Yokoyama Keitaro
Department of Kidney and Hypertension, Jikei University School of Medicine.
Clin Calcium. 2004 Jun;14(6):109-15.
Coronary artery calcification (CAC), observed in most end stage renal disease (ESRD) patients, has been reported to influence mortality and complications of cardiovascular diseases. Depend on the these reports, K/DOQI (Kidney Disease Outcomes Quality Initiative) guideline recommended to control serum Ca and phosphorus levels strictly in ESRD patients, in order to inhibit the progression of CAC. And then, we have been able to use new phosphate binder, sevelamer which dose not contain calcium and will able to use calcimimetics for secondary hyperparathyroidism as soon. Now, we should evaluate the diseases of bone as well as cardiovascular diseases according to the change of paradigms for renal osteodystrophy. It is undoubted that imaging methods play a main role on the management of CAC and coronary stenosis in end stage renal failure patients. Multidetector-row CT (MDCT) is a most useful imaging method, which has high temporal resolution and high spatial resolution. We may obtain adequate image quality for diagnosis and evaluate in 26 cases (87%), except for 4 cases not evaluated due to severe calcification. Therefore, this study suggested that 16-row MSCT is useful as a screening test for coronary angiography (CAG) even in dialysis patients.
在大多数终末期肾病(ESRD)患者中观察到的冠状动脉钙化(CAC),据报道会影响心血管疾病的死亡率和并发症。根据这些报告,肾脏疾病预后质量倡议(K/DOQI)指南建议严格控制ESRD患者的血清钙和磷水平,以抑制CAC的进展。然后,我们能够使用新的不含钙的磷结合剂司维拉姆,并且很快就能使用拟钙剂治疗继发性甲状旁腺功能亢进。现在,我们应该根据肾性骨营养不良范式的变化,对骨骼疾病以及心血管疾病进行评估。毫无疑问,成像方法在终末期肾衰竭患者的CAC和冠状动脉狭窄管理中起着主要作用。多排螺旋CT(MDCT)是一种非常有用的成像方法,具有高时间分辨率和高空间分辨率。除4例因严重钙化未评估外,我们在26例(87%)患者中获得了足够用于诊断和评估的图像质量。因此,本研究表明,即使在透析患者中,16排MSCT作为冠状动脉造影(CAG)的筛查试验也很有用。