Pontes Flávia Sirotheau Corrêa, Lopes Márcio Ajudarte, de Souza Lucas Lacerda, Dos Santos da Mata Rezende Diogo, Santos-Silva Alan Roger, Jorge Jacks, da Silva Wagner Gomes, Pires Fábio Ramôa, Rocha André Caroli, de Campos Wladimir Gushiken, Caldato Milena Coelho Fernandes, Martin Regina Matsunaga, Fonseca Felipe Paiva, Pontes Hélder Antônio Rebelo
Service of Oral Pathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Brazil.
Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2018 Jan;125(1):31-43. doi: 10.1016/j.oooo.2017.09.011. Epub 2017 Oct 10.
To describe the oral and maxillofacial manifestations of patients diagnosed with chronic kidney disease-mineral and bone disorders.
Over a 13-year period, clinicopathologic data of patients diagnosed with CKD-MBD who had oral and maxillofacial alterations were retrieved from the files of 4 Brazilian institutions. Data included clinical, radiographic, microscopic, and biochemical findings; treatment employed; and follow-up status.
Twenty-one cases were identified, with 13 patients diagnosed as brown tumor of hyperparathyroidism (BTH) and 8 as osteitis fibrosa/renal osteodystrophy (OF/RO) (4 of them clinically consistent with Sagliker syndrome). The mean age was 32.7 years, and the mandible was the most affected site (42.8%). OF/RO had an ill-defined "ground glass" radiographic appearance, and BTH produced well-defined radiolucent images. Biochemically the following mean values were obtained: parathormone 1511.07 pg/mL, calcium 9.25 mg/dL, phosphorus 5.19 mg/dL, alkaline phosphatase 941.55 U/L, urea 125.42 mg/dL, and creatinine 7.14 mg/dL. Treatment comprised vitamin D and calcium intake, parathyroidectomy, hemodialysis, renal transplantation, and local surgery. During follow-up, 5 patients with BTH were free of lesions, whereas 2 affected by OF/RO/Sagliker syndrome died.
Oral and maxillofacial manifestations of BTH and OF/RO are uncommon, but they can be associated with an important life-threatening scenario.
描述被诊断为慢性肾脏病-矿物质和骨异常患者的口腔颌面部表现。
在13年期间，从4家巴西机构的档案中检索出被诊断为慢性肾脏病-矿物质和骨异常且有口腔颌面部改变患者的临床病理数据。数据包括临床、影像学、显微镜检查和生化检查结果；采用的治疗方法；以及随访状态。
共确定21例病例，其中13例患者被诊断为甲状旁腺功能亢进棕色瘤（BTH），8例为纤维性骨炎/肾性骨营养不良（OF/RO）（其中4例临床上符合萨利克综合征）。平均年龄为32.7岁，下颌骨是最常受累部位（42.8%）。OF/RO在影像学上表现为边界不清的“磨玻璃”样外观，而BTH产生边界清晰的透光图像。生化检查获得的以下平均值为：甲状旁腺激素1511.07 pg/mL、钙9.25 mg/dL、磷5.19 mg/dL、碱性磷酸酶941.55 U/L、尿素125.42 mg/dL和肌酐7.14 mg/dL。治疗包括补充维生素D和钙、甲状旁腺切除术、血液透析、肾移植和局部手术。在随访期间，5例BTH患者病变消失，而2例受OF/RO/萨利克综合征影响的患者死亡。
BTH和OF/RO的口腔颌面部表现并不常见，但可能与严重的危及生命的情况相关。
