Abstract：
Renal osteodystrophy (ROD) starts early and progresses with further loss of kidney function in patients with chronic kidney disease (CKD). There are four distinct types of ROD based on undecalcified bone biopsy results. Adynamic bone disease and osteomalacia are the predominant forms of low bone turnover, while hyperparathyroid bone disease and mixed uremic osteodystrophy (MUO) are typically associated with high bone turnover. MUO is a prevalent but poorly described pathology that demonstrates evidence of osteomalacia on top of the high bone formation/resorption. The prevalence of MUO ranges from 5 to 63% among different studies. The pathogenesis of MUO is multi-factorial. Altered phosphate homeostasis, hypocalcemia, vitamin D deficiency, increased FGF-23, interleukins 1 and 6, TNF-α, amyloid, and heavy metal accumulation are the main inducers of MUO. The clinical findings of MUO are usually non-specific. The use of non-invasive testing such as bone turnover markers and imaging techniques might help to suspect MUO. However, it is usually impossible to precisely diagnose this condition without performing bone biopsy. The principal management of MUO is to control the maladaptive hyperparathyroidism along with correcting any nutritional mineral deficiencies that may induce mineralization defect. MUO is a common but still poorly understood bone pathology category; it demonstrates the complexity and difficulty in understanding ROD. A large prospective bone biopsy-based studies are needed for better identification as proper diagnosis and management would improve the outcome of patients with MUO.
摘要：
慢性肾脏病（CKD）患者的肾性骨营养不良（ROD）开始较早，并随着肾功能的进一步丧失而发展。根据未脱钙的骨活检结果，有四种不同类型的ROD。动力性骨病和骨软化症是低骨转换的主要形式，而甲状旁腺功能亢进性骨病和混合型尿毒症性骨病（MUO）通常与高骨转换有关。MUO是一种普遍但描述不佳的病理学,其在高骨形成/吸收之上证明了骨软化症的证据。在不同的研究中，MUO的患病率为5％至63％。MUO的发病机制是多因素的。改变磷酸盐稳态，低钙血症,维生素D缺乏，增加FGF-23，白介素1和6，TNF-α，淀粉样蛋白,重金属积累是MUO的主要诱导因子。MUO的临床发现通常是非特异性的。使用非侵入性测试，如骨转换标记和成像技术可能有助于怀疑MUO。然而,如果不进行骨活检，通常不可能准确诊断这种情况。MUO的主要管理是控制适应性不良的甲状旁腺功能亢进，并纠正可能导致矿化缺陷的任何营养矿物质缺乏。MUO是一种常见但仍然鲜为人知的骨病理学类别；它表明了理解ROD的复杂性和难度。为了更好地识别，需要进行大规模的前瞻性骨活检研究，因为正确的诊断和管理将改善MUO患者的预后。
