Renal osteopathy introduced
Healthy bones require calcium, phosphor ions, parathyroid and active vitamin D3 to work properly. Most of the calcium in adults is found in bones, which make up important compounds of calcium and phosphorus. A small number of calcium is found in the blood to be the place where calcium, bone dissolving, calcium and calcium from the kidneys are exchanged. Phosphorus is metabolized in the body by the digestive tract, the kidney, the bone three key regulating organs.
Kidney failure occurs when the kidneys regulate blood calcium and phosphate ions, vice thyroid hormone and disorder of activity of vitamin D3 balance, causing a series of "bone lesions. Main calcium phosphorus balance hormones in the body as thyroid hormone (PTH, parathyroid hormone), when low blood calcium secretion, its role is to make the calcium in the blood rise (through increased intestinal calcium absorption and release stored in bone calcium, decrease in renal excretion of calcium), and promote the phosphorus ruled out by the kidneys. Another for active vitamin D3 (Calcitriol), also known as 1, 25 25-hydroxyitamin D, is through the sunlight on the skin, liver and kidney after activation of vitamin D derivatives, its main function is to promote the intestinal absorption and renal tubular resorption, increase the body's calcium phosphorus content. Calcitriol itself inhibits the synthesis of subthyroid hormones; But the parathyrothyroxine can assist in the manufacture of Calcitriol. Another adjustment factor is Fibroblast growth factor 23 (fgf-23), which regulates phosphorus and vitamin D metabolism. High phosphorus can stimulate secretion of bone cells, fibroblast growth factor 23 makes kidney increased phosphorus ion excretion and reduce the production of vitamin D and directly inhibit the secretion of thyroid hormone.
When the patient's kidney function is not good, phosphorus will be unable to effectively discharge, accumulate in the body, 1, 25 hydroxy manufacturing will also reduce the amount of vitamin D, because the kidney is the organ that activated vitamin D. As a result, too much phosphorus will combine with calcium to further reduce the amount of calcium in the blood. Low blood calcium causes the secondary thyroid secretion PTH to increase blood calcium. Normal conditions when will increase blood Calcium combined with Calcium in parathyroid gland cells sensitive Receptor (Calcium Sensing Receptor) back besides sex inhibitor to reduce the secretion of thyroid hormone balance.
However, the hypothyroidism of the hypothyroidism is caused by hypothyroidism in the hypothyroidism of the hypothyroidism. The concentration of the fibroblast growth factor 23 will gradually rise in renal insufficiency, in order to maintain the balance of normal serum phosphate and phosphorus, but with the rise began to form the deterioration of renal function of its concentration of parathyroid gland body resistance is imbalance. Finally rising blood calcium phosphorus, parathyroid gland is no longer suppressed, but kidney already cannot be ruled out calcium, phosphorus, calcium and phosphorus compounds or calcium itself, will deposit in blood vessels, soft tissue and joint in the body. Precipitation in the blood vessels can cause hardening of the arteries, poor elasticity, high blood pressure and so on. At the same time, the bone keeps releasing calcium that causes the dense bone to become diseased. These renal osteopathy are gradually occurring in the early stages of renal deterioration, but symptoms tend to be asymptomatic in the beginning of dialysis. "Renal bone lesions" mainly contains high conversion of fibrous osteitis (the most common, dimensional vice thyroid already produce), low conversion osteomalacia and motivation insufficiency bone lesions (aluminum poisoning) and mixed bone lesions (is mixed time of parathyroid beat and osteomalacia a bone lesions).
Treatment method of renal osteopathy
In patients with renal failure, the control of phosphorus and calcium is the most important and primary prevention of hyperthyroidism and renal osteopathy. Ideal serum phosphorus should be maintained in 3.5 and 5.5 mg/dl or less or more, serum calcium acuity 8.4 and 9.5 mg/dl, or less blood calcium-phosphorus product 55 or less magnesium 2 / dl2 and vice thyroid hormone in 150 and 300 pg/ml or less or more.
