Department of Internal Medicine III, Academic Teaching Hospital Feldkirch, Carinagasse 47, Feldkirch, Austria.
Department of Internal Medicine IV, Medical University of Innsbruck, Innsbruck, Austria.
BMC Nephrol. 2019 Nov 21;20(1):425. doi: 10.1186/s12882-019-1603-8.
Pregnancy is rare in women on hemodialysis. Recommendations for the treatment of secondary hyperparathyroidism (sHPT) and preservation of bone health in pregnant dialysis patients are lacking.
We present the case of a young woman with end-stage kidney disease (ESKD) due to lupus nephritis, who developed multiple brown tumors while on hemodialysis during her second pregnancy. During her first pregnancy sHPT was well controlled and no skeletal complications occurred. Before the second pregnancy she developed severe sHPT. During pregnancy, dialysis time was increased to 24 h per week, the patient was given oral calcitriol, and the dialysate calcium concentration was set at 1.5 mmol/l. In week 20 the patient complained about bone pain in her left hip. Magnetic resonance imaging revealed a cystic lesion compatible with a brown tumor. The baby was delivered in the 36th week by cesarean section. Further assessment identified multiple brown tumors of her skeleton, including the acetabulum, tibia, ribs, skull, thoracic spine and thumb. She required multiple orthopedic surgeries. Three months after pregnancy, etelcalcetide was started, which brought about a gradual improvement in her sHPT.
This case demonstrates that the combination of pregnancy and severe sHPT in dialysis patients can have deleterious consequences for bone health.
血液透析患者妊娠较为罕见。针对妊娠透析患者继发性甲状旁腺功能亢进症（sHPT）的治疗和骨健康保护，目前尚无相关推荐意见。
我们报告了一例由狼疮性肾炎导致终末期肾病（ESKD）的年轻女性患者，她在第二次妊娠期间进行血液透析时出现了多个棕色瘤。第一次妊娠时 sHPT 得到了很好的控制，没有发生骨骼并发症。第二次妊娠前，她出现了严重的 sHPT。在妊娠期间，每周增加到 24 小时的透析时间，给予患者口服骨化三醇，并且将透析液钙浓度设置为 1.5mmol/L。妊娠第 20 周，患者主诉左侧髋骨疼痛。磁共振成像显示与棕色瘤相符的囊性病变。婴儿在第 36 周通过剖宫产分娩。进一步评估发现她的骨骼有多个棕色瘤，包括髋臼、胫骨、肋骨、颅骨、胸椎和拇指。她需要多次矫形手术。妊娠 3 个月后，开始使用依特卡塞，sHPT 逐渐改善。
本病例表明，妊娠和透析患者严重的 sHPT 同时存在可能会对骨骼健康产生不良影响。
