Osteodistrofia renal em pacientes pediátricos com doença renal crônica. Uma revisão sistemática e metanálise
Data
2024-05-25
Autores
Bedram, Leonardo Gonçalves 
Orientadores
Carvalho, Aluizio Barbosa de
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
A doença renal crônica (DRC) acarreta graves co-morbidades, entre elas o distúrbio mineral e ósseo da DRC (DMO-DRC). As alterações ósseas do DMO-DRC, diagnosticadas pela biópsia óssea, seguidas pela histomorfometria, são denominadas de osteodistrofia renal (ODR). Na criança, a ODR acarreta principalmente deformidades ósseas e déficit estatural. No entanto, a biópsia óssea é pouco utilizada na população pediátrica, o que dificulta o conhecimento do perfil da ODR na criança. Para aprimorar esse conhecimento é necessária uma análise mais profunda e robusta dos dados disponíveis na literatura. O objetivo deste estudo foi realizar uma revisão sistemática e metanálise de artigos que incluem pacientes pediátricos com DRC, submetidos à biópsia óssea, seguida de histomorfometria. As estimativas dos parâmetros histomorfométricos e laboratoriais dos artigos incluídos no estudo foram combinadas via metanálise, assim como a comparação desses parâmetros entre subgrupos. Foram analisados 5082 resumos até 2023, e um total de 28 artigos elegíveis foi incluído. Os anos de publicação variaram de 1975 a 2020, e o estudo incluiu 980 biópsias ósseas de 1015 pacientes em tratamento conservador, diálise ou transplante. Houve grande variabilidade das estimativas combinadas globais dos parâmetros histomorfométricos, com relação à denominação, abreviatura e unidades de referência. Do total de artigos, 36% não reportaram os parâmetros dinâmicos da histomorfometria e 64% reportaram os tipos clássicos da ODR, sendo a osteíte fibrosa a mais prevalente (51%). A metanálise evidenciou que a quase totalidade dos parâmetros histomorfométricos e laboratoriais globais foi heterogênea. A variabilidade dos resultados globais encontrados pode ser explicada pelas diferenças na idade, sexo, tipos de ODR e de tratamento da DRC. Apenas 21% dos artigos permitiram comparações entre subgrupos, e revelaram que o P sérico dos pacientes em diálise foi maior do que naqueles em tratamento conservador. Além disso, crianças com osteíte fibrosa apresentaram maiores níveis séricos de PTH, maiores superfície osteoide, superfície de mineralização e taxa de aposição mineral, assim como menor intervalo de tempo de mineralização, quando comparadas àquelas com doença óssea adinâmica. Apesar da variabilidade do perfil demográfico principalmente com relação à idade e sexo, além do perfil clínico das populações estudadas, os resultados obtidos estão de acordo com a literatura. No entanto, mais estudos com biópsia óssea em crianças com DRC, seguindo protocolos adequados de histomorfometria, são necessários para a maior compreensão da ODR nessa população.
Chronic kidney disease (CKD) encompasses severe comorbidities, among which the mineral and bone disorder in CKD (CKD-MBD) is prominent. The bone abnormalities of CKD-MBD, diagnosed through bone biopsy followed by histomorphometry, are referred to as renal osteodystrophy (ROD). In children, ROD primarily leads to bone deformities and growth deficits. However, bone biopsy is rarely used in the pediatric population, hindering the understanding of the ROD profile in children. To enhance this understanding, a more in-depth and robust analysis of the available literature data is required. The aim of this study was to conduct a systematic review and metaanalysis of articles including pediatric patients with CKD who underwent bone biopsy followed by histomorphometry. The estimates of histomorphometric and laboratory parameters from the included studies were combined via meta-analysis, as well as the comparison of these parameters between subgroups. A total of 5082 abstracts were reviewed up to 2023, and 28 eligible articles were included. The publication years ranged from 1975 to 2020, and the study comprised 980 bone biopsies from 1015 patients under conservative treatment, dialysis, or transplantation. There was significant variability in the combined global estimates of histomorphometric parameters in terms of naming, abbreviation, and reference units. Among the articles, 36% did not report dynamic histomorphometric parameters, and 64% reported classical types of ROD, with osteitis fibrosa being the most prevalent (51%). The meta-analysis revealed that nearly all global histomorphometric and laboratory parameters were heterogeneous. The variability of the overall results found can be explained by differences in age, sex, types of ROD, and CKD treatment. Only 21% of the articles allowed subgroup comparisons, revealing that serum phosphorus levels in patients on dialysis were higher than those in patients under conservative treatment. Moreover, children with osteitis fibrosa had higher serum PTH levels, greater osteoid surface, mineralization surface, and mineral apposition rate, as well as a shorter mineralization lag time compared to those with adynamic bone disease. Despite the demographic variability mainly concerning age and sex, as well as the clinical profile of the studied populations, the results obtained are consistent with the literature. However, more studies involving bone biopsy in children with CKD,
Chronic kidney disease (CKD) encompasses severe comorbidities, among which the mineral and bone disorder in CKD (CKD-MBD) is prominent. The bone abnormalities of CKD-MBD, diagnosed through bone biopsy followed by histomorphometry, are referred to as renal osteodystrophy (ROD). In children, ROD primarily leads to bone deformities and growth deficits. However, bone biopsy is rarely used in the pediatric population, hindering the understanding of the ROD profile in children. To enhance this understanding, a more in-depth and robust analysis of the available literature data is required. The aim of this study was to conduct a systematic review and metaanalysis of articles including pediatric patients with CKD who underwent bone biopsy followed by histomorphometry. The estimates of histomorphometric and laboratory parameters from the included studies were combined via meta-analysis, as well as the comparison of these parameters between subgroups. A total of 5082 abstracts were reviewed up to 2023, and 28 eligible articles were included. The publication years ranged from 1975 to 2020, and the study comprised 980 bone biopsies from 1015 patients under conservative treatment, dialysis, or transplantation. There was significant variability in the combined global estimates of histomorphometric parameters in terms of naming, abbreviation, and reference units. Among the articles, 36% did not report dynamic histomorphometric parameters, and 64% reported classical types of ROD, with osteitis fibrosa being the most prevalent (51%). The meta-analysis revealed that nearly all global histomorphometric and laboratory parameters were heterogeneous. The variability of the overall results found can be explained by differences in age, sex, types of ROD, and CKD treatment. Only 21% of the articles allowed subgroup comparisons, revealing that serum phosphorus levels in patients on dialysis were higher than those in patients under conservative treatment. Moreover, children with osteitis fibrosa had higher serum PTH levels, greater osteoid surface, mineralization surface, and mineral apposition rate, as well as a shorter mineralization lag time compared to those with adynamic bone disease. Despite the demographic variability mainly concerning age and sex, as well as the clinical profile of the studied populations, the results obtained are consistent with the literature. However, more studies involving bone biopsy in children with CKD,
Descrição
Citação
BEDRAM, Leonardo Gonçalves. Osteodistrofia renal em pacientes pediátricos com doença renal crônica: uma revisão sistemática e metanálise. 2024. 113 f. Dissertação (Mestrado em Nefrologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2024.