Günay GÜLBABA, Ahmet NAYIR, Sevinç EMRE, Ilmay BİLGE, Aydan ŞİRİN, Bülent KARA

Oral pulse calcitrıoltherapy in children with renal osteodystrophy

Amaç: Bu çalışmanın amacı, konvansiyonel oral D vitamini tedavisine dirençli renal osteodistrofili çocuklarda oral “pulse” kalsitriol tedavisinin etkinliğini değerlendirmekti. Gereç ve yöntem: Bazal serum kalsiyum, fosfor, alkalen fosfataz, üre, kreatinin, intakt paratiroid hormon (iPTH), osteokalsin, kalsitriol düzeyleri için örnek alındıktan ve paratiroid bezi ultrasonografisi yapıldıktan sonra haftada üç kez, 2 µg oral pulse kalsitrioil tedavisi başlandı ve tüm parametreler 4-6 ay süreyle izlendi.Bulgular: İkinci ve 6. ayda ölçülen serum iPTH düzeyleri bazal düzeye göre anlamlı olarak düştü (p

Çocuklarda renal osteodistrofide oral pulse kalsitriol tedavisi

Objective: The aim of this study was to determine the effects and safety of oral pulse calcitriol therapy in patients with renal osteodystrophy (ROD) refractory to the conventional oral vitamin D therapy. Materials and methods: After baseline determination of serum calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), urea, creatinine, intact parathyroid hormone (iPTH), osteocalcin, calcitriol levels and parathyroid gland ultrasonography, oral pulse calcitriol therapy was started at doses of 2 µg, three times a week, and all these parameters were followed up for a period of 4-6 months.Results: Serum iPTH levels measured in the 2nd and 6th months were significantly lower than basal serum iPTH levels (p

PDF

___

1) Bilge I, Emre S, Şirin A, Nayır A, Öktem F. Çocuk hemodiyaliz hastalarında dirençli sekonder hiperparatiroidizm tedavisinde intravenöz kalsitriol uygulaması. İst Tıp Fak Mecmuası 2000; 63:76-83.
2) Cano F, Delucchi A, Wolff E, Rodriguez E, Fuentes A. Calcitriol oral pulse therapy in children with renal osteodystrophy. Pediatr Nephrol 1995; 9:606-608.
3) Coizon BD, Salusky ID. Renal Osteodystrophy. In: Avner ED, Harmon WE, Niaudet P (eds). Pediatric Nephrology. Lippincott, Williams, Wilkins. Philadelphia, USA, 5th ed., 2004; pp 1347- 1373.
4) Dahl NV, Foote EF. Pulse oral calcitriol therapy for renal osteodystrophy. ANNAJ 1997; 25:550-555.
5) Delmez JA, Slatopolsky E. Recent advances in the pathogenesis and therapy of uremic secondary hyperparathyroidism. J Clin Endocrinol Metab 1991; 72:735-739.
6) Fukagawa M, Kitaoka M, Yi H, Fukuda N, Matsumoto T, Ogata E, Kurokawa K. Serial evaluation of parathyroid size by ultrasonography is another useful marker for the long-term prognosis of calcitriol pulse therapy in chronic dialysis patients. Nephron 1994; 68:221-228.
7) Gallieni M, Brancaccio D, Padovese P, Rolla D, Bedani P, Colantonio G, Bronzieri C, Bagni B, Tarolo G. Low dose intravenous calcitriol treatment of secondary hyperparathyroidism in haemodialysis patients. Kidney Int 1992; 4:1191-1198.
8) Malberti F, Surian M, Cosci P. Effect of chronic intravenous calcitriol on parathyroid function and set point of calcium in dialysis patients with refractory secondary hyperparathyroidism. Nephrol Dial Transplant 1992; 7:822-828.
9) Martinez ME, Selgas R, Miguel JL, Balaguer G, Cabezudo MJC. Osteocalcin levels in uremic patients. Nephron 1991; 59:429-433.
10) Moe SM. Renal osteodystrophy. In: Pereira BJG, Sayegh MH, Blake P (ed). Chronic Kidney Disease, Dialysis, Transplantation. Elsevier, Saunders. Philadelphia, USA, 2nd ed., 2005; pp 136- 157.
11) Muramoto H, Haruki K, Yoshimura A, Mimo N, Oda K, Tofuku Y. Treatment of refractory hyperparathyroidism in patients on haemodialysis by intermittent oral administration of 1,25 (OH)2 vitamin D3. Nephron 1991; 58:288-294.
12) Quarles LD, Davidai GA, Schwab SJ, Bartholomay DW, Lobaugh B. Oral calcitriol and calcium: efficient therapy for uremic hyperparathyroidism. Kidney Int 1988; 34:840-844.
13) Quarles LD, Yohay YD, Carroll BA, Spritzer CE, Minda SA, Bartholomay D, Lobaugh BA. Prospective trial of pulse oral versus intravenous calcitriol of hyperparathyroidism in ESRD. Kidney Int 1994; 45:1710-1721.
14) Slatopolsky E, Weerts J, Thielan J, Horst R, Harter H, Martin K. Marked suppression of secondary hyperparathyroidism by intravenous 1,25-dihydroxy-cholecalciferol in uremic patients. J Clin Invest 1984; 74: 2136-2143.
15) Sperschneider H, Humbsch K, Abendroth K. Oral calcitriol pulse therapy in hemodialysis patients. Med Klin 1997; 92:597-603.
16) Tsukomoto Y, Nomura M, Marumo F. Pharmacological parathyroidectomy by oral 1,25 (OH)2 D3 pulse therapy. Nephron 1989; 51:130-131.
17) Tsukomoto Y, Nomuro M, Takahashi Y, Takagi Y, Yoshida A, Nagaoka T, Togashi K, Kikawada R, Maromo F. The oral 1,25 (OH)2 D3 pulse therapy in haemodialysis patients with severe secondary hyperparathyroidism. Nephron 1991; 57:23-28.
18) Tsukamoto Y. Vitamin D therapy in renal osteodystrophy. Clin Calcium 2004; 14:21-26.
19) Türk S, Akbulut M, Yıldız A, Gürbilek M, Gönen S, Tombul Z, Yeksan M. Comparative effect of oral pulse and intravenous calcitriol treatment in hemodialysis patients. Nephron 2002; 90:188-194.