Bone disease in patients with chronic kidney disease under conservative management

Sao Paulo Medical Journal

Carlos Perez Gomes¹  Maria Inês Barreto Silva¹  Maria Eugênia Leite Duarte¹  David Dorigo¹  Carla Cavalheiro Da Silva Lemos¹  Rachel Bregman¹ 

[1] ,Universidade do Estado do Rio de Janeiro Hospital Universitário Pedro Ernesto Nephrology DivisionRio de Janeiro,Brazil

关键词: Renal osteodystrophy;    Kidney diseases;    Chronic kidney failure;    Renal dialysis;    Bone resorption;    Osteodistrofia renal;    Nefropatias;    Insuficiência renal crônica;    Hemodiálise;    Reabsorção óssea;   

DOI  :  10.1590/S1516-31802005000200010

来源: SciELO

【 摘 要 】

CONTEXT AND OBJECTIVE: Few studies have focused on bone disease in patients with chronic kidney disease under conservative treatment. The objective was to evaluate bone disease in patients with chronic kidney disease. DESIGN AND SETTING: Case series, at the Nephrology Division, Hospital Universitário Pedro Ernesto. METHODS: 131 patients with creatinine clearance from 10 to 60 ml/min/1.73 m² were followed up for at least one year. Serum creatinine, albumin, calcium, phosphorus, alkaline phosphatase, total CO2 (tCO2), intact parathyroid hormone (iPTH), and alkaline phosphatase were measured. Creatinine clearance was calculated from 24-hour urine creatinine measurements and protein ingestion estimates from urea assays. RESULTS: Patients presenting creatinine clearance < 30 ml/min/1.73 m² had higher iPTH values, but normal serum levels for calcium, phosphorus, alkaline phosphatase and tCO2. Patients presenting iPTH values of twice the normal upper limit (144 pg/ml) showed lower tCO2 values. Bone alkaline phosphatase was evaluated in 37 patients with creatinine clearance < 30 ml/min/1.73 m², showing correlation with alkaline phosphatase but not with parathyroid hormone. Bone biopsy on nine patients with creatinine clearance < 30 ml/min/1.73 m² and iPTH > 144 pg/ml showed osteitis fibrosa (4), mild lesion (4) and high turnover (1). CONCLUSION: The present data suggest the importance of early control for iPTH and metabolic acidosis, among patients under conservative management for chronic kidney disease, in order to prevent complications related to bone disease.

【 授权许可】

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