Bone disease in patients with chronic kidney disease under conservative management

Gomes, Carlos Perez; Silva, Maria Inês Barreto; Duarte, Maria Eugênia Leite; Dorigo, David; Lemos, Carla Cavalheiro da Silva; Bregman, Rachel

doi:10.1590/s1516-31802005000200010

Cited by 6 publications

(9 citation statements)

References 19 publications

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“…In the present study, decreased blood HCO 3 -(metabolic acidosis) was noticed in 50% and 40.9% of the cats of Stages II and III, respectively; therefore, ionized hypercalcemia, observed in those cats, could have been partially attributed to metabolic acidosis, mainly in cats of Stage III, since HCO 3 -was significantly decreased in this subset. In addition, metabolic acidosis may also enhance osteoclastic iPHT activity and bone calcium efflux to the bloodstream, as well as may reduce directly serum levels of calcitriol and, therefore, contribute to SRHPT progression (Gomes et al 2005). In humans with CKD, even in the early stages of the disease, metabolic acidosis and SRHPT have been described in conjunction with bone abnormalities (Gomes et al 2005).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, metabolic acidosis may also enhance osteoclastic iPHT activity and bone calcium efflux to the bloodstream, as well as may reduce directly serum levels of calcitriol and, therefore, contribute to SRHPT progression (Gomes et al 2005). In humans with CKD, even in the early stages of the disease, metabolic acidosis and SRHPT have been described in conjunction with bone abnormalities (Gomes et al 2005).…”

Section: Discussionmentioning

confidence: 99%

“…In humans with CKD in the early stage, serum iPTH levels twice higher than the reference value is associated with bone lesions and early cardiovascular disease (Mendonça et al 2002, Gomes et al 2005, Rasouli & Kiasari 2006. In dogs with SRHPT, other metabolic changes can also be seen, i.e.…”

Section: Introductionmentioning

confidence: 99%

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Serum intact parathyroid hormone levels in cats with chronic kidney disease

et al. 2013

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Pesq. Vet. Bras. 33(2):229-235, fevereiro 2013 229 RESUMO.-[Avaliação das concentrações séricas de paratormônio intacto em gatos com doença renal crônica.] A doença renal crônica (DRC) em gatos é frequentemente observada e caracteriza-se como alteração multissistêmi-ca, causada por alterações metabólicas, e o hiperparatireoidismo secundário renal (HPTSR) seria o mais comum e usualmente está associada com progressão da doença renal e mau prognóstico. Esse estudo teve como objetivo determinar a frequência do HPTSR, e discutir os possíveis Chronic kidney disease (CKD) is frequently observed in cats and it is characterized as a multisystemic illness, caused by several underlying metabolic changes, and secondary renal hyperparathyroidism (SRHPT) is relatively common; usually it is associated with the progression of renal disease and poor prognosis. This study aimed at determining the frequency of SRHPT, and discussing possible mechanisms that could contribute to the development of SRHPT in cats at different stages of CKD through the evaluation of calcium and phosphorus metabolism, as well as acid-base status. Forty owned cats with CKD were included and divided into three groups, according to the stages of the disease, classified according to the International Renal Interest Society (IRIS) as Stage II (n=12), Stage III (n=22) and Stage IV (n=6). Control group was composed of 21 clinically healthy cats. Increased serum intact parathyroid hormone (iPTH) concentrations were observed in most CKD cats in all stages, and mainly in Stage IV, which hyperphosphatemia and ionized hypocalcemia were detected and associated to the cause for the development of SRHPT. In Stages II and III, however, ionized hypercalcemia was noticed suggesting that the development of SRHPT might be associated with other factors, and metabolic acidosis could be involved to the increase of serum ionized calcium. Therefore, causes for the development of SRHPT seem to be multifactorial and they must be further investigated, mainly in the early stages of CKD in cats, as hyperphosphatemia and ionized hypocalcemia could not be the only factors involved.INDEX TERMS: Renal disease in cats, ionized calcium, hyperphosphatemia, secondary renal hyperparathyroidism, metabolic acidosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Serum intact parathyroid hormone levels in cats with chronic kidney disease

et al. 2013

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“…have reported that phosphate levels, even when within the normal range, have associated with a PTH elevation in patients with CKD prior to dialysis. 34 The present data have suggested that before dialysis those factors could be involved in determining LVH. Such data confirm the need for further studies on the correlation between changes in mineral metabolism and LVH since early CKD stages.…”

