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Osteodystrophy is a severe and troublesome complication of renal failure.It is important to detect and to treat early to prevent deformities and growth failure. We have studied in 21 uremic children (1-12 yrs of age) on conservative treatment and in 16 children (3-15yrs) on dialysis (HD) hormonal (iPTH,iCT and levels of 25-hydroxyvitamin D),biochemical (calcium,magnesium,phosphorus,alkaline phosphatase) and radiological signs of renal bone disease. The results can be synthesized as follows: - all HD patients show marked alterations in hormones profiling and biochemical indices; -pts. on CT have hormonal alterations also with minor reduction of GFR,with a correlation between GFR and serum phosphorus,plasma PTH and ionized calcium; -radiological signs of rickets were better correlated with biochemical alterations,while Rx signs of hyperparathyroidism appear later and did not show a relation with serum indices.

In adults on RDT has been shown that hemodialysis can deplete serum CAR levels. Since CAR is necessary for the complete oxidation of fatty acids,deviations in serum levels from normal may reflect alterations which would in turn disturb normal lipid metabolism. We have studied in 15 children, 3-12 years of age,dialyzed for 5 hours thrice weekly, serum CAR predialysis,at the end of dialysis and 3,6,12,24 hours after;the lipid pattern and the effects of oral CAR administration (100 mg/kg/day). It was observed a decrease in serum CAR in post-dialysis (-43%) with a return to predialysis values within 6 hours. The decrease in serum was associated with an equivalent appearance in dialysate of CAR.The oral administration of CAR resulted in an increase in predialysis serum levels and in a more rapid return to normal values in postdialysis,within 3 hours.Lipid abnormalities were partly corrected with a decrease plasma triglycerides and FFA,with no modification of cholesterol.