Parathyroid hormone assays - evolution and revolutions in the care of dialysis patients

Hh, Malluche; Mawad, Hanna; D, Trueba; Mc, Monier-Faugere

doi:10.5414/cnp59313

Cited by 34 publications

(10 citation statements)

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“…Bone histomorphometry indices have higher sensitivity and reliability as markers of hyperparathyroidism than serum PTH. Serum intact PTH is not reliable as a sole indicator of bone turnover and also measures fragments, like 7 to 84 PTH, which antagonize some effects of the active whole hormone (33).…”

Section: Discussionmentioning

confidence: 99%

Arterial Calcifications and Bone Histomorphometry in End-Stage Renal Disease

London¹,

Marty

Marchais³

et al. 2004

Journal of the American Society of Nephrology

543

392

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Abstract. Arterial calcification (AC) is a common complication of end-stage renal disease (ESRD). The mechanisms responsible are complex, including disturbances of mineral metabolism and active expression of various mineral-regulating proteins. An inverse relationship between AC and bone density has been documented in uremic patients. In the study presented here, which included 58 patients with ESRD on hemodialysis (HD), bone-histomorphometry characteristics were compared with the AC scores (0 to 4) determined according to the number of arterial sites with calcifications. Patients with AC scores of 0 (no calcifications), or 1 or 2 (mild calcifications) had similar serum parathyroid hormone levels and bone histomorphometry, with larger osteoclast resorption, higher osteoclast numbers, and larger osteoblastic and double tertracycline-labeled surfaces. In contrast, patients with high AC scores (3 and 4) were characterized by lower serum parathyroid hormone, low osteoclast numbers and osteoblastic surfaces, smaller or absent double tetracycline-labeled surfaces, and high percentages of aluminum-stained surfaces. According to multivariate analysis, AC score was positively associated with age (P Ͻ 0.0001), daily dose of calcium-containing phosphate binders (P ϭ 0.009), and bone aluminum-stained surfaces (P ϭ 0.037), and an inverse correlation was observed with osteoblastic surfaces (P ϭ 0.001). A high AC score is associated with bone histomorphometry suggestive of low bone activity and adynamic bone disease. These findings suggest that therapeutic interventions associated with excessive lowering of parathyroid activity (parathyroidectomy, excessive calcium or aluminum load) favor lower bone turnover and adynamic bone disease, which could influence the development and progression of AC.

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Section: Discussionmentioning

confidence: 99%

Arterial Calcifications and Bone Histomorphometry in End-Stage Renal Disease

London¹,

Marty

Marchais³

et al. 2004

Journal of the American Society of Nephrology

543

392

View full text Add to dashboard Cite

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“…Not surprisingly, however, the numbers obtained with old PTH assays closely correlate to the new whole-PTH tests ( r > 0·96) [57]. Some authors suggest an advantage of calculating the ratio of 1-84 : 7-84 PTH for evaluation of bone histology [58,59].…”

Section: Parathormon (Pth)mentioning

confidence: 99%

Diagnosis of renal osteodystrophy

Schwarz

Sulzbacher

Oberbauer

2006

Eur J Clin Investigation

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The idiom renal osteodystrophy (ROD) represents a heterogeneous pattern of bone disturbances caused by chronic renal insufficiency and concomitant diseases. For the clinical decision of therapy it is most important to differentiate between high and low or adynamic turnover ROD because the therapeutically consequences of these two ends of the ROD spectrum are fundamentally different. Bone histology remains the gold standard for the exact classification of ROD. Serological markers of bone metabolism are not suited for the accurate nomenclature of ROD but are useful for the sequential follow up of ROD after a clear diagnosis has been made. Similarly, radiological diagnosis of ROD using dual energy X-ray absorptiometry (DEXA) or quantitative computer tomography scan (q-CT) is inaccurate and thus more suited for the routine follow up of established disease.Besides mineralization, bone strength and the rate of fractures are strongly determined by the architecture of the bone matrix. This information, however, is also only available on bone biopsy sections and cannot be estimated by non-invasive diagnostic methods.In summary, bone biopsy should be used more liberally for correct classification of bone disease. The sequential follow up and guidance of therapy success can be performed by non-invasive procedures such as biochemical bone marker determination in blood. X-ray imaging and densitometry is suitable only for sequential evaluation of osteoporosis.

