肾性骨营养不良

肾脏是参与机体骨代谢的重要器官 ,肾脏病与代谢性骨病密切相关。“肾性骨病”广义而言 ,是指一切和肾脏问题有关的骨病 ;狭义的肾性骨病是指发生于慢性肾功能衰竭 (ＣＲＦ)时的代谢性骨病 ,可视为ＣＲＦ的重要的并发症 ,也即 194 3年我国学者刘士豪、朱宪彝首先提出的“肾性骨营养不良”(ｒｅｎａｌｏｓｔｅｏｄｙｓｔｒｏｐｈｙ)。它按骨组织转运的动力学变化可分为 :高转运型肾性骨病、低转运型肾性骨病及混合型。1　高运转型肾性骨病 (ｈｉｇｈｔｕｒｎｏｖｅｒｕｒｅｍｉｃｏｓｔｅｏｄｙｓ ｔｒｏｐｈｙ)1.1　病理　它主要的病理变化…     

肾性骨营养不良检测进展

肾性骨营养不良(ROD)主要包括高周转型骨病、骨软化症、无力型骨病、混合性骨病四种不同类型.高周转型骨病的骨形成率(BFR)明显升高,全段甲状旁腺激素(PTH)水平高.     

肾性骨营养不良的临床进展

目的肾性骨病是终末期肾衰竭的严重并发症,通过对其进一步的认识,改善维持血液透析和肾移植患者的生存质量;方法查阅文献,综合论点;结果1.25-(OH)2D3是继发性甲状旁腺功能亢进的重要病因;许多生化标志物在肾性骨病的诊断中有一定的价值,但骨活检仍是金指标;明确诊断者需纠正钙、磷代谢紊乱,防治铝中毒,适时应用维生素D代谢物,有适应症者需行甲状旁腺切除术;结论目前已能从细胞分子学角度阐述肾性骨病发病机制,应用生化检测手段辅助诊断,并有一些新的磷结合剂及新的维生素D代谢物应用到临床,肾性骨病的诊治进展必将改善终末期肾衰竭患者的生活质量。     

肝性骨营养不良

肝性骨营养不良南京大学医学院附属医院，南京市鼓楼医院（２１０００８）吴锡琛肝性骨营养不良是指肝病时由于钙磷或维生素Ｄ代谢紊乱，由此引起的一组代谢性骨疾病，包括低钙或高钙血症、骨质疏松、佝偻病与骨软化、继发性甲旁亢等。本文介绍钙磷代谢紊乱所致肝性骨营养...     

肝性骨营养不良

肝性骨营养不良是指肝病时由于钙磷或维生素D代谢紊乱,由此引起的一组代谢性骨疾病,包括低钙或高钙血症、骨质疏松、佝偻病与骨软化、继发性甲旁亢等。本文着重介绍钙磷代谢紊乱所致的肝性骨营养不良。一、骨质疏松:肝病时,特别是阻塞性黄疸患     

肾功衰竭继发骨营养不良

肾性骨营养不良是指由于慢性肾功能衰竭所致的骨代谢性疾病。又叫尿毒症骨营养不良、尿毒症性骨疾病、肾性佝偻病与软骨病等。临床上可见骨骼病变与转移性钙化。病理生理:肾衰早期由于钙吸收不良和肾     

碘化钾抗铅性肾细胞损害的机制探讨

碘化钾抗铅性肾细胞损害的机制探讨蒋云生夏运成罗季安邓世林祖国医学早有用昆布和海藻解铅毒的记载。经现代科学方法分析，可能与其含碘量高有关［１］。笔者曾用碘化钾（ＫＩ）治疗临床及实验性铅性肾病，发现ＫＩ可驱铅、有降低尿糖和尿蛋白、提高肾小球滤过率的作用。...     

肾性骨营养不良的基础与临床 维生素D、钙和磷对甲状旁腺素基因的调节

许多因素可以对甲状旁腺素 (ＰＴＨ)基因进行调节 ,生理状态下最重要的因素是血清钙离子 ,但是其他一些因子 ,如磷、维生素Ｄ对甲状旁腺素基因也可产生巨大的调节作用。1　ＰＴＨ基因的生物学特性ＰＴＨ是由甲状旁腺主细胞分泌的含 84个氨基酸的多肽链 ,分子质量为 90 0 0 ,其生物活性取决于Ｎ端的第 1～ 2 7个氨基酸残基。甲状旁腺细胞能够合成和分泌ＰＴＨ ,说明细胞内存在有特殊的调控ＰＴＨ的顺式元件和反式因子 ,ＰＴＨ基因是一种相对简单的人类基因组基因。ＰＴＨ基因存在于 11号染色体短臂上 ,含有 3个外显子和 2个内含子。ＰＴＨ基…     

强骨胶囊治疗肾性骨病临床观察

目的 观察与分析强骨胶囊在治疗慢性肾功能不全并肾性骨病中的临床疗效.方法 选取82例慢性肾病患者作为研究对象,对其实施相应的血液透析措施和给予强骨胶囊、钙片等治疗6个月,观察治疗前后患者骨密度、骨钙索(BGP)、尿吡啶酚(PYD)、雌二醇(E2)、睾酮(T)、血钙(Ca)、磷(P)、碱性磷酸酶(ALP)等指标改变.结果 骨密度改变:给予药物治疗前骨密度正常11例,骨密度水平低下71例;药物治疗后骨密度水平正常28例,骨密度水平低下12例,好转42例;在药物治疗前后进行比较比较,具有统计学差异(P＜.05).治疗后的BGP显著增加(P＜0.05)PYD显著下降(P＜0.05);治疗后T显著提高(P＜0.05).结论 使用强骨胶囊治疗6个月后,使患者骨密度得到明显改善,缓解临床症状,无明显不良反应,值得临床推广使用.     

