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Fini M, Nicolialdini N, Gandolfi M, Mattiolibelmonte M, Giavaresi G, Zucchini C, De Benedittis A, Amati S, Ravaguoli A, Krayewski A, Rocca M, Guzzardella GA, Biagini G, Giardino R. Biomaterials for Orthopedic Surgery in Osteoporotic Bone: A Comparative Study in Osteopenic Rats. Int J Artif Organs 2018. [DOI: 10.1177/039139889702000510] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To evaluate orthopedic devices in pathological bone, an experimental study was performed by implanting Titanium (Ti) and Hydroxyapatite (HA) rods in normal and osteopenic bone. Twenty-four rats were used: 12 were left intact (Control: C) while the other 12 were ovariectomized (OVX). After 4 months all the animals were submitted to the implant of Ti or HA in the left femoral condyle (Ti-C, HA-C, Ti-OVX, HA-OVX). Two months later the animals were sacrificed for histomorphometric, ultrastructural and microanalytic studies. Our results show a significant difference between the Affinity Index (A.I.) of HA-C and Ti-C (77.0 ± 7.4 vs 61.2 ± 9.7) (p < 0.05). No significant differences were observed between the osteointegration of Ti-C and Ti-OVX (61.2 ± 9.7 vs 48.2 ± 6.7). Significant differences also exist between the osteointegration of HA-C and HA-OVX (77.0 ± 7.4 vs 57.6 ± 11.5) (p < 0.01). Microanalysis shows some modifications in Sulphur (S) concentration at the bone/biomaterial interface of the Ti-OVX group. Therefore our results confirmed the importance of biomaterials characteristics and of bone quality in osteointegration processes.
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Affiliation(s)
- M. Fini
- Experimental Surgery Department (Rizzoli Orthopaedic Institute) and Chair of Surgical Pathophysiology, University of Bologna,
| | - N. Nicolialdini
- Experimental Surgery Department (Rizzoli Orthopaedic Institute) and Chair of Surgical Pathophysiology, University of Bologna,
| | - M.G. Gandolfi
- Institute of Histology and General Embriology, University of Bologna, Bologna
| | | | - G. Giavaresi
- Experimental Surgery Department (Rizzoli Orthopaedic Institute) and Chair of Surgical Pathophysiology, University of Bologna,
| | - C. Zucchini
- Institute of Histology and General Embriology, University of Bologna, Bologna
| | | | - S. Amati
- Institute of Normal Human Morphology, University of Ancona, Ancona
| | - A. Ravaguoli
- Institute for Technological Research on Ceramics of CNR, Faenza - Italy
| | - A. Krayewski
- Institute for Technological Research on Ceramics of CNR, Faenza - Italy
| | - M. Rocca
- Experimental Surgery Department (Rizzoli Orthopaedic Institute) and Chair of Surgical Pathophysiology, University of Bologna,
| | - G-A. Guzzardella
- Experimental Surgery Department (Rizzoli Orthopaedic Institute) and Chair of Surgical Pathophysiology, University of Bologna,
| | - G. Biagini
- Department of Materials Sciences, University of Ancona, Ancona
| | - R. Giardino
- Experimental Surgery Department (Rizzoli Orthopaedic Institute) and Chair of Surgical Pathophysiology, University of Bologna,
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Vogiatzi MG, Jacobson-Dickman E, DeBoer MD. Vitamin D supplementation and risk of toxicity in pediatrics: a review of current literature. J Clin Endocrinol Metab 2014; 99:1132-41. [PMID: 24456284 DOI: 10.1210/jc.2013-3655] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
CONTEXT Although vitamin D toxicity is rare in children, increased use of vitamin D formulations, re-examination of optimal vitamin D levels, and use of higher doses lend potential for an increased incidence of vitamin D toxicity. EVIDENCE ACQUISITION A PubMed search was conducted through May 2013 for cases of vitamin D intoxication and vitamin D trials in pediatrics. Safety data were collected and reviewed. EVIDENCE SYNTHESIS A small number of pediatric studies tested vitamin D doses at or above the currently recommended upper tolerable intake. In children and adolescents, vitamin D excess was rare and usually asymptomatic. Recent cases of intoxication relate to errors in manufacturing, formulation, or prescription; involve high total intake in the range of 240,000 to 4,500,000 IU; and present with severe hypercalcemia, hypercalciuria, or nephrocalcinosis. However, mild hypercalcemia and hypervitaminosis using currently recommended doses have been reported in infants with rickets. CONCLUSIONS Although rare, cases of vitamin D intoxication that present with dramatic life-threatening symptoms still occur in children. Moreover, recent studies in infants raise a potential need for monitoring vitamin D levels when doses at or above the currently recommended upper range are used. Further studies are needed to clarify these findings. The Drugs and Therapeutics Committee of the Pediatric Endocrine Society suggests obtaining serum 25-hydroxyvitamin D levels in infants and children who receive long-term vitamin D supplementation at or above the upper level intake that is currently recommended.
