The spectrum of bone disease in 200 chronic hemodialysis patients
a correlation between clinical, biochemical and histological findings
Palavras-chave:
Renal osteodystrophy, Chronic renal failure, Hemodialysis, Aluminum intoxication, Bone metabolismResumo
INTRODUÇÃO: A osteodistrofia renal compreende todas as formas de alterações do metabolismo mineral que afetam o tecido ósseo de pacientes renais crônicos. PACIENTES E MÉTODOS: 200 pacientes submetidos a diálise regular foram investigados quanto aos aspectos clínicos, laboratoriais e histopatológicos relacionados com doença óssea. RESULTADOS: As lesões de alto turnover foram observadas em 74.5% dos pacientes, sendo que 57.5% eram portadores de osteíte fibrosa. Pacientes com lesão mínima estavam em diálise por menos tempo e em geral eram assintomáticos. Pacientes com osteopatia alumínica (16.5%) tiveram a maior exposição ao alumínio por via oral e/ou parenteral e, ao lado dos portadores de doença mista de alto turnover, eram os mais sintomáticos. A grande maioria dos pacientes (82.5%) fazia uso irregular de vitamina D. Foi alta a incidência de doença adinâmica (n=8) nos pacientes paratireoidectomizados (n=12). Na osteíte fibrosa foram observados os níveis mais elevados de fosfatase alcalina. CONCLUSÕES: A utilização de calcitriol e quelantes de fósforo de forma irregular e em doses insuficientes parece ter sido a principal causa para a resposta reduzida ao tratamento do hiperparatireoidismo secundário. A fosfatase alcalina pode ser considerada um bom marcador bioquímico do turnover ósseo. A intensidade das manifestações clínicas relacionadas com o sistema músculo esquelético correlacionam-se com o tipo histológico da lesão óssea e com o tempo em diálise.
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