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SON DÖNEM KRONİK BÖBREK YETMEZLİĞİNDE PARATİROİD BEZLERİNİN ULTRASONOGROFİK BOYUTLARININ KALSİYUM METABOLİZMASI VE KEMİK DÖNGÜSÜ İLE İLİŞKİSİ VE ERİTROPOETİN TEDAVİSİNİN ROLÜ

Yıl 2019, , 19 - 25, 25.02.2019
https://doi.org/10.18229/kocatepetip.532110

Öz

AMAÇ: Çalışmanın amacı, son dönem kronik böbrek yet-mezliği olan hastalarda paratiroid bez boyutlarının hiper-paratiroidi ve kemik hastalığı ile ilişkisini belirlemek ve eritropoetin tedavisi ile ilişkisini ortaya koymaktır. GEREÇ VE YÖNTEM: Çalışmaya sürekli ayaktan periton diyalizi (SAPD) ünitesinde renal replasman tedavisi almakta olan 20 hasta, hemodiyaliz ünitesinden 40 hasta ve evre 4 prediyaliz (GFR 15-29 ml/dk) olan 20 hasta alındı. Hastalara paratiroid ultrasonografi, biyokimya - hematoloji tetkikleri ve kemik mineral dansitometri (KMD) ölçümleri yapıldı. BULGULAR: Prediyaliz hastaların parathormon (PTH) değerleri SAPD ve hemodiyaliz hastalarına göre daha düşük saptandı (sırasıyla p=0.002, p=0.001). Prediyaliz hastalarda adenom sayısı, periton diyalizi hastalarına göre düşük olduğu bulundu (p=0.015). Prediyaliz hastalarının paratiroid adenom volümü, hemodiyaliz hastalarına göre daha düşük saptandı (p=0.032). Son bir yılda kullanılan total eritropoetin (EPO) dozu; PTH düzeyi, adenom sayısı ve adenom volümünün yanı sıra, PTH’nın arttırdığı kemik yapım markerları olan alkalen fosfataz ve osteokalsin düzeyi ile de pozitif korelasyon göstermiştir (sırasıyla r=0.257 p=0.021, r=0.312 p=0.005). Ortalama PTH değerleri 496.5±439.7 pg/ml olarak bulundu ve adenom volümü ile PTH salgısı arasında pozitif korelasyon mevcuttu (p=0.001).
SONUÇ: PTH sekresyonunun en yüksek otonom değerlere sahip olan hastalar, en fazla eritropoetin kullanmış hastalardır. Bu bulgular, eritropoetinin paratiroid gland büyüklüğünü arttırmanın yanı sıra otonomitesini de arttırdığını göstermektedir.

