Renal osteodystrophy and growth in children undergoing CAPD TAMIE ITO, SHIGEHARU HORIIKE and KIKUO IITAKA Department of Pediatrics and Radiology*, Kit

Size: px

Start display at page:

Download "Renal osteodystrophy and growth in children undergoing CAPD TAMIE ITO, SHIGEHARU HORIIKE and KIKUO IITAKA Department of Pediatrics and Radiology*, Kit"

なごみやなぎしま
4 years ago
Views:

1 Renal osteodystrophy and growth in children undergoing CAPD TAMIE ITO, SHIGEHARU HORIIKE and KIKUO IITAKA Department of Pediatrics and Radiology*, Kitasato University School of Medicine (Directer: Prof. Kimio Yashiro) Key words: renal osteodystrophy, growth, rickets, secondary hyperparathyroidism, CAPD Renal osteodystrophy (ROD) and growth were assessed in 20 children undergoing CAPD. Serum calcium and inorganic phosphorus levels were maintained with normal limits in these patients. Elevated alkaline phosphatase and c-pth levels and abnormal radiological bone changes of ROD were observed in patients with severe ROD, but they were not correlated each other in patients with mild ROD. Fifteen patients showed the radiological bone changes of ROD with deterioration and improvement in some patients, and administration of vitamin D seems to be necessary to prevent ROD during CAPD treatment. The growth of older children was poor during CAPD, but catch up growth was observed in young children under the age of 7 years. The growth was affected by rickets in young children, but the presence of mild secondary hyperparathyroidisms seemed to have little influence on growth in older children.

2 NS: Nephrotic syndrome, k: kidey, RPGN : Rapidly progressive glomerulonephritis, ATN: Acute tubular necrosis, FGS: Focal glomerulosclerosis, HUS: Hemolytic uremic syndrome, HSPN: Henoch shonlein purpura nephritis, N: Nephropathy, CGN Chronic glomerulonephritis

3 Table 2 Radiological bone changes of secondary hyperparathyroidism and rickets. I. Radiological findings of secondary hyperparathyroidism A. Granular demineralization of skull 0. normal, no granular demineralization 1. granular demineralization: inner table, diploe, outer table cliff erenciable 2. granular demineralization: inner table, diploe, outer table undifferenciable B. Lamina d Ara of alveolar bone 0. intact lamina dura 1. faintly visible lamina dura 2. diminished lamina dura C. Subperiosteal bone resorption 0. normal, no subperiosteal bone resorption 1. subperiosteal bone resorption: cortical continuity present 2. subperiosteal bone resorption: cortical continuity lost D. Osteosclerotic changes of metaphysis 0. normal, no osteosclerotic changes 1. osteosclerotic changes present II. Radiological findings of rickets A. Ricketic changes at growth plates 0. normal 1. widening of growth plates, only 2. widening of growth plates with irregularity of metaphyseal surface 3. widening of growth plates with metaphyseal "cupping" 4. metaphyseal resorption with pencil tip formation III. Others pseudofructure brown tumor ectopic calcification

4 Table 3 Grading of radiological bone changes of secondary hyperparathyroidism and rickets. Fig. 2 ALP and PTH-C levels of patients <7 years of age during CAPD. Fig. 1 Serum calcium and inorganic phosphorus levels using Al (OH) 3 (Lt) and CaCO3 (Rt) during CAPD.

5 Fig. 3 ALP and PTH-C levels of patients years of age during CAPD. Fig. 4 Grading of radiological bone changes during CAPD. Among 10 patients <7 years at start of CAPD (Lt) 5 had changes of rickets and 7 had secondary hyperparathyroidism. Among 10 patients 7 years at start of CAPD (Rt) 3 had changes of rickets and 8 had secondary hyperparathyroidism.

7 Fig. 7 Radiographic bone changes of pt. 14. The left picture shows bone sclerosis in the distal end of femur ( ). The right picture shows improvement of sclerotic changes with the growth of 10 cm in one year ( ). Fig. 8 Growth curve for boys <7 years at start of CAPD in the left and 7 years at start of CAPD in the right (---on conservative therapy or hemodialysis. \ on CAPD).