Section: O F the Patients W I T H C H R O N I C K I D N E Y Disease (mentioning

confidence: 50%

Hipertrofia ventricular esquerda em pacientes com doença renal crônica em tratamento conservador

Bregman¹,

Lemos²,

Pecoits‐Filho³

et al. 2010

J. Bras. Nefrol.

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Cardiovascular disease (CVD) remains the major cause of death in patients with chronic kidney disease (CKD). Left ventricular hypertrophy (LVH) is present in 75% of patients starting dialysis, suggesting that LVH might be present from an early stage of CKD. Few studies have addressed the predialysis prevalence of LVH. This study evaluated 309 clinically stable patients under treatment for at least three months at five Brazilian centers. Biochemical profile and inflammatory markers were assessed. Data were shown as mean ± SD. Left ventricular hypertrophy was present in 53% of the patients, whose mean age was 60 ± 13years. The mean age of those without LVH was 55 ± 14 years. Diabetes mellitus was the underlying disease in 35% of the patients in both groups. Estimated glomerular filtration rate was 30 ± 11 and 32 ± 12 mL/min for patients with and without LVH, respectively (p = 0.19). The distribution of patients showed that 60% of those with LVH were in stage 4. Multivariate logistic regression analysis indicated the following independent determinants for LVH: age (p < 0.001); calcium (p < 0.001); hemoglobin (p < 0.048); and diastolic blood pressure (p < 0.001). Systolic blood pressure, lipids, and inflammatory markers showed no correlation with LVH. In conclusion, the incidence of LVH was high even among patients under conservative treatment, and, except for age, LVH correlated with reversible factors. The need for strictly diagnosing CKD and preventing LVH in the predialysis phase is emphasized to decrease mortality due to CVD in that population.

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“…progressiva da função renal vai desencadear múltiplos sinais e sintomas para o paciente (2), afetando quase todos os seus sistemas orgânicos (11)(12)(13). Dentre esses sintomas, podemos citar: hiperpotassemia, acidose metabólica, hipocalcemia, edema periférico, insuficiência cardíaca congestiva, cãibras, fraqueza muscular, etc (1)(2)(3)11).…”

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Eficácia de um protocolo de exercícios físicos em pacientes com insuficiência renal crônica, durante o tratamento de hemodiálise, avaliada pelo SF-36

Soares¹,

Viesser²,

Rzniski

et al. 2011

Fisioter. mov.

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OBJETIVO: Analisar os efeitos de um protocolo de exercícios fisioterapêuticos em pacientes renais crônicos, durante a terapia hemodialítica, visando à melhora de sua qualidade de vida. MATERIAIS E MÉTODOS: Foram avaliados 27 pacientes, com idade média de 51 ± 10,5 anos, índice de massa corpórea média de 24,3 ± 3,8 e em tratamento hemodialítico há aproximadamente 50 ± 27,7 meses. Os pacientes assinaram o Termo de Consentimento Livre e Esclarecido e, durante três meses, participaram de um programa de tratamento, durante a hemodiálise, composto por alongamentos musculares de membros inferiores, de membro superior (que não apresentasse a fístula arteriovenosa), lombar e cervical (caso o paciente não apresentasse o cateter cervical de diálise); fortalecimentos musculares de membros inferiores e membro superior, sem o acesso vascular; e relaxamento. Foi aplicado o questionário de qualidade de vida SF-36 antes e após o período de tratamento. RESULTADOS: Após o tratamento, o teste SF-36 mostrou melhora significativa das seguintes variáveis: capacidade funcional, nível de dor, vitalidade e saúde mental. Também foi observado que, antes do tratamento, dez pacientes relatavam cãibras musculares e, após a fisioterapia, somente quatro pacientes continuaram relatando essas contrações. CONCLUSÃO: Conclui-se que a atuação da fisioterapia durante a hemodiálise contribuiu para a melhora da qualidade de vida de pacientes renais crônicos.

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Bone disease in patients with chronic kidney disease under conservative management

Abstract: The present data suggest the importance of early control for iPTH and metabolic acidosis, among patients under conservative management for chronic kidney disease, in order to prevent complications related to bone disease.

Cited by 6 publications

References 19 publications

Serum intact parathyroid hormone levels in cats with chronic kidney disease

Serum intact parathyroid hormone levels in cats with chronic kidney disease

Hipertrofia ventricular esquerda em pacientes com doença renal crônica em tratamento conservador

Eficácia de um protocolo de exercícios físicos em pacientes com insuficiência renal crônica, durante o tratamento de hemodiálise, avaliada pelo SF-36

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