Koall W, Luci V
Z Gesamte Inn Med. 1983 Sep 15;38(18):481-8.
In 25 (33.8%) of 74 chronically haemodialysed patients a distinct osteopathy with bone pain, spontaneous fractures, arthralgias and weakness of the muscles due to dialysis was present. In comparison to a group without complaints the duration of the dialysis was longer by 6 months, the mineral contents of the bones was decreased in 38%, in the comparative group in 22%. A progressive demineralisation was found in 46%, in the comparative group in 20%. Hypercalcaemias under vitamin D2 caused a therapy resistance. In 1 exemplary case (type IIc, PTH 0.3 micrograms/l) in the 3rd year of dialysis a fracture of the neck of the femur took place and an endoprosthesis was implanted. There was a progressive demineralisation of about 16%. The suspicion of a typical combination with an encephalopathy due to dialysis did not confirm itself. A pseudocyst in the brain was found. The differential diagnosis to the hypercalcaemia-induced psychosis in the osteopathy due to dialysis is discussed. In a prophylactic application dihydrotachysterine proved favourable for avoidance of an osteopathy due to dialysis. Parallel to the clinical progressing of the osteopathy due to dialysis a progressive demineralisation could be demonstrated at the peripheral mineral contents of the bones. Extreme losses of minerals appeared from the 4th to the 59th month of dialysis from - 16% to - 37% and from the 22nd to the 87th month from plus 11% to minus 14% of the age-and-sex-specific normal values. Successful transplantations led to the stagnation of the progressive demineralisation, unsucessful transplantations increase them. The influence of the non-refined water for the production of dialysate by possible aluminium intoxications on the development of the osteopathy due to dialysis is discussed.
在74例长期血液透析患者中，有25例（33.8%）出现了明显的骨病，表现为骨痛、自发性骨折、关节痛以及因透析导致的肌肉无力。与无相关症状的一组相比，透析时间长6个月，38%的患者骨矿物质含量降低，而对照组为22%。46%的患者存在进行性脱矿，对照组为20%。维生素D2治疗下的高钙血症导致治疗抵抗。在1例典型病例（IIc型，甲状旁腺激素0.3微克/升）中，透析第3年发生股骨颈骨折并植入了假体。存在约16%的进行性脱矿。透析所致脑病典型组合的怀疑未得到证实，而是发现了脑内假囊肿。讨论了与透析性骨病中高钙血症所致精神病的鉴别诊断。预防性应用二氢速甾醇对避免透析性骨病有利。随着透析性骨病临床进展，可在骨的外周矿物质含量处证实进行性脱矿。透析第4至59个月矿物质极端丢失率为-16%至-37%，第22至87个月为年龄和性别特异性正常值的+11%至-14%。成功的移植导致进行性脱矿停滞，不成功的移植则使其加剧。讨论了用于生产透析液的未净化水可能因铝中毒对透析性骨病发展的影响。