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Affiliation(s)
- Maria G Vogiatzi
- Weill Cornell Medical College (M.G.V.), New York, New York 10065; SUNY Downstate Medical Center (E.J.-D.), Brooklyn, New York 11203; and University of Virginia Health System (M.D.D.), Charlottesville, Virginia 22908
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Curran SP, Chan CT. Intensive hemodialysis: normalizing the "unphysiology" of conventional hemodialysis? Semin Dial 2011; 24:607-13. [PMID: 22122548 DOI: 10.1111/j.1525-139x.2011.01010.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Interest in intensified hemodialysis (HD) regimens is increasing internationally, as there is growing evidence that they are associated with improved outcomes. Appreciation that conventional hemodialysis (CHD), delivered as 4-hour sessions three times a week, is not providing optimal physiological replacement of renal function has led to the development of intensified dialysis therapies. These include long intermittent hemodialysis typically lasting 6-8 hours and delivered three times a week, short daily hemodialysis, providing more frequent sessions 4-7 days a week lasting 2-3.5 hours, and nocturnal hemodialysis, performed 5-7 days a week for 6-8 hours. Studies evaluating outcomes from these programs have indicated superior results to those achieved with CHD, including favorable modifications of cardiovascular risk factors and improvements in a variety of clinical measures. The objective of this review is to present available evidence supporting the hypothesis that in an attempt to provide a "more normal physiology," intensified HD regimens achieve outcomes superior to those historically achieved with CHD.
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Affiliation(s)
- Simon P Curran
- Division of Nephrology, Department of Medicine, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
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Greenbaum LA, Warady BA, Furth SL. Current advances in chronic kidney disease in children: growth, cardiovascular, and neurocognitive risk factors. Semin Nephrol 2009; 29:425-34. [PMID: 19615563 PMCID: PMC2765584 DOI: 10.1016/j.semnephrol.2009.03.017] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Linear growth and neurocognitive development are two of the most important differences between adults and children, in terms of clinical issues that must be addressed in patients with chronic kidney disease (CKD). Correction of metabolic acidosis, nutritional deficiency, and renal osteodystrophy improve linear growth, but many children require administration of growth hormone to achieve normal growth. A variety of neurocognitive deficits occur in children with CKD, although there has been an improvement in outcome via improved dialysis, correction of malnutrition, and decreased aluminum exposure. Although growth and neurocognitive development are delayed, cardiovascular complications are accelerated in children with CKD, and are reflected in a dramatic increase in cardiovascular mortality compared with healthy children. Other early cardiovascular complications in children with CKD include left ventricular hypertrophy, cardiac dysfunction, and vascular calcifications.
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Affiliation(s)
- Larry A Greenbaum
- Division of Pediatric Nephrology, Department of Pediatrics, Emory University, 2015 Uppergate Drive NE, Atlanta, GA 30322, USA.
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The effect of fluoride on enamel and dentin formation in the uremic rat incisor. Pediatr Nephrol 2008; 23:1973-9. [PMID: 18563453 PMCID: PMC7462915 DOI: 10.1007/s00467-008-0890-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Revised: 03/28/2008] [Accepted: 05/04/2008] [Indexed: 11/06/2022]
Abstract
Renal impairment in children is associated with tooth defects that include enamel pitting and hypoplasia. However, the specific effects of uremia on tooth formation are not known. In this study, we used rat mandibular incisors, which continuously erupt and contain all stages of tooth formation, to characterize the effects of uremia on tooth formation. We also tested the hypothesis that uremia aggravates the fluoride (F)-induced changes in developing teeth. Rats were subjected to a two-stage 5/6 nephrectomy or sham operation and then exposed to 0 (control) or 50 ppm NaF in drinking water for 14 days. The effects of these treatments on food intake, body growth rate, and biochemical serum parameters for renal function and calcium metabolism were monitored. Nephrectomy reduced food intake and weight gain. Intake of F by nephrectomized rats increased plasma F levels twofold and further decreased food intake and body weight gain. Uremia affected formation of dentin and enamel and was more extensive than the effect of F alone. Uremia also significantly increased predentin width and induced deposition of large amounts of osteodentin-like matrix-containing cells in the pulp chamber. In enamel formation, the cells most sensitive to uremia were the transitional-stage ameloblasts. These data demonstrate that intake of F by rats with reduced renal function impairs F clearance from the plasma and aggravates the already negative effects of uremia on incisor tooth development.
