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Grupo de Estudio del Metabolismo Fosfocálcico Sociedad Uruguaya de Nefrología. Cátedra de Nefrología – Facultad de Medicina Montevideo – Uruguay. METABOLISMO FOSFOCALCICO (AÑO 1985). CALCIO n = 339 9 ± 1.3 mg/dl < 8 mg/dl 14 %

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slide1

Grupo de Estudio del

Metabolismo FosfocálcicoSociedad Uruguaya de Nefrología

Cátedra de Nefrología – Facultad de Medicina

Montevideo – Uruguay

metabolismo fosfocalcico a o 1985
METABOLISMO FOSFOCALCICO(AÑO 1985)
  • CALCIO n = 339 9 ± 1.3 mg/dl

< 8 mg/dl 14 %

8 – 9 mg/dl 33 %

9.1 – 11 mg/dl 51%

> 11 mg/dl 2%

metabolismo fosfocalcico a o 19853
METABOLISMO FOSFOCALCICO(AÑO 1985)
  • FOSFORO n = 339 5.5 ± 1.4 mg/dl

< 5.5 mg/dl 48%

5.5 – 7 mg/dl 40%

> 7 mg/dl 12 %

metabolismo fosfocalcico a o 19854
METABOLISMO FOSFOCALCICO(AÑO 1985)
  • PTH n = 339

8 – 1.2 9 %

1.3 – 5 46 %

5.1 – 10 25 %

> 1020 %

metabolismo fosfocalcico abril octubre 2004
METABOLISMO FOSFOCALCICO(abril – octubre 2004)

n = 2415 M: 59.6 % F: 40.4 %

EDAD: 59.8 ± 16.9 años (2 – 94)

Ca: 9.03 ± 0.79 mg/dl (5 – 11.5)

P: 5.8 ± 1.6 mg/dl (1.3 – 11)

FA: 272 ± 222 (15 – 2000)

PTHi: 484 ± 533 pg/ml (2.3 – 4000)

metabolismo fosfocalcio pautas doqi
METABOLISMO FOSFOCALCIOPAUTAS DOQI
  • CALCIO: 8.4 - 9.5 mg/dl
  • FOSFORO: 3.5 - 5.5 mg/dl

• PTHi: 150 – 300 pg/ml

metabolismo fosfocalcico abril octubre 2004 n 2415
METABOLISMO FOSFOCALCICO(abril - octubre 2004) n = 2415
  • Calcio < 8.4 mg/dl 20.7 %

8.4 – 9.5 mg/dl52.6 %

> 9.5 mg/dl 26.8 %

  • Fósforo < 3.5 mg/dl 5.5 %

3.5 – 5.5 mg/dl39.8 %

> 5.5 mg/dl 54.7 %

  • PTHi > 150 pg/ml 29 %

150 – 300 pg/ml21.6 %

> 300 pg/ml 49.4 %

slide9
Cannata et al* SUN

(n = 7512) (n = 2415)

PTHi < 150 47 % 29 %

150 – 300 22 % 21.6 %

> 300 31 % 49.4 %

P > 5.5 49 % 54.7 %

* Sólo 9.5% tenían Ca, P, PTHi y PxCa dentro del rango propuesto por las pautas K/DOQI (Cannata et al, JASN 14: 474A, 2003).

epidemiology of renal osteodystrophy in uruguay current indications of bone biopsies

Epidemiology of Renal Osteodystrophy in UruguayCurrent indications of bone biopsies

H. Caorsi*, I. Olaizola*, L. Labruna#, V. Jorgetti&, G. Acuña*, A. Petraglia*, L. Fajardo*, A. Alvarez*, P Ambrosoni*.

* Grupo de estudio del metabolismo Fosfocálcico – Sociedad Uruguaya de Nefrología – Uruguay

# Histomorfometría Osea. Instituto de Reumatología, Montevideo - Uruguay

& Histomorfometría Osea. Universidad de Sao Paulo, Sao Paulo - Brasil

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Aims
  • To analyze the prevalence of the different types of bone disease over the time in dialysis patients in Uruguay.
  • To determine current indication of bone biopsy in the diagnosis of renal osteodystrophy.

Bone Biopsies and Clinical Features of Patients1985 – 2000

  • 167 Bone biopsies from hemodialysis symptomatic patients.
  • 4% Diabetics.
  • 93 Female; 74 Male.
  • Age: 54 ± 13 years.
  • Length of dialysis: 53 ± 33 months
results histological diagnosis according to year of bone biopsies 1985 2000
ResultsHistological Diagnosis According to Year of Bone Biopsies1985 – 2000

1985 - 1990

HD pts./year: 1187

n = 66 BB

1991 - 1996

HD pts./year: 1602

n = 84 BB

1997 - 2000

HD pts./year: 2254

n = 17 BB

c

b

% Al in MF: 42.5 ± 47a

% Al in MF : 20 ± 28a

% Al in MF : 27 ± 18

ap < 0.001; bp < 0.01; cp < 0.05

% samples [Al]water: 88% (< 10 μg/l) 97% (< 2 μg/l)

renal osteod y stro phy i n uruguay bone biopsy registr y i pth levels
Renal Osteodystrophyin UruguayBone Biopsy RegistryiPTH levels

iPTH

pg/ml

1400

1300

1200

1100

1000

900

800

700

600

500

400

300

200

100

0

p < 0,001

OF

OMa y ABDa

conclusions
Conclusions
  • Survival rates of patients on dialysis have increased with improve crescent of dialytic therapy, but the resultant increased duration of dialysis has led to rise in hyperparathyroidism. Our results show a significant increase in osteitis fibrosa in the last years. This can be explained by a longer time on dialysis of the patients.
  • On the other hand, low turnover bone disease aluminium related (OM and ABD) decreased significantly, and we find that ABD without aluminium appears in the last period.
  • The percentage of aluminium in the mineralization front in bone biopsies has diminished over the time.
  • The modification of histological forms observed should be related to the improvement in the dialysis water treatment and the reduction of oral aluminium exposure.