Cervar M, Stavljenic A, Vukicević S
Lijec Vjesn. 1989 Apr-May;111(4-5):164-9.
Aluminum intoxication is common in patients with chronic renal failure because of absorption of aluminum during dialysis from aluminum-containing dyalysate water and ingestion of phosphate binders containing aluminum. Aluminum accumulation in the body is followed by bone disease, encephalopathy and anemia. Bone diseases can be recorded in 44% of the patients treated with long-term dialysis. Two early histologic types of retarded bone turnover can be seen, i.e. osteomalacia and aplastic bone disease. In dialyzed patients, osteomalacia is usually followed by low PTH level in human serum. On the contrary, studies on uremic rats have shown that previous parathyroidectomy can prevent aluminum intoxication, because hyperparathyroidism in an early phase of chronic renal failure increases aluminum absorption from the gut and its accumulation in the body. As the pathogenesis of aluminum-induced alterations is unclear, the prevention of bone disease should be provided through lowering the aluminum intake in dialyzed patients. Bone biopsy is unavoidable for the early detection and diagnosis of the disease. Promising results in the treatment of aluminum intoxication have been obtained using deferoxamine, a chelating agent.
铝中毒在慢性肾衰竭患者中很常见，这是由于在透析过程中铝从含铝的透析液水中被吸收以及摄入了含铝的磷结合剂。铝在体内蓄积后会引发骨病、脑病和贫血。长期透析治疗的患者中，44%会出现骨病。可以观察到两种早期组织学类型的骨转换延迟，即骨软化症和再生障碍性骨病。在接受透析的患者中，骨软化症通常伴随着人血清中甲状旁腺激素水平降低。相反，对尿毒症大鼠的研究表明，先前的甲状旁腺切除术可以预防铝中毒，因为慢性肾衰竭早期的甲状旁腺功能亢进会增加肠道对铝的吸收及其在体内的蓄积。由于铝诱导的病变发病机制尚不清楚，应通过降低透析患者的铝摄入量来预防骨病。骨活检对于疾病的早期检测和诊断是必不可少的。使用螯合剂去铁胺治疗铝中毒已取得了有前景的结果。