Kaynakça

  • 1.De Francisco ALM, Fresnedo GF, Rodrio E, Pinera C,Parathyroidectomy in dialysis patients. Kidney İnt. 2002; 61: 161-6.
  • 2. Malluche H, Monier-Faugere C. Risk of adynamic bone disease in dialyzed patients. Kidney İnt.1992; 42: 62-7.
  • 3. Vieira H, Kunnii I, Nishida S. Evolution of PTH Assays. Arq Bras Endocrinol Metab 2006; 50: 621-7.
  • 4.D’ Amour P, Brossard JH, Rakel A. Evidence that the Amino-terminal composition OF Non-Parathyroid Hormone Fragments Starts before Position 19. Clinical Chemistry, 2005; 51: 169-6.
  • 5.Harrison’s Principles of İnternal Medicine(çeviri) fıfteenthedition. 2004; 1551-1566.
  • 6. Silver J, Levi R. Regulation of PTH synthesis and secretionrelevant to the management of seconder hyperparathyroidism in chronic kidney disease. Kidney International 2005; 95: 8-12.
  • 7.Galbraith SC, Quarles LD: Tertiary hyperparathyroidism andrefractory secondary hyperparathyroidism, in Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, edited by Favus MJ, New York, Raven Press, 1993; 159.
  • 8. Giuseppetti GM, Giovagnoni A, Baldelli S, Macchini M,Bordoni E: Correlzaioni Cliniche e Radio-ecotomografiche nell’ Iperparatiroidismo Secondario. Radiol Med 1986; 72: 29-31.
  • 9. Johnson WJ, Mccarthy JT, Van Heerden JA, Sterioff S, Grant CS, Kao PC: Results of subtotal parathyroidectomy in hemodialysis patients. Ani J Med, 1988; 84: 23-32.
  • 10.Malmaeus J, Grimelius L, Johannson H, Akerstrom G,Dunghall S: Parathyroid pathology in hyperparathyroidism secondary to chronic renal failure. Scandi Urol Nephrol 1984; 18: 157-66.
  • 11. Mccarron DA, Muther RS, Lenfesty B, Bennetf WM:Parathyroid function in persistent hyperparathyroidism: Relationship to gland size. Kidney International 1982; 22: 662-70.
  • 12. Gladziwa U, Ittel TH, Dakshinamurty KV, Schacht B, Riehl J,Sieberth HG: Secondary hyperparathyroidism and sonographic evaluation of parathyroid gland hyperplasia in dialysis patients. Clin Nephrol 1992; 38: 162-66.
  • 13. Bland KI, Tidwell S, Von Fraunhofer JA, Morris RR, Mccoy MT, Wathen RL: Intraoperative localization of parathryoid glands using methylothionine chloride tetramethylthionine chloride in secondary hyperparathyroidism. Surgery Gynecol Obstet 1985; 160: 42-8.
  • 14.Indridason OS, Heath H, Khosla S, Yohay DA, Quarles LD.Non-suppressible parathyroid hormone secretion is related to gland size in uremic secondry hyperparathyroidism. Kidney international 1996; 50: 1663-71.
  • 15.Kakuta T, Tanaka R, Kanai G et al. Relationship betweenthe weight of parathyroid glands and their secretion of parathyroid hormone in hemodialysis patients with secondary hyperparathyroidism. Ther Apher Dial 2008; 12: 385-90.
  • 16. Tominaga Y, Inaguma D, Matsuoka S. Is the Volume of theparathyroid gland a predictor of Maxacalcitol response in advanced secondary hyperparathyroidism? Ther Apher Dial 2006; 10: 198–02.
  • 17.Tominaga Y, Matsuoka S, Sato T. Clinical features andHyperplastic patterns of parathyroid glands in hemodialysis patients with advanced secondary hyperparathyroidism refractory to Maxacalcitol treatment and required parathyroidectomy. Ther Apher Dial 2007; 11: 266–73.
  • 18. Öztürk M. Eritropoetinin Paratiroid Fizyolojosindeki Etkileri.Yan dal uzmanlık tezi, Van: 2006.
  • 19.Mun KC, Golper TA. Impaired biological activity oferthropoetin by cyanate carbamylation. Blood Purification, 2000; 18: 13-7.
  • 20.Takenaka T, Itaya Y, Ishikawa I. Skeletal effects oferythropoietin in hemodialysis patients. Int Urol Nephrol 2003; 35: 407-13.
  • 21.Lai YH, Tsai JC, Chen HC, Guh JY, Hwang SJ, Tsai JH. Lackof Influence of Recombinant Human Erythropoietin on Parathyroid Function in Hemodialysis Patients with Secondary Hyperparathyroidism. Nephron 1995; 70: 223-28.
  • 22. Doğukan A, Şahpaz F, Balcı TA. Kronik periton diyalizihastalarında kemik mineral dansitesi ile vitamin D düzeyleri arasındaki ilişki. Turk Nephro Dial Transplan Journal 2009; 18: 1-4.
  • 23. Stavroulopoulos A, Porter CJ, Roe S, Hosking DJ, Cassidy MJD: Relationship between vitamin D status, parathyroid hormone levels and bone mineral density in patients with chonic kidney disease stages 3 and 4. Nephrology 2008; 13: 63-7.
  • 24.Wolf M, Shah A, Gutierrez O. Vitamin D levels and earlymortality among incident hemodialysis patients. Kidney Int 2007; 72: 1004-13.

