Patolog

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Grupo de Estudio del Metabolismo
FosfocálcicoSociedad Uruguaya de Nefrología
Cátedra de Nefrología Facultad de
Medicina Montevideo Uruguay
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METABOLISMO FOSFOCALCICO(AÑO 1985)

• CALCIO n 339 9 1.3 mg/dl
• lt 8 mg/dl 14
• 8 9 mg/dl 33
• 9.1 11 mg/dl 51
• gt 11 mg/dl 2

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METABOLISMO FOSFOCALCICO(AÑO 1985)

• FOSFORO n 339 5.5 1.4 mg/dl
• lt 5.5 mg/dl
  48
• 5.5 7 mg/dl
  40
• gt 7 mg/dl
  12

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METABOLISMO FOSFOCALCICO(AÑO 1985)

• PTH n 339
• 8 1.2 9
  
• 1.3 5 46
  
• 5.1 10 25
• gt 10 20

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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)

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METABOLISMO FOSFOCALCIOPAUTAS DOQI

• CALCIO 8.4 - 9.5 mg/dl
• FOSFORO 3.5 - 5.5 mg/dl
• PTHi
  150 300 pg/ml

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METABOLISMO FOSFOCALCICO(abril - octubre
2004) n 2415

• Calcio lt 8.4 mg/dl 20.7
• 8.4 9.5 mg/dl
  52.6
• gt 9.5 mg/dl
  26.8
• Fósforo lt 3.5 mg/dl 5.5
• 3.5 5.5 mg/dl
  39.8
• gt 5.5 mg/dl
  54.7
• PTHi gt 150 pg/ml 29
• 150 300 pg/ml 21.6
  
• gt 300 pg/ml
  49.4

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METABOLISMO FOSFOCALCICO (abril - octubre
2004)
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• Cannata et al
  SUN
• (n
  7512) (n 2415)
  
• PTHi lt 150 47
  29
• 150 300 22
  21.6
• gt 300 31
  49.4
• P gt 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).

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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

1. To analyze the prevalence of the different types
   of bone disease over the time in dialysis
   patients in Uruguay.
2. 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

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ResultsFrequency of Different Histological
Forms 1985 2000
n 167
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ResultsHistological Diagnosis According to Year
of Bone Biopsies 1985 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
a p lt 0.001 b p lt 0.01 c p lt 0.05
samples Alwater 88 (lt 10
µg/l) 97 (lt 2 µg/l)
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ResultsFreqcuency of Adinamic Bone Disease with
and without Aluminium Over the Time
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Renal Osteodystrophy in UruguayBone Biopsy
Registry iPTH levels
iPTH pg/ml
1400 1300 1200 1100 1000 900 800 700 600 500 400 3
00 200 100 0
p lt 0,001
OF
OMa y ABDa
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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.

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