Diet control for renal osteopathy
The average person eats about 900 to 1,200 milligrams of phosphorus a day. But for kidney patients, the daily diet of 800 to 900 milligrams is the limit. Eat foods that contain high phosphorus, such as internal organs (liver, heart), fish eggs, dried fish, fresh milk, egg yolks and cheese. Whole grains (brown rice, whole wheat bread), edamame, nuts (cashews, almonds), and mushrooms; Lecithin food, instant noodles, yeast powder, yoghurt, and kelp. High phosphorus drinks such as cola, pearl milk tea, mixed coffee and oolong tea should be avoided. Those with lower levels of phosphorus include green tea, black tea and sports drinks. Using ice or ice water to quench your thirst and avoid weight and phosphorus increases.
Taking "phosphate binder" in each meal, such as calcium, aluminum (stomach), can reduce the absorption of phosphorus in food, but the long-term use of calcium tablet is easy to cause constipation and blood calcium value is too high; Prolonged exposure to aluminium can cause aluminum poisoning. If the p value is still poorly controlled blood, again afraid the side effects of calcium, aluminum, can consider to own taking does not contain calcium or aluminum phosphate binder, such as "Sevelamer hydochloride (p, Renagel ®)", "lanthanum carbonate (fox lino, Fosrenal ®)", etc.
Active vitamin D
Oral or injectable active vitamin D3 (Calcitriol) may inhibit hyperthyroidism. Another new drugs at one's own expenses: vitamin D2 derivatives, renal bone le (Zemplar ®, Paricalcitol), is a selective vitamin D receptor activator, the small intestinal calcium absorption and bone mineral metabolism in relatively less Calcitriol, increase bone synthesis ability is Calcitriol plus. Can be used in patients of Calcitriol therapy was invalid. Can have a decrease of parathyroid hormone effect, also is not cause blood in the rising of the concentrations of calcium, phosphorus, there are oral and injected two formulations available. High blood calcium (greater than 11.2 mg), high blood phosphorus (greater than 6.5 mg) and low parathyroid hormone (less than 150 pg/mL) are taboo. The differences between the two types of vitamin D in the long-term prognosis and survival rate were inconclusive.
Calcium (calcimimetics) :
The new generation of "analog calcium" drugs, which can be combined with a calcium ion induction receptor, reduce the secondary thyroid function without increasing blood calcium and blood phosphorus concentration. The simulated calcium can be used in combination with calcium, phosphor and active vitamin D. Study and active vitamin D match use can increase the parathyroid gland inhibition effect, enabling calcium phosphate concentration can reach a standard range and reduce the need to remove the parathyroid gland can also be decreased fracture risk, risk of cardiovascular hospitalization. At present, the drug is mainly used in patients with severe hyperthyroidism and cannot be operated on. The recommended dose is 30 milligrams a day, and the results are incrementally increased to 180 milligrams per day. Low blood calcium (less than 8.4 milligrams) is a no-no. Compared to the active vitamin D, the simulated calcium can be used in patients with high blood phosphorus. Side effects are lower blood calcium and stomach upset.
An injection of subthyroidectomy or percutaneous puncture alcohol (ethanol)
Surgical indications: the presence of persistent hyperthyroidism and complications, and when internal medicine is ineffective, such as (1) severe itching; (2) calcification of metastatic soft tissue, even causing ischemic skin ulcers or apparent calcification (calciphylaxis); (3) high levels of calcium or hyperphosphatemia and severe hypothyroidism (iPTH is more than 8 times normal or more than 800 pg/ml); (4) there is no effect on the phosphorus binding agent or the enhancement of dialysis time; (5) cannot explain musculoskeletal lesions, etc., shall accept the parathyroid gland excision or percutaneous puncture of alcohol (ethanol) injected into the parathyroid glands, and most of the symptoms of postoperative improvement can be obtained.