To review the main imaging findings of renal osteodistrophy and to underline the importance of recognising them and of distinguishing them from other entities.

Renal osteodistrophy is a broad term given to a wide spectrum of musculoskeletal abnormalities that may develop in the context of renal insufficiency. The main biochemical event leading to these abnormalities is the disturbance of the calcium-phosphate metabolism - with parathyroid hormone hypersecretion and vitamin D deficiency - but there are also other contributing factors such as amyloid deposition. The interaction of these mechanisms cause a multiplicity of structural changes in bone, although joints and soft tissues may also be affected.

Conventional radiology, namely plain film radiography, is still the most widely used method to document renal osteodisthrophy abnormalities. The main imaging findings in this entity result from osteopenia, osteosclerosis and osteomalacia, and can be recognized in radiology studies in the appropriate setting. Besides generalized osteopenia, a frequently subtle but virtual pathognomonic sign of bone loss is subperiosteal bone resorption along the radial aspect of the middle phalanges of the hand. It is also important to recognize resorbtion of bone at other sites, such as subchondral...

Renal osteodistrophy comprises a wide spectrum of musculoskeletal abnormalities that must be recognised by the radiologist. Some changes may be subtle but very specific, and other changes must be distinguished from entities such as malignancy, fractures or inflammatory artropathies Besides being aware of these changes, it is paramount to carefully evaluate their pattern of involvement and to always bear in mind the clinical and laboratorial setting. Conventional radiology, namely plain film radiography is still the most widely used method to document renal osteodisthrophy abnormalities, although...