THE RELATIONSHIP WITH CALCIUM METABOLISM AND BONE TURNOVER OF ULTRASONOGRAPHIC DIMENSIONS OF PARATHYROID GLANDS IN END-STAGE CHRONIC RENAL FAILURE AND THE ROLE OF ERYTHROPOETIN TREATMENT

Yıl 2019, , 19 - 25, 25.02.2019
https://doi.org/10.18229/kocatepetip.532110

Öz

OBJECTIVE: The aim of the study is to determine the association of parathyroid gland dimensions with hyperparathyroidism and bone disease in patients with end stage chronic renal failure and to demonstrate its association with erythropoietin treatment. MATERIAL AND METHODS: Twenty patients undergoing renal replacement therapy at the continuous ambulatory peritoneal dialysis (CAPD) unit, 40 patients from hemodialysis unit and 40 patients with stage 4 predialysis (GRF 15-29 ml / min) were included in the study. Patient parathyroid ultrasonography, biochemistry-hematology tests and bone mineral densitometry (BMD) measurements were performed. RESULTS: The PTH values of predialysis patients were lower than those of SAPD and hemodialysis patients (respectively p=0.002, p=0.001). Patients with predialysis had a lower number of adenomas than patients with peritoneal dialysis (p=0.015). The parathyroid adenoma volume of patients with predialysis was lower than that of hemodialysis patients (p=0.032). The total erythropoetin (EPO) dose used in the last year; showed positive correlation with PTH level, adenoma number, adenome volume, and bone building markers (osteocalcin and alkaline phosphatase) (respectively r=0.257 p=0.021, r=0.312 p=0.005). Mean PTH values were 496.5 ± 439.7 pg / ml and there was a positive correlation between adenoma volume and PTH secretion (p=0.001).

CONCLUSIONS: Patients with the highest autonomic levels of PTH secretion were the patients with the most erythropoetin use. These findings suggest that erythropoetin not only increases parathyroid gland size but also increases autonomy

