Comparative study of alkaline phosphatase isoenzymes, bone histology, and skeletal radiography in dialysis bone disease.

Abstract

Liver, intestinal, and bone alkaline phosphatase isoenzymes were measured using heat stability and Lphenylalanine inhibition techniques in 78 patients on intermittent haemodialysis. Fifty-five patients had abnormalities in one or more of the isoenzymes. Changes in bone and intestinal alkaline phosphatase activities seemed to be related and raised liver isoenzyme activity was associated with the development of liver disease. Abnormal histological and radiological findings were better correlated with bone alkaline phosphatase levels than with total-alkaline phosphatase, and serial estimations of bone isoenzyme activity were useful in assessing the response of renal osteodystrophy to treatment with a vitamin D analogue. Serum alkaline phosphatase isoenzyme measurement provides another useful and non-invasive index for monitoring metabolic bone disease in patients with chronic renal failure.

Changes in Protein-Bound Calcium During Haemodialysis in Relation to Bone Disease

“…By measuring total, heat-stable and phenylalanine-stable activities, quantitative assessment of bone, liver and intestinal isoenzymes can be made. The normal range for bone alkaline phosphatase in 44 healthy volunteers over the age of 20 years was 0-30 IU/1 (mean 14, 2 S D = 15 IU/1) [8], Skeletal surveys including X-rays of pelvis, spine, feet and hands were carried out on all patients at 6-to 12-month intervals.…”

Bone Metabolism and Its Assessment in Renal Failure

“…Evaluation of the isoenzyme of bone [96][97][98] has not yet become a widely employed procedure. Its use could be of help, better than total alkaline phosphatase, in the study of renal osteodystrophy [97,99.100] and other metabolic bone diseases.…”

“…Increased alkaline phosphatase is also found in young and adolescent subjects, as an expres sion of active bone growth [95]. Evaluation of the isoenzyme of bone [96][97][98] has not yet become a widely employed procedure. Its use could be of help, better than total alkaline phosphatase, in the study of renal osteodystrophy [97,99.100] and other metabolic bone diseases.…”

“…However most of the data refer to total serum alkaline phosphatase. The bone isoenzyme has not been extensively employed, and only few reports have correlated bone isoenzyme with bone histology in dialysis patients, showing some advantage compared to total alkaline phosphatase [97]. Total alkaline phosphatase, bone isoenzyme, intact PTH, BGP and X-ray bone erosions have been studied comparatively in hemodi alysis patients [100].…”

“…Therefore taking into account alkaline phosphatase activity visible in bone, extended to a larger osteoblastic surface than shown by tetracycline, clearly favorably in fluences the correlation of serum enzyme activity with the dynamic bone parameters. The use of alkaline phosphatase 390 Coen/Mazzaferro Bone Metabolism and Its Assessments in Renal Failure assays [96][97][98], able to measure the isoenzyme of bone derivation, definitely improves the diagnostic value of this parameter in renal bone disease [99], A more promising marker of bone disease in predialysis chronic renal failure appears to be serum BGP. At variance from intact iPTH and alkaline phosphatase, for which disappearance from serum is due to peripheral metabolism, BGP is a 49-residue low-molecular-weight protein, cleared mainly by kidney filtration.…”