8 Fig. 11 Mean SDS changes of height during CAPD in different age groups. Fig. 9 Growth curve for girls (---on conservative therapy or hemodialysis, on CAPD). Fig. 10 Relationship between bone age and calender age in CAPD patients.

9 Fig, 12 SDS changes at the start and at the last follow up of CAPD in different age groups. Fig. 14 Serum Vit D metabolites levels during CAPD. Fig. 13 Mean changes of SDS ( SDS) during CAPD in different age groups ( all patients, for patients >7 years and for patients 7 years).

12 1) Oreopoulos DG, Katirtzoglou A: Dialysis and transplantation in young children. Br Med J 1: , ) Balfe JW, Irwin M-A, Oreopoulos DG: An assessment of continuous ambulatory peritoneal dialysis (CAPD) in children. in CAPD Update, edited by Moncrief JW and Popovich RP, Masson Publishing USA, Inc, 1981, ) Fourinier A, Moriniere P, Sebert JL, Dkhissi H, Atik A, Laffon P, Renaud H, Gueris J, Gregoire I, Idrissi A, Garabedian M: Calcium carbonate, an aluminium-free agent for control of hyperphosphatemia, hypocalcemia, and hyperparathyroidism in vremia. Kidney Int 29: s114- s119, ) Gonella M, Calabrese G, Vagelli G, Pratesi G, Lamon S, Talarico S: Effects of high CaCO3 supplements on serum calcium and phosphorus in patients on regular hemodialysis treatment. Clinical Nephlol 24: , ) Iitaka K, Yoshioka T, Maruno T, Sakai T: Continuous ambulatory peritoneal dialysis in children-serum levels and mass transfer. Jap J Ne ph 28: , ) Hewitt IK, Stefanidis C, Reilly BJ, Kooh SW, Balfe JW: Renal osteodystrophy in children undergoing continuous ambulatory peritoneal dialysis. J Pediatr 103: , ) Paunier L, Salusky IB, Slatopolsky E, Kangarloo H, Kopple JD, Horst RL, Coburn JW, Fine RN: Renal osteodystrophy in children undergoing continuous ambulatory peritoneal dialysis. Pediatr Res 18: , ) Salusky IB, Fine RN, Kangarloo H, Gold R, Paunier L, Goodman W, Brill JE, Gilli G: High dose calcitriol for control of renal osteodystrophy in children on CAPD. Kidney Int 32: 89-95, ) Rapoport J, Shany S, Chaymovitz C: Continuous ambulatory peritoneal D. Nephron: 48, 1-3, 1988 dialysis and vitamin 18) Salusky IB, Coburn JW, Brill J, Foley J, Slatopolsky E, Fine RN, Goodman WG : Bone disease in pediatric patients undergoing dialysis with CAPD or CCPD. Kidney Int 33: , ) litaka K, Ito T, Sakai T: Growth and dietary intake of calorie and protein during continuous ambulatory peritoneal dialysis in children. Recent advances in pediatric nephrology, edited by K Murakami et al, Elsevier Science Publishers 1987, pp BV., 20) Mehls O, Ritz E, Hunziker EB, Tonshoff B, Heinrich U: Role of growth hormone in growth hormone in growth failure of uraemia-perspectives for application of recombinant growth hormone. Acta Pediatr Scand [Supple] 343: , 1988

Title 外傷性脊髄損傷患者の泌尿器科学的研究第 3 報 : 上部尿路のレ線学的研究並びに腎機能について Author(s) 伊藤, 順勉 Citation 泌尿器科紀要 (1965), 11(4): Issue Date URL

Title 外傷性脊髄損傷患者の泌尿器科学的研究第 3 報 : 上部尿路のレ線学的研究並びに腎機能について Author(s) 伊藤, 順勉 Citation 泌尿器科紀要 (1965), 11(4): 278-291 Issue Date 1965-04 URL http://hdl.handle.net/2433/112732 Right Type Departmental Bulletin Paper