肾性高血压的发病机制及处理原则

循环动脉血压升高是所有高血压病的共同表现,其中８５%的病因是原发性高血压,其余的我们称继发性或症状性高血压。肾脏与高血压息息相关,从发生机制上看,可以说一切高血压的发生都有肾脏的参与,甚至是主要的参与因素。例如原发性高血压时肾素血管紧张素醛固酮对血压的调节;再如胰岛素抵抗综合征所致的高血压有肾小管对钠的再吸收增加的参与等。肾性高血压是指原发性肾实质或肾血管病变作为病因所导致的高血压而言,是最常见的继发性高血压,约占所有高血压病人的１０%。肾性高血压按解剖分为肾实质性高血压和肾血管性高血压;按发生机制分为容…     

肾性骨病的影像学诊断

肾性骨病亦称肾性骨营养不良 (ｒｅｎａｌｏｓｔｅｏｄｙｓ ｔｒｏｐｈｙ) ,是由于肾小球衰竭或肾小管功能障碍引起的骨病 ,过去发病很少 ,近来由于治疗的改善 ,病人的生存期提高 ,此病较以前多见且是由于肾脏各种疾病引起的电解质紊乱、酸碱平衡失调和内分泌功能失常在骨结构上的反映。根据病因 ,肾性骨病可分为肾小球性及肾小管性 ,前者引起的骨病以骨软化、佝偻病、纤维囊性骨炎、骨硬化为主 ,后者则以骨软化、佝偻病为主 ,很少发生纤维囊性骨炎和骨硬化。肾透析性骨病是慢性肾衰及透析时有害因素作用引起之骨病 ,亦可称为透析性骨营养不…     

Bone scintigraphy in evaluation of the effect of renal transplantation in patients with renal osteodystrophy

Bone scintigraphy before and after renal transplantation was studied in 14 patients with renal osteodystrophy. The radionuclide distribution patterns visualized on the images before transplantation were classified into two groups; one group with markedly increased tracer uptake throughout the whole skeleton, especially in the skull, another group with prominent tracer uptake in the soft tissues. These abnormal tracer accumulations improved after renal transplantation. Bone scintigraphy before and after renal transplantation provides useful information concerning the follow-up of patients with renal osteodystrophy.     

尿毒症肾性骨病继发甲状旁腺腺瘤的诊治探讨

目的　探讨尿毒症肾性骨病继发甲状旁腺腺瘤的诊治方法、疗效及预后。方法　比较罗钙全冲击治疗、甲状旁腺腺瘤切除术两种治疗方式的疗效及预后。结果　罗钙全冲击治疗后 ,患者病情反而加重 ;未行正规治疗 ,疾病进展至晚期或钙化防御者 ,不可逆转 ;行甲状旁腺腺瘤切除术者 ,短期效果良好。结论　甲状旁腺功能亢进应强调早期诊断 ,治疗方案要个体化、正规化。治疗上 ,罗钙全等活性维生素D3 冲击治疗效果不佳 ,甲状旁腺腺瘤切除术短期效果明显 ,且理论上不会导致甲状旁腺功能低下 ,是一种有选择价值的治疗方法     

Diagnostic image (35). Epiphysiolysis of the knee due to renal osteodystrophy

A 14-year-old boy with long-standing renal insufficiency presented with a virtually symptom free slipped epiphysis of the right knee.     

Influence of age, sex and body weight on renal osteodystrophy in predialysis patients with chronic renal failure

The aim of the present investigation was to examine the influence of age, sex and body weight on osseous changes in pre-dialysis patients with chronic renal failure (CRF). 87 patients (44 males and 43 females) aged 18-60 years with CRF were studied. The levels of serum creatinine, total and ionized calcium, phosphorus, alkaline phosphatase, intact parathormone and serum osteocalcine were followed up. Body weight is presented as BMI. 47 of the patients were subjected to double X-ray absorptiometry of lumbar vertebra (Lunar) and 40 patients were examined by computed tomography osteometry. RESULTS: No reliable differences in the levels of biochemical parameters in male and female patients with the same degree of CRF were established. A tendency towards an increase in the level of intact parathormone and serum osteocalcine in women with both initial and advanced CRF was recorded. The BMI in patients with advanced CRF was lower as compared to those with initial CRF. Different stages of osseous changes were observed in 29 males (74.35%) and in 25 females (60.97%). A tendency for a higher frequency and severity of osseous changes in men aged up to 40 years was observed. After this age males and females were equally affected. A high positive correlation (r = 0.50) between BMI and the percentage of the normal Bone Mineral Density/Bone Mineral Content in females with CRF stage II and III was noticed. CONCLUSIONS: No significant difference in the frequency and severity of osseous changes in male and female uremic patients was observed. Bone changes were more frequent and pronounced in males up to 40 years of age, while this tendency reversed after the menopause. The higher body weight was beneficial for the osseous changes only in females with advanced CRF, while in all other patients no correlation with densitometric parameters was noticed.