Low serum levels of alkaline phosphatase of bone origin: a good marker of adynamic bone disease in haemodialysis patients

Couttenye, Marie M.; D’Haese, Patrick C.; Hoof, Viviane Van; Lemoniatou, E.; Goodman, William G.; Verpooten, Gert A.; Broe, Marc E. De

doi:10.1093/ndt/11.6.1065

Cited by 108 publications

(92 citation statements)

References 36 publications

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“…Of course, it remains the case that bone biopsy is the desirable but rarely achievable diagnostic maneuver, although even the much-vaunted accuracy of bone biopsy must be set aside for the increasing lack of histomorphometric interpretative expertise and the known skeletal metabolic heterogeneity seen in CKD. Despite histologic studies demonstrating bALP as a good marker of bone turnover in patients undergoing hemodialysis (Table 1) (71,72), its use has not become widespread, probably reflecting difficulties of measurement and concerns over cross-reaction with liver-derived ALP.…”

Section: Pth or Alp: Combine For The Best Of Both Worldsmentioning

confidence: 99%

PTH—A Particularly Tricky Hormone

Garrett

Sardiwal

Lamb

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryPlasma parathyroid hormone (PTH) concentrations are commonly measured in the context of CKD, as PTH concentration elevation is typical in this clinical context. Much has been inferred from this raised PTH concentration tendency, both about the state of skeletal integrity and health and also about the potential clinical outcomes for patients. However, we feel that reliance on PTH concentrations alone is a dangerous substitute for the search for, and use of, more precise and reliable biomarkers. In this article, we rehearse these arguments, bringing together patient-level and analytical considerations for the first time.

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Section: Pth or Alp: Combine For The Best Of Both Worldsmentioning

confidence: 99%

PTH—A Particularly Tricky Hormone

Garrett

Sardiwal

Lamb

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…A menor prevalência foi encontrada nos pacientes que mantinham PTH aproximadamente 1 a 3 vezes o limite superior do valor de referência (81). Assim, valores de PTH acima de 3 vezes o normal associado a níveis de fosfatase alcalina elevados são considerados preditores de HPT, enquanto a doença adinâmica do osso é mais comum em pacientes com PTH menores que 2 vezes o limite superior e com valores não elevados de fosfatase alcalina (82,83).…”

Section: Contra-indicações à Paratireoidectomia E Diagnóstico Diferenunclassified

Indicações de paratireoidectomia no hiperparatireoidismo secundário à insuficiência renal crônica

Lacativa¹,

Filho

Gonçalves³

et al. 2003

Arq Bras Endocrinol Metab

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Arq Bras Endocrinol Metab vol 47 nº 6 Dezembro 2003 644 RESUMOO hiperparatireoidismo é uma manifestação comum na insuficiência renal crônica (IRC), com alta morbi-mortalidade e difícil manejo clínico. As indicações clássicas da paratireoidectomia são: hipercalcemia persistente, principalmente após transplante renal, prurido intratável, fraturas patológicas, dor óssea refratária ao tratamento medicamentoso e calcificação metastática. Infelizmente, esta última não responde à paratireoidectomia e a calcificação dos vasos está relacionada ao aumento da mortalidade. Assim, novos critérios para indicação mais precoce de paratireoidectomia são necessários. Níveis séricos de PTH maiores que 10 vezes o limite da normalidade, apesar da adequada reposição de cálcio e calcitriol, produto cálcio x fósforo maior que 70(mg/dl) 2 , tumor marrom quando é urgente a regressão da massa, artrite e/ou periartrite incapacitantes e ruptura de tendões estão entre outras indicações a serem consideradas. Alguns cuidados são necessários para excluir doenças ósseas concomitantes, como amiloidose e intoxicação por alumínio. Esta revisão visa a orientar os endocrinologistas sobre as indicações e melhor momento de realizar paratireoidectomia no hiperparatireoidismo da IRC. Hyperparathyroidism is a common complication of end-stage renal insufficiency, with a high morbi-mortality and difficult medical control. Classical indications for parathyroidectomy are: persistent hypercalcemia, especially after kidney transplantation, untreatable pruritus, pathologic fractures, bone pain refractory to medical treatment, and metastatic calcifications. Unfortunately, this latter complication does not respond to parathyroidectomy, and blood vessels calcifications are associated with increased mortality. Severe osteitis fibrosa and bone deformities also never disappear. Thus, new criteria for early parathyroidectomy are needed. Serum intact PTH higher than 10 times the upper limit of normality despite adequate calcium and calcitriol supplements, calcium-phosphorus product higher than 70(mg/dL) 2 , "brown tumor" whenever a rapid regression is needed, incapacitating arthritis and/or periarthritis, and rupture of tendons are among other indications that should be considered. Care must be taken to exclude concomitant diseases such as amiloidosis and aluminum intoxication. This review intends to advise endocrinologists about the indications and timing of surgery in hyperparathyroidism due to chronic renal failure.

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“…However, the overall results of these studies have been inconsistent and the clinical utility of BTMs other than for PTH and BALP has not been sufficiently validated in CKD. Serum PTH and BALP are useful for differentiating high and low bone turnover disease [14,19,20]. However, their diagnostic accuracy, especially for PTH is only modest, as the serum levels significantly overlap between high and low bone turnover states; thus only extreme values are diagnostically helpful in individual patients [16,21].…”

Section: Diagnosis Of Osteoporosis and Fracture Risk Assessmentmentioning

confidence: 99%

Fragility Fractures in Chronic Kidney Disease: Assessment and Pharmacologic Management

Anpalahan

Venkatesan

Anpalahan

2014

Advances in Nephrology

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Fractures are common in all stages of chronic kidney disease (CKD), and are associated with increased morbidity and mortality. Both CKD and osteoporosis often coexist as they both are strongly age associated. However, the management of fragility fractures in CKD poses many dilemmas. These include diagnosing the aetiology of fractures and choosing appropriate treatment. This paper reviews the current evidence for the assessment and pharmacologic management of fragility fractures in CKD.

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Low serum levels of alkaline phosphatase of bone origin: a good marker of adynamic bone disease in haemodialysis patients

Cited by 108 publications

References 36 publications

PTH—A Particularly Tricky Hormone

PTH—A Particularly Tricky Hormone

Indicações de paratireoidectomia no hiperparatireoidismo secundário à insuficiência renal crônica

Fragility Fractures in Chronic Kidney Disease: Assessment and Pharmacologic Management

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