Osteonecrosis in renal insufficiency

Osteonecrosis in chronic renal disease is a high risk complication for patients undergoing dialysis and after renal transplantation. Main localisation is the femoral head, followed by the humeral head, talus, humeral condyles, distal femoral condyles, cuboid and the carpal bones. So far, the pathogenesis remains unsolved, but several risk factors like cortisone intake are discussed. Besides the clinical examination and blood tests, the diagnosis is based on radiological findings. X-ray, as well as MRI are high sensitive tools detecting early changes in bone structure. Therapeutical options range from non-invasive treatment to the known surgical approaches of treating avascular bone necrosis. Some difficulties occur with endoprosthetic implantation in patients with chronic renal diseases. This review wants to provide an overview of osteonecrosis due to renal insufficiency in adults and children and the current therapeutical approaches.