Mathias R, Salusky I, Harman W, Paredes A, Emans J, Segre G, Goodman W
Division of Nephrology, Children's Hospital, Boston, MA.
J Am Soc Nephrol. 1993 Jun;3(12):1938-46. doi: 10.1681/ASN.V3121938.
Renal bone disease has been well defined in adult patients receiving chronic dialysis and in children on peritoneal dialysis/continuous ambulatory peritoneal dialysis. However, little is known about the histologic features in patients undergoing chronic hemodialysis in a children's hospital center. Twenty one patients, aged 17.5 +/- 1.5 yr, on hemodialysis for 35 +/- 6 months underwent iliac crest bone biopsies and deferoxamine infusion tests. Nineteen of 21 patients were receiving oral calcitriol. The 21 patients were classified by histomorphometry as follows: osteitis fibrosa, 5; mild hyperparathyroidism, 3; normal histology, 3; aplastic, 6; and mixed lesions, 4. Four of 21 patients were surface positive for aluminum, and seven other patients stained positive for iron in bone. Serum parathyroid hormone (PTH) levels correlated directly with the bone formation rate (r = 0.84) and with eroded bone perimeter (r = 0.67). Eight of the nine patients with serum PTH levels above 125 pg/mL had marrow fibrosis. All patients with serum calcium levels < 10.0 mg/dL and serum PTH levels > 125 pg/mL had either osteitis fibrosa or mixed bone lesions--a group of patients that might benefit from aggressive vitamin D therapy. In contrast, an examination of patients with serum calcium levels > 10.0 mg/dL and serum PTH levels < 65 pg/mL correctly identified three out of three patients with aluminum-related bone disease. These findings suggest that measurements of serum intact PTH levels by the immunoradiometric assay method may be valuable in distinguishing high-turnover lesions from normal or low-turnover skeletal lesions in this population.
肾性骨病在接受慢性透析的成年患者以及接受腹膜透析/持续非卧床腹膜透析的儿童中已有明确界定。然而，对于儿童医院中心接受慢性血液透析患者的组织学特征却知之甚少。21例年龄为17.5±1.5岁、接受血液透析35±6个月的患者接受了髂嵴骨活检和去铁胺输注试验。21例患者中有19例正在接受口服骨化三醇治疗。通过组织形态计量学将这21例患者分类如下：纤维性骨炎5例；轻度甲状旁腺功能亢进3例；组织学正常3例；骨再生障碍6例；混合性病变4例。21例患者中有4例骨表面铝染色阳性，另有7例患者骨中铁染色阳性。血清甲状旁腺激素（PTH）水平与骨形成率直接相关（r = 0.84），与侵蚀骨周长也直接相关（r = 0.67）。血清PTH水平高于125 pg/mL的9例患者中有8例存在骨髓纤维化。所有血清钙水平<10.0 mg/dL且血清PTH水平>125 pg/mL的患者均患有纤维性骨炎或混合性骨病变——这组患者可能从积极的维生素D治疗中获益。相比之下，对血清钙水平>10.0 mg/dL且血清PTH水平<65 pg/mL的患者进行检查，正确识别出了3例铝相关性骨病患者中的3例。这些发现表明，采用免疫放射分析方法测定血清完整PTH水平对于区分该人群中高转换性病变与正常或低转换性骨骼病变可能具有重要价值。
