Studies on the pathogenesis of renal osteodystrophy

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• Subtotal parathyroidectomy (PTX) was performed in patients with renal osteodystrophy (ROD) associated with secondary hyperparathyroidism (2°HPT) and bone changes were followed up and from the postoperative studies the pathogenesis of ROD was discussed retrospectively.10 patients were selected from those who underwent PTX over one year earlier and in whom bone mineral content (BMC) and bone density could be measured. The patients were 4 males and 6 females, mean age 40.2 years, mean duration of hemodialysis 7 years and 14 months. BMC of the radius and bone density on X-ray film of the 2nd metacarpal were periodically measured before and after PTX. Mean levels of Al-P before PTX were 107.3 KA units and those of c-PTH were 23.0ng/ml: after PTX they returned to normal in all patients. The weight of the removed parathyroid glands ranged from 0.45 to 7.15g (mean weight 3.58g).BMC of the radius determined by photon absorptiometry was significantly increased within 6 months after PTX and thereafter continued to increase slightly, but the widths of the bone did not increase. The rate of increase in BMC ranged from 8% to 82% compared with the preoperative value but BMC was equivalent to only about 75.5% of normal controls even after they increased. ΔGSmin and ΔGSmax and S·GS/D measured by microdensitometry increased but index D was unchanged and MCI decreased unexpectedly. From these results, it is considered that increase in BMC depends on the increase in the mineralization rather than bone volume.In conclusion, the pathogenesis of ROD in these 10 patients depended chiefly on 2°HPT, moreover other factors, for example, accumulation of aluminium in the bone, may contribute to the incomplete recovery of BMC even after PTX.

• 社団法人 日本透析医学会の論文

社団法人 日本透析医学会 | 論文

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