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“…Essas técnicas superestimam os níveis de PTH biologicamente ativos, pois, detectam fragmentos não ativos da molécula 2 , o que explica a presença de altos níveis de PTH associados à doença óssea de baixa remodelação em alguns pacientes. [3][4][5] Novos ensaios para dosagem desse hormônio têm sido desenvolvidos, porém, até o presente momento, não existem estudos que demonstrem a superioridade desses ensaios, com relação aos anteriores, uma vez que não foram realizados estudos com biopsia óssea, para avaliar se distintas faixas de níveis de PTH são capazes de predizer que tipo de lesão óssea acomete o paciente. [6][7][8][9] Vale lembrar que existem vários testes para dosagem de PTH.…”

Section: Adendo Das Diretrizes Brasileiras De Prática Clínica Para O unclassified

Adendo das diretrizes brasileiras de prática clínica para o distúrbio mineral e ósseo na doença renal crônica capítulo 2

Carvalho¹,

Gueiros²,

Gueiros³

et al. 2012

J. Bras. Nefrol.

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Prevention and treatment of secondary hyperparathyroidism in CKD das análises mostrarem uma tendência de elevação ou de descenso ou após a instituição do tratamento, seja ele para reduzir ou elevar os níveis de PTH (Opinião). 1.2 Deve-se aumentar a frequência de avaliação dos níveis séricos de PTH se os resultados das análises mostrarem uma tendência de elevação ou de descenso ou após a instituição do tratamento, seja ele para reduzir ou elevar os níveis de PTH (Opinião).1.3 A amostra de sangue para dosagem do PTH deverá ser obtida, preferencialmente em jejum. Nos pacientes em hemodiálise (HD), as amostras poderão ser obtidas no início da sessão de diálise (Opinião).1.4 Os laboratórios de análises clínicas devem informar ao médico qual o método que utilizam para a dosagem do PTH e, para cada método, qual a fonte ideal, se plasma ou soro, além das características ideais de coleta e armazenamento (Evidência).1.5 A frequência de dosagem da FA deve ser a mesma que a do PTH (Opinião).2 prevenção e trAtAmento do HiperpArAtireoidismo secundário nA drc pacieNtes com Drc estágios iii a v 2.1 Nos pacientes com DRC estágios III a V, os níveis ideais de PTH não são conhecidos. No entanto, sugerimos que os pacientes com níveis de PTH acima do limite superior de referência para o método, sejam avaliados quanto à presença de hipocalcemia, hiperfosfatemia ou fração de excreção de fósforo (P) elevada, e deficiência de 25-hidroxivitamina D (25-vit D). Se forem detectadas alterações nesses parâmetros, estes devem ser corrigidos; sais de Ca para correção da hipocalcemia, orientação dietética e/ou uso de quelantes de P para correção da hiperfosfatemia e uso de ergocalciferol (vitamina D 2 ) ou colecalciferol (vitamina D 3 ) para correção da hipovitaminose D (Evidência).

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Parathyroid hormone assays - evolution and revolutions in the care of dialysis patients

Cited by 34 publications

References 0 publications

Arterial Calcifications and Bone Histomorphometry in End-Stage Renal Disease

Arterial Calcifications and Bone Histomorphometry in End-Stage Renal Disease

Diagnosis of renal osteodystrophy

Adendo das diretrizes brasileiras de prática clínica para o distúrbio mineral e ósseo na doença renal crônica capítulo 2

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