Kaynakça

  • 1.De Francisco ALM, Fresnedo GF, Rodrio E, Pinera C,Parathyroidectomy in dialysis patients. Kidney İnt. 2002; 61: 161-6.
  • 2. Malluche H, Monier-Faugere C. Risk of adynamic bone disease in dialyzed patients. Kidney İnt.1992; 42: 62-7.
  • 3. Vieira H, Kunnii I, Nishida S. Evolution of PTH Assays. Arq Bras Endocrinol Metab 2006; 50: 621-7.
  • 4.D’ Amour P, Brossard JH, Rakel A. Evidence that the Amino-terminal composition OF Non-Parathyroid Hormone Fragments Starts before Position 19. Clinical Chemistry, 2005; 51: 169-6.
  • 5.Harrison’s Principles of İnternal Medicine(çeviri) fıfteenthedition. 2004; 1551-1566.
  • 6. Silver J, Levi R. Regulation of PTH synthesis and secretionrelevant to the management of seconder hyperparathyroidism in chronic kidney disease. Kidney International 2005; 95: 8-12.
  • 7.Galbraith SC, Quarles LD: Tertiary hyperparathyroidism andrefractory secondary hyperparathyroidism, in Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, edited by Favus MJ, New York, Raven Press, 1993; 159.
  • 8. Giuseppetti GM, Giovagnoni A, Baldelli S, Macchini M,Bordoni E: Correlzaioni Cliniche e Radio-ecotomografiche nell’ Iperparatiroidismo Secondario. Radiol Med 1986; 72: 29-31.
  • 9. Johnson WJ, Mccarthy JT, Van Heerden JA, Sterioff S, Grant CS, Kao PC: Results of subtotal parathyroidectomy in hemodialysis patients. Ani J Med, 1988; 84: 23-32.
  • 10.Malmaeus J, Grimelius L, Johannson H, Akerstrom G,Dunghall S: Parathyroid pathology in hyperparathyroidism secondary to chronic renal failure. Scandi Urol Nephrol 1984; 18: 157-66.
  • 11. Mccarron DA, Muther RS, Lenfesty B, Bennetf WM:Parathyroid function in persistent hyperparathyroidism: Relationship to gland size. Kidney International 1982; 22: 662-70.
  • 12. Gladziwa U, Ittel TH, Dakshinamurty KV, Schacht B, Riehl J,Sieberth HG: Secondary hyperparathyroidism and sonographic evaluation of parathyroid gland hyperplasia in dialysis patients. Clin Nephrol 1992; 38: 162-66.
  • 13. Bland KI, Tidwell S, Von Fraunhofer JA, Morris RR, Mccoy MT, Wathen RL: Intraoperative localization of parathryoid glands using methylothionine chloride tetramethylthionine chloride in secondary hyperparathyroidism. Surgery Gynecol Obstet 1985; 160: 42-8.
  • 14.Indridason OS, Heath H, Khosla S, Yohay DA, Quarles LD.Non-suppressible parathyroid hormone secretion is related to gland size in uremic secondry hyperparathyroidism. Kidney international 1996; 50: 1663-71.
  • 15.Kakuta T, Tanaka R, Kanai G et al. Relationship betweenthe weight of parathyroid glands and their secretion of parathyroid hormone in hemodialysis patients with secondary hyperparathyroidism. Ther Apher Dial 2008; 12: 385-90.
  • 16. Tominaga Y, Inaguma D, Matsuoka S. Is the Volume of theparathyroid gland a predictor of Maxacalcitol response in advanced secondary hyperparathyroidism? Ther Apher Dial 2006; 10: 198–02.
  • 17.Tominaga Y, Matsuoka S, Sato T. Clinical features andHyperplastic patterns of parathyroid glands in hemodialysis patients with advanced secondary hyperparathyroidism refractory to Maxacalcitol treatment and required parathyroidectomy. Ther Apher Dial 2007; 11: 266–73.
  • 18. Öztürk M. Eritropoetinin Paratiroid Fizyolojosindeki Etkileri.Yan dal uzmanlık tezi, Van: 2006.
  • 19.Mun KC, Golper TA. Impaired biological activity oferthropoetin by cyanate carbamylation. Blood Purification, 2000; 18: 13-7.
  • 20.Takenaka T, Itaya Y, Ishikawa I. Skeletal effects oferythropoietin in hemodialysis patients. Int Urol Nephrol 2003; 35: 407-13.
  • 21.Lai YH, Tsai JC, Chen HC, Guh JY, Hwang SJ, Tsai JH. Lackof Influence of Recombinant Human Erythropoietin on Parathyroid Function in Hemodialysis Patients with Secondary Hyperparathyroidism. Nephron 1995; 70: 223-28.
  • 22. Doğukan A, Şahpaz F, Balcı TA. Kronik periton diyalizihastalarında kemik mineral dansitesi ile vitamin D düzeyleri arasındaki ilişki. Turk Nephro Dial Transplan Journal 2009; 18: 1-4.
  • 23. Stavroulopoulos A, Porter CJ, Roe S, Hosking DJ, Cassidy MJD: Relationship between vitamin D status, parathyroid hormone levels and bone mineral density in patients with chonic kidney disease stages 3 and 4. Nephrology 2008; 13: 63-7.
  • 24.Wolf M, Shah A, Gutierrez O. Vitamin D levels and earlymortality among incident hemodialysis patients. Kidney Int 2007; 72: 1004-13.
Toplam 24 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Makaleler-Araştırma Yazıları
Yazarlar

Harun Düğeroğlu Bu kişi benim

Ümit Öztürk Bu kişi benim

Mustafa Öztürk Bu kişi benim

Yayımlanma Tarihi 25 Şubat 2019
Kabul Tarihi 30 Mayıs 2018
Yayımlandığı Sayı Yıl 2019