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Greenbaum LA, Benador N, Goldstein SL, Paredes A, Melnick JZ, Mattingly S, Amdahl M, Williams LA, Salusky IB. Intravenous paricalcitol for treatment of secondary hyperparathyroidism in children on hemodialysis. Am J Kidney Dis 2007; 49:814-23. [PMID: 17533024 DOI: 10.1053/j.ajkd.2007.03.008] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Accepted: 03/13/2007] [Indexed: 11/11/2022]
Abstract
BACKGROUND Secondary hyperparathyroidism is a common complication in children receiving hemodialysis. Active vitamin D is an effective therapy, but its use is often limited by hypercalcemia and increased calcium x phosphorus (Ca x P) product. Paricalcitol, a selective vitamin D receptor activator, causes less sustained hypercalcemia and increase in Ca x P product than calcitriol and has been used effectively in adult hemodialysis patients. STUDY DESIGN Double blind, placebo-controlled. SETTING & PARTICIPANTS Hemodialysis units and pediatric subjects receiving hemodialysis. INTERVENTION After a washout period of 2 to 6 weeks, 29 subjects aged 5 to 19 years received either paricalcitol or placebo for up to 12 weeks (0.04 mug/kg if initial intact parathyroid hormone [iPTH] level < 500 pg/mL [ng/L]; 0.08 mug/kg if initial iPTH level > 500 pg/mL [ng/L]). The dose was increased by 0.04 mug/kg every 2 weeks until there was a 30% decrease in iPTH level from baseline or calcium level greater than 11 mg/dL (>2.74 mmol/L) or Ca x P product greater than 75 mg(2)/dL(2) (>6.04 mmol(2)/L(2)). OUTCOMES & MEASUREMENTS Two consecutive 30% decreases from baseline in iPTH levels and safety of paricalcitol, including hypercalcemia and increase in Ca x P product. RESULTS 60% of the paricalcitol group had 2 consecutive 30% decreases from baseline iPTH levels compared with 21% in the placebo group (P = 0.06). The paricalcitol group had a mean decrease in iPTH level of 164 pg/mL (ng/L), whereas the placebo group had a mean increase of 238 pg/mL (ng/L; P = 0.03). There was no difference from baseline to final visit in calcium, phosphorus, or Ca x P product values in either group. LIMITATIONS Low power to detect differences in safety between groups and a short-term study. CONCLUSION Paricalcitol decreased iPTH levels in children receiving hemodialysis with no significant changes in serum calcium, phosphorus, or Ca x P product values during the course of the study.
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Affiliation(s)
- Larry A Greenbaum
- Emory University and Children's Healthcare of Atlanta, GA 30322, USA.
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Sheth RD, Goldstein SL. Comparison of 1-84 and intact parathyroid hormone assay in pediatric dialysis patients. Pediatr Nephrol 2005; 20:977-81. [PMID: 15856315 DOI: 10.1007/s00467-005-1862-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Revised: 01/11/2005] [Accepted: 01/11/2005] [Indexed: 10/25/2022]
Abstract
The non-invasive diagnosis of renal osteodystrophy (ROD) in patients with end-stage renal disease (ESRD) remains dependent on the determination of an accurate parathyroid hormone (PTH) level. Older assays that determine the "intact" PTH molecule are known to cross react with various PTH fragments, resulting in overestimation of PTH levels. Recently, assays that determine the whole 1-84 PTH molecule have been made available. Monthly PTH values in chronic dialysis patients at our institution were compared using the Nichols Bio-Intact PTH (BiPTH, 1-84 PTH) and the intact PTH (iPTH) assay over 3 consecutive months. One hundred twenty-four samples were obtained from 51 (29 male) pediatric dialysis patients (27 HD). The mean patient age was 14.2+/-5.6 years (1.8-25.7 years), with 12 patients<10 years and 15 patients <30 kg. The mean 1-84 PTH/iPTH ratio was 0.48+/-0.11. While BiPTH values correlated closely with iPTH values ( r =0.98, P <0.05), we observed significant intra-patient (16.4+/-15.4%; range: -73.9 to 67.7%, total % error: 47.2%) and inter-patient (17.2+/-18.9%; range: -73.9 to 129.9%, total % error: 55%) variability in the 1-84 PTH/iPTH ratio over the 3-month study period. Thus, our findings suggest that ROD management based on prior associations between iPTH levels and bone biopsy findings should not be extrapolated using the newer 1-84 PTH assay.
