Treatment of abnormal PTH levels in CKD-MBD

سال انتشار: 1397
نوع سند: مقاله کنفرانسی
زبان: فارسی
مشاهده: 369

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شناسه ملی سند علمی:

CNAMED06_026

تاریخ نمایه سازی: 2 تیر 1397

چکیده مقاله:

STAGES OF CHRONIC KIDNEY DISEASE: Stage 1 – Normal glomerular filtration rate (GFR) ≥90 mL/min per 1.73 m2  Stage 2 – GFR between 60 to 89 mL/min per 1.73 m2 Stage 3 – GFR between 30 and 59 mL/min per 1.73 m2 Stage 4 – GFR between 15 and 29 mL/min per 1.73 m2  Stage 5 – GFR of <15 mL/min per 1.73 m2 or requires dialysis treatment Children with CKD stage 2 usually have no signs or symptoms of bone abnormalities. However, these children may have evidence of abnormalities on laboratory testing (eg, decreased serum calcitriol and elevated serum parathyroid hormone [PTH]); this period should be used to educate the child and family about CKD and its impact on bone metabolism. Subtle signs of renal osteodystrophy begin to be observed when the GFR decreases to 50 percent of normal (stage 3 diseases), these children should be monitored for evidence of bone disease by physical examination and laboratory evaluation, and Physical findings include muscle pain, weakness, and bony changes such as varus and valgus deformities of the long bones.Laboratory abnormalities of bone metabolism (eg, elevated PTH) are common in stage 3 disease and require therapeutic interventions.KDOQI guidelines in the management of bone metabolic abnormalities in children with CKD include the following:  Management (frequency of monitoring and therapeutic interventions) is based upon the child s level of kidney function.  Therapy focuses on the prevention of phosphate retention and hypovitaminosis D (development of secondary hyperparathyroidism, which results in renal osteodystrophy).  Suggest that serum concentrations of calcium, phosphate, and parathyroid hormone should be measured on an ongoing basis in all children with stages 2 to 5 of CKD  In children with an elevated serum PTH and/or phosphate level, we recommend reducing the PTH and/or phosphate concentration with dietary restriction of phosphorus and the use of phosphate binders, if necessary.  In children with CKD stage 2 to 4, if serum PTH is above the target range, 25-hydroxyvitamin D concentration should be measured. If the 25-hydroxyvitamin D level is <30 ng/Ml, we suggest that ergocalciferol or cholecalciferol be given, If the level is > 30 ng/mL and the serum calcium level is <10 mg/dL, we recommend calcitriol therapy. In children with CKD stage 5 and PTH levels > 300 pg/mL, we suggest that calcitriol should be administered until serum PTH is reduced to a range between 200 to 300 pg/mL, although the optimal target range remains controversial. Serum calcium should be maintained within a normal range for the laboratory used, generally between 8.8 and 9.7 mg/dL, if the patient is hypocalcemic, we recommend that calcium supplementation and/or vitamin D therapy be given.

نویسندگان

Mohammad Tagi Hosani Tabatabaii

Shahid Beheshti University of Medical Sciences, Tehran ,Iran