Valenti⁵ 

[1] CNR-IFC of Reggio Calabria, Section of Clinical Epidemiology and Biostatistics, 89124 Reggio Calabria, Italy;Clinica Medica 1, Department of Medicine, University of Padova, 35128 Padova, Italy;L. Sacco’ Department of Biomedical and Clinical Sciences, Università degli Studi di Milano “La Statale”, 20157 Milano, Italy;National Research Council (CNR), Institute of Clinical Physiology (IFC), 56124 Pisa, Italy;Section of Internal Medicine, Department of Medicine, University of Verona, 37134 Verona, Italy;

关键词: bone biopsy;    histomorphometry;    kidney;    osteodystrophy;    ROD;   

DOI  :  10.3390/jcm10194617

来源: DOAJ

【 摘 要 】

The use of bone biopsy for histomorphometric analysis is a quantitative histological examination aimed at obtaining quantitative information on bone remodeling, structure and microarchitecture. The labeling with tetracycline before the procedure also allows for a dynamic analysis of the osteoblastic activity and mineralization process. In the nephrological setting, bone biopsy is indicated to confirm the diagnosis of subclinical or focal osteomalacia and to characterize the different forms of renal osteodystrophy (ROD). Even if bone biopsy is the gold standard for the diagnosis and specific classification of ROD, the use of this approach is very limited. The main reasons for this are the lack of widespread expertise in performing or interpreting bone biopsy results and the cost, invasiveness and potential pain associated with the procedure. In this regard, the sedation, in addition to local anesthesia routinely applied in Italian protocol, significantly reduces pain and ameliorates the pain perception of patients. Concerning the lack of widespread expertise, in Italy a Hub/Spokes model is proposed to standardize the analyses, optimizing the approach to CKD patients and reducing the costs of the procedure. In addition, new tools offer the possibility to evaluate the osteogenic potential or the ability to form bone under normal and pathological conditions, analyzing mesenchymal stem cells and their ability to differentiate in the osteogenic lineage. In the same way, circulating microRNAs are suggested as a tool for exploring osteogenic potential. The combination of different diagnostic approaches and the optimization of the bioptic procedure represent a concrete solution to spread the use of bone biopsy and optimize CKD patient management.

【 授权许可】

Unknown