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Affiliation(s)
- Rita D Sheth
- Department of Pediatrics, Baylor College of Medicine, and texas Children's Hospital, 6621 Fannin Street MC 3-2482, Houston, TX 77030, USA.
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Greenbaum LA, Grenda R, Qiu P, Restaino I, Wojtak A, Paredes A, Benador N, Melnick JZ, Williams LA, Salusky IB. Intravenous calcitriol for treatment of hyperparathyroidism in children on hemodialysis. Pediatr Nephrol 2005; 20:622-30. [PMID: 15785941 DOI: 10.1007/s00467-004-1792-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2003] [Revised: 10/27/2004] [Accepted: 10/28/2004] [Indexed: 10/25/2022]
Abstract
This double-blind, placebo-controlled study evaluated the safety and efficacy of intravenous (i.v.) calcitriol (Calcijex) for treatment of secondary hyperparathyroidism (secondary HPT) in pediatric end-stage renal disease (ESRD) patients on hemodialysis (HD). After a 2 to 6-week washout period of all vitamin D compounds, patients with two consecutive PTH values > 400 pg mL(-1), calcium levels < or = 10.5 mg dL(-1) and calcium x phosphorus product values < or = 70 mg2 dL(-2) were eligible for the treatment phase. Patients received a bolus injection of calcitriol or placebo three times a week, immediately after dialysis for up to 12 weeks. Initial doses (0.5-1.5 microg) were based on the severity of secondary HPT. The dose was increased every two weeks by 0.25 microg until there was at least a 30% decrease in PTH from baseline, or Ca > 11.0 mg dL(-1), or Ca x P > 75 mg2 dL(-2). Overall, 11/21 (52%) patients in the calcitriol group had two consecutive > or = 30% decreases from baseline in serum PTH compared with 5/26 (19%) patients in the placebo group (P=0.03). The mean total alkaline phosphatase decreased from 274 to 232 IU L(-1) in the calcitriol group and increased from 547 to 669 IU L(-1) in the placebo group (P=0.002). The mean bone-specific alkaline phosphatase decreased from 72.5 to 68 microg L(-1) in the calcitriol group and increased from 105.3 to 148.5 microg L(-1) in the placebo group (P=0.03). The incidence of two consecutive occurrences of elevated calcium x phosphorus (Ca x P > 75 mg2 dL(-2)) product was higher in the calcitriol group than in the placebo group (P=0.01). Two consecutive occurrences of phosphorus > 6.5 mg dL(-1) occurred in 71% of the calcitriol group and 46% of the placebo group (P=0.14). Calcium levels > 10.5 mg dL(-1) were more common in the calcitriol group than in the placebo group (P=0.01). There was a direct relationship between serum phosphorus concentration and the percentage change in PTH from baseline in both the calcitriol group (r=0.46; P<0.0001) and the placebo group (r=0.21; P=0.0005). This study demonstrates that i.v. calcitriol, at initial doses of 0.5-1.5 microg, effectively reduces PTH levels in pediatric HD patients and that patients should be closely monitored for hyperphosphatemia and elevated Ca x P product.
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Affiliation(s)
- Larry A Greenbaum
- Department of Pediatrics, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA.
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Greenbaum LA, Del Rio M, Bamgbola F, Kaskel F. Rationale for growth hormone therapy in children with chronic kidney disease. Adv Chronic Kidney Dis 2004. [DOI: 10.1053/j.ackd.2004.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
Increased longevity and improved medical management of children with chronic illnesses has led to a focus on the short- and long-term consequences of these conditions on bone health. Bone loss is influenced by diet, malabsorption, and disease-related imbalances in bone turnover. It may be exacerbated by common medications, especially corticosteroids. Assessment of bone mass and quality, calcium absorption, kinetically derived rates of bone turnover, and biochemical markers of bone turnover have increased our knowledge of the pathophysiology of bone loss in these children as well as provided insights into possible therapeutic interventions. Increased intake of calcium and vitamin D, while useful, is unlikely to prevent or resolve bone loss in many chronically ill children. Emphasis on combination of nutritional interventions with exercise and newer bone-sparing therapies may be necessary.
