Shin S K, Kim D H, Kim H S, Shin K T, Ma K A, Kim S J, Kwak Y S, Ha S K, Sherrard D J
Department of Nephrology and Clinical Pathology, School of Medicine, Ajou University, Suwon, Kyunggi, Korea.
Perit Dial Int. 1999;19 Suppl 2:S402-7.
The purpose of the present study is to investigate whether an ethnic difference exists in the incidence of renal osteodystrophy between Asian and Western countries in end-stage renal disease (ESRD) patients. We evaluated bone histology in 58 pre-dialysis patients (28 male, 30 female; mean age: 47.7 years). All patients had bone biopsies with quantitative histomorphometry and serological parameters such as intact PTH, osteocalcin, total alkaline phosphatase, and basal and deferoxamine-stimulated serum aluminum levels. We observed that 91.4% of all evaluated patients showed renal osteodystrophy before the start of dialytic therapy. Mild osteitis fibrosa were observed in 21 patients (36.2%), severe osteitis fibrosa in 5 patients (8.6%), mixed lesions in 7 patients (12.1%), osteomalacia in 6 patients (10.3%), aplastic bone disease in 14 patients (24.1%), and normal bone in 5 patients (8.6%). Among the bone histomorphometric parameters, fibrosis area rate (%) showed the best correlation with intact PTH, and osteocalcin and osteoid area rate (%) with total alkaline phosphatase. Aluminum-related bone disease was not observed. Among patients with aplastic bone disease, only 14.3% showed aluminum deposition of any significance (5% < stainable bone surface aluminum < 25%). In the diabetic patients, aplastic bone disease was most common, but no case was related to aluminum intoxication. In conclusion, the distribution of renal osteodystrophy in our study was different from that of Western countries in pre-dialysis patients. Our patients tended to have more mild-form osteitis fibrosa and normal findings, and less severe-form osteitis fibrosa and aplastic bone disease. Aluminum-related bone disease was not observed.
本研究的目的是调查亚洲和西方国家晚期肾病（ESRD）患者肾性骨营养不良的发病率是否存在种族差异。我们评估了58例透析前患者（28例男性，30例女性；平均年龄：47.7岁）的骨组织学情况。所有患者均接受了骨活检，包括定量组织形态计量学检查以及血清学参数检测，如完整甲状旁腺激素、骨钙素、总碱性磷酸酶，以及基础和去铁胺刺激后的血清铝水平。我们观察到，在开始透析治疗前，所有评估患者中有91.4%表现出肾性骨营养不良。21例患者（36.2%）观察到轻度纤维性骨炎，5例患者（8.6%）观察到重度纤维性骨炎，7例患者（12.1%）观察到混合性病变，6例患者（10.3%）观察到骨软化症，14例患者（24.1%）观察到再生障碍性骨病，5例患者（8.6%）骨正常。在骨组织形态计量学参数中，纤维化面积率（%）与完整甲状旁腺激素的相关性最佳，骨钙素和类骨质面积率（%）与总碱性磷酸酶的相关性最佳。未观察到铝相关性骨病。在再生障碍性骨病患者中，只有14.3%表现出有任何意义的铝沉积（5%＜可染色骨表面铝＜25%）。在糖尿病患者中，再生障碍性骨病最为常见，但无一例与铝中毒相关。总之，我们研究中肾性骨营养不良的分布与西方国家透析前患者不同。我们的患者倾向于有更多轻度纤维性骨炎和正常表现，而重度纤维性骨炎和再生障碍性骨病较少。未观察到铝相关性骨病。
