Specific measurement of PTH (1-84) in various forms of renal osteodystrophy (ROD) as assessed by bone histomorphometry

Lehmann, G.; Stein, Günter; Hller, Manfred; Schemer, Rudolf; Ramakrishnan, Kastooriranganathan; Goodman, William G.

doi:10.1111/j.1523-1755.2005.00513.x

Cited by 77 publications

(52 citation statements)

References 24 publications

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“…Since 1999, third-generation PTH assays that do not cross-react with 7-84 PTH are available (19). Although highly interesting in better understanding PTH physiology, these assays have not been found to provide more clinically meaningful information than the second-generation PTH assays when compared to bone biopsy data (20)(21)(22). Adding to this finding is the fact that the only currently available third-generation assay is an immuno-radiometric assay, available to a limited number of laboratories only and the KDIGO working group did not recommend its use (3).…”

Section: Choosing a Pth Assaymentioning

confidence: 99%

Interpretation of serum parathyroid hormone concentrations in dialysis patients: what do the KDIGO guidelines change for the clinical laboratory?

Souberbielle

Cavalier

Gadrey

2010

Clinical Chemistry and Laboratory Medicine

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The Kidney Disease: Improving Global Outcomes (KDIGO) have recently replaced the K/DOQI guidelines to help nephrologists in diagnosing, treating and monitoring chronic kidney disease mineral and bone disorders (CKD-MBD). Here, we comment on the KDIGO recommendations concerning the interpretation of parathyroid hormone (PTH) concentrations in dialysis patients: ''In patients with CKD stage 5D, we suggest maintaining iPTH in the range of approximately two to nine times the upper normal limit of the assay. We suggest that marked changes in PTH concentrations in either direction within this range prompt an initiation or change in therapy to avoid progression to concentrations outside of this range''. Our comments concern the interpretation of PTH in dialysis patients, but also the more global problem of establishing normal values for PTH. Clin Chem Lab Med 2010;48:769-74.

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Section: Choosing a Pth Assaymentioning

confidence: 99%

Interpretation of serum parathyroid hormone concentrations in dialysis patients: what do the KDIGO guidelines change for the clinical laboratory?

Souberbielle

Cavalier

Gadrey

2010

Clinical Chemistry and Laboratory Medicine

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“…[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. A maioria dos estudos, realizados até a publicação do KDOQI 2003, baseou-se nos resultados com o teste produzido pela Nichols (Allegro) e que atualmente não é comercializado.…”

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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“…The third generation 'whole' PTH assays, which only measure PTH (1-84) molecule, are available but is not currently recommended for routine clinical use. The ratio of PTH (1-84)/ PTH (7-84) has been assessed in the context of discriminating renal osteodystrophy subtypes, for which the findings have been inconsistent (30)(31)(32)(33). There is limited evidence for its role in predicting clinical outcomes such as mortality and cardiovascular events (34)(35)(36).…”

Section: Management Of Shpt In Ckdmentioning

confidence: 99%

Pharmacological Management of Secondary Hyperparathyroidism in Patients with Chronic Kidney Disease

Salam

Khwaja

Wilkie

2016

Drugs

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or Article Brief (if supplied by editors): As a 'Therapy in Practice' article, we would like this to provide a succinct, up-to-date clinically orientated guide to the optimum management of secondary hyperparathyroidism in patients with chronic kidney disease. The review should include an appropriate background to the development of SHPT. It should focus primarily on pharmacological treatments but as appropriate, non-pharmacological approaches (dietary, surgical) may be discussed to fully place pharmacological therapy in context. Submission date: 31 st March 2016Word count: 4156 Compliance with Ethical StandardsFunding and conflict of interest statement from each author: Takeaway messages from the article SHPT is associated with adverse outcomes in CKD and dialysis patients  Optimum PTH level is unclear in pre-dialysis CKD and the recommended range is wide for dialysis patients.  Management of SHPT is largely pharmacological focussing on lowering PTH  PTH lowering treatment has not shown improved cardiovascular risk, fractures and mortality. AbstractSecondary hyperparathyroidism (SHPT) is a common complication of CKD and is part of the chronic kidney disease-mineral bone disorder (CKD-MBD). SHPT is associated with increased risk of fracture and mortality, thus SHPT control is recommended as kidney function declines. Effective SHPT management becomes more difficult once skeletal and cardiovascular adverse effects associated with severe SHPT have become established. However, interventional studies to lower parathyroid hormone (PTH) have so far shown inconsistent results in improving patient-centred outcomes such as mortality, cardiovascular events and fracture. Pharmacological treatment effect on PTH level is also inconsistent between predialysis CKD and dialysis patients which adds to the complexity of SHPT management. This review aims to give an overview on the pathophysiology, pharmacological and non-pharmacological treatment for SHPT in CKD including some of the limitations of current therapeutic options.

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Specific measurement of PTH (1-84) in various forms of renal osteodystrophy (ROD) as assessed by bone histomorphometry

Cited by 77 publications

References 24 publications

Interpretation of serum parathyroid hormone concentrations in dialysis patients: what do the KDIGO guidelines change for the clinical laboratory?

Interpretation of serum parathyroid hormone concentrations in dialysis patients: what do the KDIGO guidelines change for the clinical laboratory?

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

Pharmacological Management of Secondary Hyperparathyroidism in Patients with Chronic Kidney Disease

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