The Royal Australasian College of Physicians

S VOL. 1 , NO. 3 2x4 THE CLINICAL APPLICATION OF BONE BIOPSY W I T H PARTICULAR REFERENCE TO RENAL DISEASE JOAN P. INCHAM, A. W. IRFLAND, J. H. STEWART and Depariinetii of Medicine, Sydiiey Uiriversiiy, and Reiial Unit, Sydney Hospiial, Sydney, NS W Bone biopsy is a simple, relatively painless procedure offering useful information in the investigation of metabolic bone disease. Undecalcified sections are used for the following reasons : ( I ) They provide the only quantitative estimate of osteoid tissue and a diagnosis of osteomalacia is made on this basis; (2) Areas of increased resorptive activity due to hyperparathyroidisni are shown. The skeletal pathology of renal failure is complex. Histological features of osteoporosis, osteosclerosis, osteomalacia and osteitis fibrosa have all been described either alone or in combination. The present series consisted of three groups of patients: ( I ) Thirty patients who were on the point of entering the chronic dialysis/transplantation programme. Six of these had evidence of osteoscierosis, 15 showed some degree of hyperparathyroidism, (severe i n eight cases). Mild osteomalacia was present in ten patients, whilst severe osteomalacia and osteoporosis were not seen prior to dialysis; (2) A second group of patients had undergone a renal transplant 6-24 months prior to skeletal biopsy. Post-transplant biopsies showed less hyperparathyroidisni but some osteoporosis; (3) A third group consisted of patients in renal failure who were referred because of pain. In this group there were several patients with severe osteomalacia. It was concluded that gross osteoinalacia is not a feature in the majority of patients with chronic renal failure. The development of this lesion in a few individuals probably depends on the presence of extraneous factors. CELLS FORMING SPECIFIC ANTIBODY I N TISSUES I N AN EXPERIMENTAL MODEL OF MULTIPLE