The localization of aluminium and other elements in bone tissue of a case of renal osteodystrophy with an associated dialysis encephalopathy syndrome.

Bone tissue from a patient with chronic renal failure and a dialysis encephalopathy syndrome has been studied by histological and histochemical means, by flame emission spectroscopy and by electron probe X-ray microanalysis. There was significant renal osteodystrophy manifest as an osteomalacia. Emission spectroscopy showed the presence of iron (Fe), aluminium (Al), silicon (Si), zinc (Zn), strontium (Sr), lead (Pb) and copper (Cu) in the concentration range 100-1000 parts per million (ppm). Electron probe X-ray microanalysis showed focal concentrations of Fe and Si in the marrow tissue only, whereas Al was localized to the calcification front zones at the junction of osteoid and mineralized tissue of both trabecular and cortical bone. It is concluded that the presence of Al at these sites could interfere with the mineralization process and significantly contribute to the pathogenesis of haemodialysis-related osteomalacia and that it is unlikely that the other elements detected are significant in this regard.