Iliac crest bone biopsy for diagnosis of aluminum toxicity and a guide to the use of deferoxamine.

ABSTRACT

Diagnosis of aluminum-related bone disease in patients with renal failure often requires a bone biopsy. Percutaneous biopsy of the iliac crest has been safely carried out as an outpatient procedure in over 300 patients. No instances of significant bleeding or infection have occurred. The procedure was well accepted in 85% to 90% of patients recently surveyed. Before biopsy, each patient received two short courses of oral tetracycline, separated by a ten- to 14-day interval. Double tetracycline labeling permits the evaluation of dynamic characteristics of bone for the diagnosis of aplastic disease due to aluminum toxicity. When a diagnosis of aluminum toxicity is established, treatment with the chelating agent deferoxamine (DFO) administered during dialysis is effective for aluminum removal. Initially, a standardized infusion of DFO, 40 mg/kg, is administered over two hours immediately following dialysis treatment. The increase in plasma aluminum 24 to 48 hours following such an infusion provides an index of tissue aluminum stores and provides a guide to the appropriate therapeutic dose of DFO. DFO (2 to 4 g) is administered once weekly during the last two hours of dialysis; in rare cases higher dosages have been used. Reported side effects of DFO therapy include hypotension, hypoferremia, and allergic reactions; other investigators have reported ocular abnormalities and unusual infections. Patients are reevaluated after 6 to 12 months of therapy with a DFO infusion test and/or bone biopsy. However, the duration of therapy needed for the successful treatment of aluminum-related bone disease is uncertain.