PDF: Facial lesions caused by renal osteodystrophy in a patient with chronic renal insufficiency: a case report

The kidneys regulate different systems in the human body, being responsible for body metabolite excretion, electrolyte balance and arterial blood pressure regulation, red blood cell secretion, gluco-neogenesis, and vitamin D production.

The final kidney disease stage is called Chronic Renal Insufficiency (CRI), which is characterized by extensive damage as well as a progressive and irreversible loss of the kidney glomerular, tubular and endocrine functions.

A reduced or absent function of the kidneys can lead to alterations in the function of other body systems, known as Uremic Syndrome. 

Major uremic syndrome manifestations include central and peripheral neurological damage, as well as cardiovascular, skin, ophthalmic, endocrine, gastrointestinal and bone damage.

Renal osteodystrophy is defined as a skeletal change showing specific characteristics whose etiology is related to hormonal deregulation in the uremic syndrome, which interferes with bone apposition and resorption in the patient with CRI, and can affect up to 50% of the patients with end-stage renal disease (ESRD).

Facial skeleton lesions are the first symptoms in most cases. Osteodystrophy can be divided into three groups: high remodeling bone disease, low remodeling bone disease, and an in-between group. 

The present study aims to report a case of a patient with CRI who developed the high remodeling facial osteodystrophy type (osteitis fibrosa) and to discuss the main features of the disease, as well as its associations with bone pathologies.