Renal bone disease in pediatric and young adult patients on hemodialysis in a children's hospital.
Renal bone disease in pediatric and young adult patients on hemodialysis in a children's hospital.
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发表时间：
1993-06
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通讯作者：
R. Mathias;I. Salusky;W. Harman;A. Paredes;J. Emans;G. Segre;W. Goodman
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作者：
R. Mathias;I. Salusky;W. Harman;A. Paredes;J. Emans;G. Segre;W. Goodman
肾骨病在接受慢性透析的成人患者和接受腹膜透析/持续动态腹膜透析的儿童中已经得到了明确的定义。然而，对儿童医院中心接受慢性血液透析的患者的组织学特征知之甚少。21例患者，年龄17.5 +/- 1.5岁，血液透析35 +/- 6个月，行髂骨活检和去铁胺输注试验。21例患者中有19例口服骨化三醇。21例患者经组织形态学分类如下：纤维性骨炎5例；轻度甲状旁腺功能亢进，3名；正常组织学，3分；再生障碍性6;4、混合性病变。21例患者中有4例表面铝阳性，另外7例骨铁染色阳性。血清甲状旁腺激素（PTH）水平与骨形成率（r = 0.84）和骨周长侵蚀（r = 0.67）直接相关。9例血清PTH水平高于125 pg/mL的患者中有8例发生骨髓纤维化。所有血清钙水平为125 pg/mL的患者要么患有纤维性骨炎，要么患有混合性骨病变——这组患者可能受益于积极的维生素D治疗。相比之下，对血清钙水平> - 10.0 mg/dL和血清甲状旁腺激素水平< 65 pg/mL的患者进行检查，可以正确识别出3 / 3的铝相关性骨病患者。这些发现表明，通过免疫放射测定法测量血清完整甲状旁腺激素水平可能对区分高周转率病变与正常或低周转率骨骼病变有价值。
Renal bone disease has been well defined in adult patients receiving chronic dialysis and in children on peritoneal dialysis/continuous ambulatory peritoneal dialysis. However, little is known about the histologic features in patients undergoing chronic hemodialysis in a children's hospital center. Twenty one patients, aged 17.5 +/- 1.5 yr, on hemodialysis for 35 +/- 6 months underwent iliac crest bone biopsies and deferoxamine infusion tests. Nineteen of 21 patients were receiving oral calcitriol. The 21 patients were classified by histomorphometry as follows: osteitis fibrosa, 5; mild hyperparathyroidism, 3; normal histology, 3; aplastic, 6; and mixed lesions, 4. Four of 21 patients were surface positive for aluminum, and seven other patients stained positive for iron in bone. Serum parathyroid hormone (PTH) levels correlated directly with the bone formation rate (r = 0.84) and with eroded bone perimeter (r = 0.67). Eight of the nine patients with serum PTH levels above 125 pg/mL had marrow fibrosis. All patients with serum calcium levels 125 pg/mL had either osteitis fibrosa or mixed bone lesions--a group of patients that might benefit from aggressive vitamin D therapy. In contrast, an examination of patients with serum calcium levels > 10.0 mg/dL and serum PTH levels < 65 pg/mL correctly identified three out of three patients with aluminum-related bone disease. These findings suggest that measurements of serum intact PTH levels by the immunoradiometric assay method may be valuable in distinguishing high-turnover lesions from normal or low-turnover skeletal lesions in this population.