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Affiliation(s)
- S A Abrams
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas 77030, USA.
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Abstract
Despite advances in the management of patients with chronic renal failure, histologic features associated with secondary hyperparathyroidism remain the predominant skeletal findings; however, over the last decade the prevalence of adynamic bone has increased in both adult and pediatric patients with chronic renal failure. The management of children with secondary hyperparathyroidism and mild to moderate chronic renal failure should be started early, and should include correction of hypocalcemia and metabolic acidosis, maintenance of age-appropriate serum phosphorus levels, and institution of vitamin D therapy when serum intact parathyroid hormone (PTH) measurements are elevated to maintain the blood levels within normal limits; however, in children undergoing chronic dialysis therapy, the current recommendation is to maintain the serum intact PTH levels at least 2-4 times the upper limits of normal to prevent the development of low bone turnover disease. Serum calcium, phosphorus, alkaline phosphatase, and PTH levels should be monitored frequently, especially in infants and very young children. Discontinuation or reduction of vitamin D should be considered when there is a rapid decline in PTH levels, persistent elevation in serum calcium and serum phosphorus levels, and a significant diminution in alkaline phosphatase levels. In addition, a reduction in the calcium concentration of the dialysis fluid, and judicious use of calcium-containing salts as phosphate binding agents should also be performed in these patients. Although not yet extensively used in pediatric patients with secondary hyperparathyroidism, several therapeutic alternatives, such as the less calcemic vitamin D analogs, including paricalcitol [19-nor-1,25-(OH)(2)D(2)] and doxercalciferol [1-alpha-(OH)(2)D(2)], calcimimetics, and the availability of a calcium-free, aluminum-free phosphate binder such as sevelamer hydrochloride and lanthanum carbonate, may play significant roles in the future management of children with secondary hyperparathyroidism to promote linear growth, prevent parathyroid gland hyperplasia, avoid calciphylaxis and, in the long run, avert vascular calcifications.
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Affiliation(s)
- Cheryl P Sanchez
- Department of Pediatrics, University of Wisconsin Medical School, Madison, Wisconsin 53706, USA.
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Alon US. Preservation of bone mass in pediatric dialysis and transplant patients. ADVANCES IN RENAL REPLACEMENT THERAPY 2001; 8:191-205. [PMID: 11533920 DOI: 10.1053/jarr.2001.26352] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Renal osteodystrophy continues to be a major challenge to the physician treating the child with end-stage renal disease (ESRD). The gold standard for the assessment of bone status is bone histomorphometry, which divides bone pathology into 3 main types; high-turnover, low-turnover, and mixed disease. The high-turnover disease, related to hyperparathyroidism, has been the one most extensively investigated; however, optimal therapy, especially in the growing child, is yet unclear. Overzealous treatment might result in adynamic bone disease (an extreme example of low-turnover disease), and further interference with statural growth. Pre-existent bone disease after kidney transplantation seems to worsen immediately, probably because of the high dose of corticosteroids used. In children who attain normal kidney function in the allograft, bone status seems to improve over time. Little is known about bone in transplanted patients with reduced glomerular filtration rate (GFR). The correlation between bone histology and its main surrogates, bone remodeling markers and bone mineral density, is yet unclear, but it might serve to follow the progress of an individual patient. New therapeutic modalities aimed at suppressing hyperparathyroidism, and consequently bone resorption, as well as agents directly attenuating bone resorption, should be further investigated for their effect on bone in patients with ESRD or after transplantation. Similarly, agents stimulating bone formation, particularly growth hormone, require further attention for their potential to improve bone status. Bone health and the child's somatic growth at ESRD or after kidney transplantation are closely related, and therapy should be aimed at achieving optimal results for both.
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Affiliation(s)
- U S Alon
- Section of Pediatric Nephrology and Bone and Mineral Disorders Clinic, The Children's Mercy Hospital, University of Missouri at Kansas City, Kansas City, MO 64108, USA.