Kaynak Göster

APA Düğeroğlu, H., Öztürk, Ü., & Öztürk, M. (2019). SON DÖNEM KRONİK BÖBREK YETMEZLİĞİNDE PARATİROİD BEZLERİNİN ULTRASONOGROFİK BOYUTLARININ KALSİYUM METABOLİZMASI VE KEMİK DÖNGÜSÜ İLE İLİŞKİSİ VE ERİTROPOETİN TEDAVİSİNİN ROLÜ. Kocatepe Tıp Dergisi, 20(1), 19-25. https://doi.org/10.18229/kocatepetip.532110
AMA Düğeroğlu H, Öztürk Ü, Öztürk M. SON DÖNEM KRONİK BÖBREK YETMEZLİĞİNDE PARATİROİD BEZLERİNİN ULTRASONOGROFİK BOYUTLARININ KALSİYUM METABOLİZMASI VE KEMİK DÖNGÜSÜ İLE İLİŞKİSİ VE ERİTROPOETİN TEDAVİSİNİN ROLÜ. KTD. Şubat 2019;20(1):19-25. doi:10.18229/kocatepetip.532110
Chicago Düğeroğlu, Harun, Ümit Öztürk, ve Mustafa Öztürk. “SON DÖNEM KRONİK BÖBREK YETMEZLİĞİNDE PARATİROİD BEZLERİNİN ULTRASONOGROFİK BOYUTLARININ KALSİYUM METABOLİZMASI VE KEMİK DÖNGÜSÜ İLE İLİŞKİSİ VE ERİTROPOETİN TEDAVİSİNİN ROLÜ”. Kocatepe Tıp Dergisi 20, sy. 1 (Şubat 2019): 19-25. https://doi.org/10.18229/kocatepetip.532110.
EndNote Düğeroğlu H, Öztürk Ü, Öztürk M (01 Şubat 2019) SON DÖNEM KRONİK BÖBREK YETMEZLİĞİNDE PARATİROİD BEZLERİNİN ULTRASONOGROFİK BOYUTLARININ KALSİYUM METABOLİZMASI VE KEMİK DÖNGÜSÜ İLE İLİŞKİSİ VE ERİTROPOETİN TEDAVİSİNİN ROLÜ. Kocatepe Tıp Dergisi 20 1 19–25.
IEEE H. Düğeroğlu, Ü. Öztürk, ve M. Öztürk, “SON DÖNEM KRONİK BÖBREK YETMEZLİĞİNDE PARATİROİD BEZLERİNİN ULTRASONOGROFİK BOYUTLARININ KALSİYUM METABOLİZMASI VE KEMİK DÖNGÜSÜ İLE İLİŞKİSİ VE ERİTROPOETİN TEDAVİSİNİN ROLÜ”, KTD, c. 20, sy. 1, ss. 19–25, 2019, doi: 10.18229/kocatepetip.532110.
ISNAD Düğeroğlu, Harun vd. “SON DÖNEM KRONİK BÖBREK YETMEZLİĞİNDE PARATİROİD BEZLERİNİN ULTRASONOGROFİK BOYUTLARININ KALSİYUM METABOLİZMASI VE KEMİK DÖNGÜSÜ İLE İLİŞKİSİ VE ERİTROPOETİN TEDAVİSİNİN ROLÜ”. Kocatepe Tıp Dergisi 20/1 (Şubat 2019), 19-25. https://doi.org/10.18229/kocatepetip.532110.
JAMA Düğeroğlu H, Öztürk Ü, Öztürk M. SON DÖNEM KRONİK BÖBREK YETMEZLİĞİNDE PARATİROİD BEZLERİNİN ULTRASONOGROFİK BOYUTLARININ KALSİYUM METABOLİZMASI VE KEMİK DÖNGÜSÜ İLE İLİŞKİSİ VE ERİTROPOETİN TEDAVİSİNİN ROLÜ. KTD. 2019;20:19–25.
MLA Düğeroğlu, Harun vd. “SON DÖNEM KRONİK BÖBREK YETMEZLİĞİNDE PARATİROİD BEZLERİNİN ULTRASONOGROFİK BOYUTLARININ KALSİYUM METABOLİZMASI VE KEMİK DÖNGÜSÜ İLE İLİŞKİSİ VE ERİTROPOETİN TEDAVİSİNİN ROLÜ”. Kocatepe Tıp Dergisi, c. 20, sy. 1, 2019, ss. 19-25, doi:10.18229/kocatepetip.532110.
Vancouver Düğeroğlu H, Öztürk Ü, Öztürk M. SON DÖNEM KRONİK BÖBREK YETMEZLİĞİNDE PARATİROİD BEZLERİNİN ULTRASONOGROFİK BOYUTLARININ KALSİYUM METABOLİZMASI VE KEMİK DÖNGÜSÜ İLE İLİŞKİSİ VE ERİTROPOETİN TEDAVİSİNİN ROLÜ. KTD. 2019;20(1):19-25.

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