Therapeutic Results in Renal Tubular Osteomalacia 



203 



et al. (1965) proposed a combination of a primary renal defect and a primary 

 skeletal defect. Kuhlencordt (1958) proposed a general disturbance of phosphoryla- 

 tion. These theories have recently been reviewed by Falkson and Frame (1958), 

 Williams et al. (1960), and Frame et al. (1965). 



The treatment of choice has generally been vitamin D in massive doses. This 

 treatment has not been entirely satisfactory, since a complete cure is not often accom- 

 plished (Tapia et al., 1964; Pierce et al., 1964). Addition of calcium supplements has 

 been advocated as has oral supplements of phosphate (Lafferty et al., 1964; Fraser 

 et al., 1958; Frame and Smith, 1958; Kuhlencordt, 1958). Three cases are reported 

 here, in which the effect of treatment with oral supplements of inorganic phosphate 

 and phosphate supplements plus vitamin D was investigated with the aid of ■'"Ca 

 or ^^Sr. 



Clinical material 



consists of three cases of renal tubular osteomalacia. The 



The clinical materia 

 most important clinical findings are found in Table 1. 



Table 1. Laboratory data in three cases of renal tubular osteomalacia. Averages of several 



determinations 



T. C. 



Iiitreatcd Treated 



M. B. 

 Untreated Tri-.it( 



J. ('. 



'11 treated Treated 



Height (cm) 



Weight (kg) 



Plasma : 



Ca (mEq/L) 



P inorganic (mg"o). . . . 

 Alk. phosphatase (U) . . . 

 Creatinine (mg'',,) .... 

 Stand, bicarbonate (mEq/L) 



Urine : 



Ca (mg/day) 



P inorganic (mg/day) 

 Tubular reabsorption 



ofP(%) 



Hydroxyprolinc (mg/day) . 



Glucose 



Aminoacids 



Radiography 



158 



57 



4.7 

 2.1 

 6 



0.9 

 23 



110 



550 



190 

 1500 



Occasionally 



Normal 



Severe osteopenia 



133 

 35 



5.1 4.6 



2.0 2.1 



6 31 

 0.8 0.5 



23 22 



180 

 500 



61 



4.6 

 2.9 



19 

 0.7 



23 



200 

 1350 



54.9 



None 



Normal 



Severe osteopenia 



150 

 68 



4.9 



1.6 

 6 



0.6 

 25 



120 



450 



78 



4.9 



2.9 

 7 



0.8 

 24 



47.3 



None 

 Normal 



Severe osteopenia 



Case T. C. Male, born in 1912. The father and paternal uncle probably suffered 

 from the same disorder. As a child he is said to have had rickets. At the age of 35 he 

 first noted skeletal symptoms. At the age of 48 he was admitted with the fullblown 

 clinical picture of renal tubular osteomalacia. After a detailed study treatment was 

 started with vitamin D plus oral supplements of sodium monophosphate. The dosages 

 were settled at 65.000 I.U. vitamin Do and 8 Cm sodium monophosphate. 



Case M. B. Female, born in 1944. Family history non-contributory. Skeletal 

 symptoms were first noted at the age of 12. Admitted to several hospitals, and 

 treated with vitamin Do In doses amounting to 240.000 I.U. This treatment was 

 sedated 20 months before admission to Malmo General Hospital. At that time, age 18, 



