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儿童慢性肾脏病矿物质和骨异常

Chronic kidney disease mineral and bone disorder in children.

作者信息

Wesseling Katherine, Bakkaloglu Sevcan, Salusky Isidro

机构信息

Pediatric Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

出版信息

Pediatr Nephrol. 2008 Feb;23(2):195-207. doi: 10.1007/s00467-007-0671-3. Epub 2007 Nov 28.

Abstract

Childhood and adolescence are crucial times for the development of a healthy skeletal and cardiovascular system. Disordered mineral and bone metabolism accompany chronic kidney disease (CKD) and present significant obstacles to optimal bone strength, final adult height, and cardiovascular health. Decreased activity of renal 1 alpha hydroxylase results in decreased intestinal calcium absorption, increased serum parathyroid hormone levels, and high-turnover renal osteodystrophy, with subsequent growth failure. Simultaneously, phosphorus retention exacerbates secondary hyperparathyroidism, and elevated levels contribute to cardiovascular disease. Treatment of hyperphosphatemia and secondary hyperparathyroidism improves growth and high-turnover bone disease. However, target ranges for serum calcium, phosphorus, and parathyroid hormone (PTH) levels vary according to stage of CKD. Since over-treatment may result in adynamic bone disease, growth failure, hypercalcemia, and progression of cardiovascular calcifications, therapy must be carefully adjusted to maintain optimal serum biochemical parameters according to stage of CKD. Newer therapeutic agents, including calcium-free phosphate binding agents and new vitamin D analogues, effectively suppress serum PTH levels while limiting intestinal calcium absorption and may provide future therapeutic alternatives for children with CKD.

摘要

儿童期和青春期是健康骨骼和心血管系统发育的关键时期。矿物质和骨代谢紊乱伴随慢性肾脏病(CKD)出现,对达到最佳骨强度、最终成人身高和心血管健康构成重大障碍。肾1α羟化酶活性降低导致肠道钙吸收减少、血清甲状旁腺激素水平升高以及高转换型肾性骨营养不良,继而出现生长发育迟缓。同时,磷潴留会加重继发性甲状旁腺功能亢进,而升高的磷水平会导致心血管疾病。治疗高磷血症和继发性甲状旁腺功能亢进可改善生长发育和高转换型骨病。然而,血清钙、磷和甲状旁腺激素(PTH)水平的目标范围会因CKD的阶段而异。由于过度治疗可能导致动力缺失性骨病、生长发育迟缓、高钙血症以及心血管钙化进展,因此必须根据CKD的阶段仔细调整治疗方案,以维持最佳的血清生化参数。新型治疗药物,包括不含钙的磷结合剂和新型维生素D类似物,可有效抑制血清PTH水平,同时限制肠道钙吸收,可能为CKD患儿提供未来的治疗选择。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5150/2668632/d6bb81d7e454/467_2007_671_Fig1_HTML.jpg

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