Assessment of Osteodystrophy in Patients with Chronic Renal Failure

Brown, D. J.; Dawborn, J K; Thomas, D.; Xipell, J.M.

doi:10.1111/j.1445-5994.1982.tb02470.x

Cited by 3 publications

(2 citation statements)

References 6 publications

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“…2). A pre-operative bone biopsy was carried out in 24 patients and the histological grade (grades 0-4) assessed on the basis of the extent of bone resorption and fibrosis and osteoclast count [5,6]. This is shown in figure 2.…”

Section: Methodsmentioning

confidence: 99%

“…In the 15 patients in whom it was measured, plasma PTH level was raised to between 10 and over 40 times normal. 21 patients had radiological evidence of hyperparathyroidism, graded for severity on the basis of cortical tunnelling, subperiosteal erosions and tuft resorption [5]. The severity varied according to the length of pre operative vitamin D therapy and the indication for surgery ( fig.…”

Section: Methodsmentioning

confidence: 99%

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Parathyroidectomy in Chronic Renal Failure

Dawborn

Brown

Douglas

et al. 1983

Nephron

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Parathyroidectomy was carried out in 26 patients over a 14-yΕar period. Excellent results were obtained in patients with severe hyperparathyroidism. Vascular calcification, hypercalcaemia and pruritus did not justify surgery unless associated with unequivocal hyperparathyroidism. 13 patients required intravenous calcium infusion for up to 2 weeks to control post-operative hypocalcaemia. Calcium requirements could be predicted from the pre-operative plasma alkaline phosphatase level. Following operation continued treatment with vitamin D was necessary to prevent hypocalcaemia. Hyperparathyroidism recurred in 1 patient after 8 years and 4 patients developed osteomalacia. Since parathyroid hormone may have toxic effects other than those on bone, maintenance of normal levels should be a long-term objective in the treatment of patients with chronic renal failure. Where large parathyroid glands are present, surgical reduction in gland mass is a logical prelude to long-term suppression of parathyroid hormone with vitamin D and phosphate-binding agents.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Parathyroidectomy in Chronic Renal Failure

Dawborn

Brown

Douglas

et al. 1983

Nephron

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Assessment of Osteodystrophy in Patients With Chronic Renal Failure

Gupta

1983

Australian and New Zealand Journal of Medicine

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syndrome was present in both lungs at autopsy, the changes being stated t o be of three to four days duration. Increase in the lung water may be a feature of this condition. It remains speculative as to whether pulmonary edema alone was the cause of the left sided change though as the paper states this seemed most likely.With respect to Dr Nikolic's comment on Figure 2, we have not sought to distinguish between areas of normal and hyperperfusion on the lung scan, believing that such distinction might be suspect in absolute terms. The scan seeks to show discrete areas of relative hypoperfusion. It was, in any case, performed some three days after the resolution of the asymmetric change, at a time of diffused alveolar change in both lung fields.It may be difficult to form valid conclusions about dynamic states in the living from post mortem angiograph y.The patient was on positive end expired pressure ranging between five and ten centimeters of water pressure for the entire duration of assisted ventilation.In response t o the final question raised, the patient was fully heparinised from the first post-operative day, when the diagnosis of pulmonary embolism was suspect. Two days later heparinisation was ceased, the patient's clinical feature at the time suggesting that the disturbance in pulmonary gas transfer was due to the diffuse parenchymal lung lesion rather than pulmonary embolism. In fact, both conditions were present and cessation of heparin therapy was in retrospect unwise. This is the essential thrust of the case report, that is, that unilateral alveolar consolidation may co-exist with pulmonary artery obstruction and may in fact result from it. The physician should be alerted to this hazardous possibility.Heparinisation was recommenced when the results of the lung scan were known. The development of the bilateral diffuse alveolar change meant that both the lung scan and the pulmonary angiography were performed in an extremely hypoxic patient.I would like to thank Dr Nikolic for his interest and his comments.

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Quantitative computed tomography for spinal bone mineral measurements in chronic renal failure

Karantanas¹,

Kalef-Ezra²,

Sferopoulos³

et al. 1996

The British Journal of Radiology

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The aim of this study was to assess non-invasively the status of spinal trabecular bone in patients with chronic renal failure and the influence of the disease stage. Single energy quantitative computed tomography (CT) was used in 89 patients with chronic renal failure to measure spinal trabecular bone equivalent density. 23 patients were independent of dialysis and 66 were receiving long-term haemodialysis. Spinal trabecular bone density of the patients was compared with locally determined normal ranges. Although trabecular bone mineral density (BMD) was lower (9% on average) in the patients who were not dependent on dialysis compared with the predicted mean normal values (BMDp) for age- and sex-matched normal subjects, the difference was not statistically significant. A statistically significant reduction was found in patients on dialysis (BMD/BMDp 0.75 +/- 0.16, Z-score -1.3). Osteosclerosis was found in 11 patients and they were excluded from the study. Longitudinal measurements in 42 patients on dialysis without osteosclerosis showed a 2.9% mean reduction in BMD/BMDp over a period of 8 months. All but one of the 16 haemodialysis patients with osteopenic spinal fractures had trabecular BMD values lower than the fracture threshold determined by our technique. In conclusion, end-stage chronic renal failure was associated with reduction in the spinal trabecular bone density.

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Assessment of Osteodystrophy in Patients with Chronic Renal Failure

Cited by 3 publications

References 6 publications

Parathyroidectomy in Chronic Renal Failure

Parathyroidectomy in Chronic Renal Failure

Assessment of Osteodystrophy in Patients With Chronic Renal Failure

Quantitative computed tomography for spinal bone mineral measurements in chronic renal failure

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