Sanchez C P, Salusky I B
Department of Pediatrics, UCLA School of Medicine, CA 90095-1752, USA.
Adv Ren Replace Ther. 1996 Jan;3(1):14-23. doi: 10.1016/s1073-4449(96)80037-9.
Renal osteodystrophy represents a spectrum from high- to low-turnover bone lesions. The specific pattern, however, may change during selected therapeutic interventions. As in the past, osteitis fibrosa remains the most frequent histologic lesion in pediatric patients on dialysis, although recently the prevalence of low-turnover bone lesions without aluminum toxicity has been increasing in the pediatric population. This may be a consequence of aggressive calcitriol and calcium therapy. The different factors involved in the development of secondary hyperparathyroidism include hyperphosphatemia, hypocalcemia, altered vitamin D synthesis, impairments in parathyroid hormone (PTH) secretion and metabolism, and, recently, possible downregulation of renal PTH/PTH-rP messenger RNA receptor. New developments in molecular biology have demonstrated the relationship between vitamin D and PTH. The use of high-dose pulse intravenous, intraperitoneal, and oral calcitriol therapy has significantly decreased serum PTH levels and retarded the progression of osteitis fibrosa. These therapeutic interventions, however, may have led to the development of adynamic bone lesions. The impact of adynamic bone lesions in the young and growing skeleton remains to be determined.
肾性骨营养不良表现为从高转换到低转换的一系列骨病变。然而，在特定的治疗干预过程中，具体模式可能会发生变化。与过去一样，纤维性骨炎仍然是接受透析的儿科患者中最常见的组织学病变，尽管最近在儿科人群中无铝毒性的低转换骨病变的患病率一直在上升。这可能是积极使用骨化三醇和钙剂治疗的结果。继发性甲状旁腺功能亢进发展过程中涉及的不同因素包括高磷血症、低钙血症、维生素D合成改变、甲状旁腺激素（PTH）分泌和代谢受损，以及最近肾PTH/PTH-rP信使核糖核酸受体可能下调。分子生物学的新进展已经证明了维生素D与PTH之间的关系。使用大剂量脉冲静脉、腹腔和口服骨化三醇治疗已显著降低血清PTH水平，并延缓了纤维性骨炎的进展。然而，这些治疗干预可能导致了动力缺乏性骨病变的发生。动力缺乏性骨病变对年轻且仍在生长的骨骼的影响尚待确定。
