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April 1, 1974

Rickets, American Style

JAMA. 1974;228(1):97. doi:10.1001/jama.1974.03230260067035

RICKETS is seldom a matter of nutritional deprivation or lack of exposure to sunlight in most parts of the United States. The occasional child we see with classic rickets—by x-ray film and bone biopsy—usually represents one of a group of disorders characterized by loss of calcium or phosphorus in the urine, classified under the heading of "tubular disorders." This term indicates that the primary fault is attributed to impaired tubular reabsorption of calcium or phosphorus without abnormality in the glomeruli or the glomerular filtration of these solutes. The result, for the bones, is exactly the same as old-fashioned avitaminosis D. The prognosis lies not in the bone disease but in the associated renal disease that may lead to renal failure. It is possible to describe briefly the more common tubular syndromes leading to rickets as follows:

  1. Renal tubular acidosis: rickets, nephrocalcinosis, nephrolithiasis, metabolic acidosis with alkaline urine, hypokalemia.