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Grupo de Estudio del Metabolismo Fosfocálcico Sociedad Uruguaya de Nefrología PowerPoint Presentation
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Grupo de Estudio del Metabolismo Fosfocálcico Sociedad Uruguaya de Nefrología

Grupo de Estudio del Metabolismo Fosfocálcico Sociedad Uruguaya de Nefrología

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Grupo de Estudio del Metabolismo Fosfocálcico Sociedad Uruguaya de Nefrología

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  1. Grupo de Estudio del Metabolismo FosfocálcicoSociedad Uruguaya de Nefrología Cátedra de Nefrología – Facultad de Medicina Montevideo – Uruguay

  2. METABOLISMO FOSFOCALCICO(AÑO 1985) • CALCIO n = 339 9 ± 1.3 mg/dl < 8 mg/dl 14 % 8 – 9 mg/dl 33 % 9.1 – 11 mg/dl 51% > 11 mg/dl 2%

  3. METABOLISMO FOSFOCALCICO(AÑO 1985) • FOSFORO n = 339 5.5 ± 1.4 mg/dl < 5.5 mg/dl 48% 5.5 – 7 mg/dl 40% > 7 mg/dl 12 %

  4. METABOLISMO FOSFOCALCICO(AÑO 1985) • PTH n = 339 8 – 1.2 9 % 1.3 – 5 46 % 5.1 – 10 25 % > 1020 %

  5. METABOLISMO FOSFOCALCICO(abril – octubre 2004) n = 2415 M: 59.6 % F: 40.4 % EDAD: 59.8 ± 16.9 años (2 – 94) Ca: 9.03 ± 0.79 mg/dl (5 – 11.5) P: 5.8 ± 1.6 mg/dl (1.3 – 11) FA: 272 ± 222 (15 – 2000) PTHi: 484 ± 533 pg/ml (2.3 – 4000)

  6. METABOLISMO FOSFOCALCIOPAUTAS DOQI • CALCIO: 8.4 - 9.5 mg/dl • FOSFORO: 3.5 - 5.5 mg/dl • PTHi: 150 – 300 pg/ml

  7. METABOLISMO FOSFOCALCICO(abril - octubre 2004) n = 2415 • Calcio < 8.4 mg/dl 20.7 % 8.4 – 9.5 mg/dl52.6 % > 9.5 mg/dl 26.8 % • Fósforo < 3.5 mg/dl 5.5 % 3.5 – 5.5 mg/dl39.8 % > 5.5 mg/dl 54.7 % • PTHi > 150 pg/ml 29 % 150 – 300 pg/ml21.6 % > 300 pg/ml 49.4 %

  8. METABOLISMO FOSFOCALCICO(abril - octubre 2004)

  9. Cannata et al* SUN (n = 7512) (n = 2415) PTHi < 150 47 % 29 % 150 – 300 22 % 21.6 % > 300 31 % 49.4 % P > 5.5 49 % 54.7 % * Sólo 9.5% tenían Ca, P, PTHi y PxCa dentro del rango propuesto por las pautas K/DOQI (Cannata et al, JASN 14: 474A, 2003).

  10. Epidemiology of Renal Osteodystrophy in UruguayCurrent indications of bone biopsies H. Caorsi*, I. Olaizola*, L. Labruna#, V. Jorgetti&, G. Acuña*, A. Petraglia*, L. Fajardo*, A. Alvarez*, P Ambrosoni*. * Grupo de estudio del metabolismo Fosfocálcico – Sociedad Uruguaya de Nefrología – Uruguay # Histomorfometría Osea. Instituto de Reumatología, Montevideo - Uruguay & Histomorfometría Osea. Universidad de Sao Paulo, Sao Paulo - Brasil

  11. Aims • To analyze the prevalence of the different types of bone disease over the time in dialysis patients in Uruguay. • To determine current indication of bone biopsy in the diagnosis of renal osteodystrophy. Bone Biopsies and Clinical Features of Patients1985 – 2000 • 167 Bone biopsies from hemodialysis symptomatic patients. • 4% Diabetics. • 93 Female; 74 Male. • Age: 54 ± 13 years. • Length of dialysis: 53 ± 33 months

  12. ResultsFrequency of Different Histological Forms1985 – 2000 n = 167

  13. ResultsHistological Diagnosis According to Year of Bone Biopsies1985 – 2000 1985 - 1990 HD pts./year: 1187 n = 66 BB 1991 - 1996 HD pts./year: 1602 n = 84 BB 1997 - 2000 HD pts./year: 2254 n = 17 BB c b % Al in MF: 42.5 ± 47a % Al in MF : 20 ± 28a % Al in MF : 27 ± 18 ap < 0.001; bp < 0.01; cp < 0.05 % samples [Al]water: 88% (< 10 μg/l) 97% (< 2 μg/l)

  14. ResultsFreqcuency of Adinamic Bone Disease with and without Aluminium Over the Time

  15. Renal Osteodystrophyin UruguayBone Biopsy RegistryiPTH levels iPTH pg/ml 1400 1300 1200 1100 1000 900 800 700 600 500 400 300 200 100 0 p < 0,001 OF OMa y ABDa

  16. Conclusions • Survival rates of patients on dialysis have increased with improve crescent of dialytic therapy, but the resultant increased duration of dialysis has led to rise in hyperparathyroidism. Our results show a significant increase in osteitis fibrosa in the last years. This can be explained by a longer time on dialysis of the patients. • On the other hand, low turnover bone disease aluminium related (OM and ABD) decreased significantly, and we find that ABD without aluminium appears in the last period. • The percentage of aluminium in the mineralization front in bone biopsies has diminished over the time. • The modification of histological forms observed should be related to the improvement in the dialysis water treatment and the reduction of oral aluminium exposure.