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Macher MA, Baudouin V, Akil R, Loirat C. [Current treatment of renal osteodystrophy in children]. Arch Pediatr 2000; 4:91s-94s. [PMID: 9246312 DOI: 10.1016/s0929-693x(97)86470-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- M A Macher
- Service de néphrologie, hôpital Robert-Debré, Paris, France
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Demircin G, Oner A, Ecin N, Bülbül M, Somuncu I, Tunali H. Microfocal radiography in the diagnosis of childhood renal osteodystrophy. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1998; 40:461-5. [PMID: 9821707 DOI: 10.1111/j.1442-200x.1998.tb01969.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Renal osteodystrophy is common in children with chronic renal failure (CRF) and X-ray is an intensive method in the diagnosis of the disease. In this study we compared microfocal radiography with conventional method for the diagnosis of renal osteodystrophy. METHODS The X-rays of left wrists of 21 children with CRF and chronic renal insufficiency were taken by conventional and microfocal methods. RESULTS Both methods revealed osteopenia in all patients (100%), widening, fraying and cupping of ulnar and radial metaphysis in 10 (47.6%), osteosclerosis in three (14.2%) and pseudofracture in one (4.7%) patient. Microfocal radiography demonstrated osteosclerosis in one patient, pseudofracture in four and subperiosteal resorption in five patients that were not detected by conventional method. CONCLUSION Two methods were found to be significantly different in demonstrating the changes due to rickets and hyperparathyroidism and it is concluded that microfocal radiography may be preferred in the diagnosis of childhood renal osteodystrophy.
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Affiliation(s)
- G Demircin
- Dr Sami Ulus Children's Hospital, Department of Nephrology, Ankara, Turkey
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Duarte ME, Peixoto AL, Pacheco AS, Peixoto AV, Rodriguez RD, Lugon JR, Cruz EA. The spectrum of bone disease in 200 chronic hemodialysis patients: a correlation between clinical, biochemical and histological findings. SAO PAULO MED J 1998; 116:1790-7. [PMID: 10030103 DOI: 10.1590/s1516-31801998000500002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Renal osteodystrophy includes the complete range of mineral metabolism disorders that affect the skeleton in patients with chronic renal failure. PATIENTS AND METHODS 200 patients with end-stage renal disease and on dialysis were investigated regarding the clinical, biochemical and histological findings of bone disease. RESULTS The spectrum of renal osteodystrophy consisted mainly of high turnover bone lesions (74.5%), including osteitis fibrosa in 57.5%. Patients with mild bone disease were on dialysis for shorter periods of time and were mostly asymptomatic. Patients with aluminum-related bone disease (16.5%) had the greatest aluminum exposure, either orally or parenterally, and together with patients with high turnover mixed disease, were the most symptomatic. Although on a non-regular basis, the vast majority of the patients (82.5%) had been receiving vitamin D. The incidence of adynamic bone disease was high (n = 8) among parathyroidectomized patients (n = 12). Significantly higher serum levels of alkaline phosphatase were observed in osteitis fibrosa. CONCLUSIONS The use of calcitriol and phosphate-binding agents on a non-regular basis seems to be the reason for the apparent reduced response to the treatment of secondary hyperparathyroidism. Alkaline phosphatase has been shown to be a fair marker for bone turnover in patients with osteitis fibrosa. The severity of the clinical manifestations of bone disease correlates with the histological features of bone lesion and to the time spent on dialysis.
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Affiliation(s)
- M E Duarte
- Department of Pathology, Universidade Federal Fluminense-Niterói, Brazil
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Abstract
OBJECTIVE To review the medical literature on management of end-stage renal disease (ESRD) and its complications in the pediatric patient. DATA SOURCES AND STUDY SELECTION MEDLINE searches (1970-1997) of the English-language literature. Clinical trials and reviews of drug therapy management were included, and bibliographies were reviewed for relevant articles. DATA SYNTHESIS Principles of renal replacement therapy in children have been expanded to include maintenance of fluid and electrolyte balance and to manage the complications of ESRD in children. Types of renal replacement and their complications are reviewed. Complications of ESRD are reviewed with emphasis on drug therapy management of anemia of chronic renal failure, growth retardation, and hypertension. A discussion of the use of vitamins and supplements to maintain bone and mineral homeostasis is provided, and specific recommendations for vaccination of children with ESRD are given. CONCLUSIONS Children with end-stage renal failure present a unique challenge to the pharmacist. Renal replacement therapy for children with ESRD involves some form of dialysis and an intensive medication regimen. Complications must be treated with appropriate drug therapy. Drug therapy must be monitored closely for dosage adjustment, clinical response, drug interactions, and toxicity. Patients and families must receive continuous education and follow-up to encourage compliance. The pharmacist must work closely with the healthcare team to optimize drug therapy and improve patient education and compliance.
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Affiliation(s)
- P S Smith
- University of Tennessee, Department of Pharmacy, College of Pharmacy, Knoxville, USA
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