Kronik Böbrek Hastalarıında Paratiroid Hormon Ölçüm Sonuçlarıına Etki Eden Faktörler

Paratiroid hormon (PTH) paratiroid bezden sekrete edilen polipeptid yapıda bir hormondur. PTH serum kalsiyum ve fosfor dengesinin düzenlenmesinde önemli role sahiptir. Kronik böbrek hastalığı (KBH) olan kişilerde böbrek fonksiyonlarındaki azalmaya bağlı olarak kalsiyum ve fosfor dengesi bozulur. Mineral dengesindeki bu bozulma PTH düzeyinde artışa yol açar. KBH' da PTH ve mineral dengesindeki bozuklukla giden geniş spektrumlu klinik patolojilere kronik böbrek hastalığının mineral ve kemik bozukluğu (KBH-MKB) adı verilir. KBH-MKB'nun takibinde paratiroid hormon kullanılır. Ancak yapılan çalışmalar PTH sonuçları arasında standardizasyonun olmadığını göstermiştir. PTH sonucunda farklılıklara yol açan nedenler arasında kullanılan metotların farklılığı, serumda bulunan PTH yıkım ürünleri, kişinin Vitamin D durumu, ısı, numune alma ve işlemeye yönelik faktörler sayılabilir. PTH ölçümlerinde sayılan bu faktörlerin standardize edilmesine ihtiyaç vardır. Ayrıca ölçüm yapılan belirlenmesi gerekmektedir. Bunlara ek olarak; PTH ölçüm sonuçları rapor edilirken ölçüm yapılan yöntem, numune alma ve işleme ile ilgili faktörler ve doğru bir referans aralık sonuç raporunda belirtilmelidir. Bu şekilde sonuçların yorumlanmasına ek katkı sağlanabilir. Bu yazıda kronik böbrek hastalarında paratiroid hormon ölçüm sonucunu hastanın kliniği haricinde etkileyecek faktörler irdelenmiş ve PTH ölçüm sonuçlarında değişkenliklere yol açabilecek faktörlerle ilgili güncel bilgi sunulmuştur

The Factors Affecting Parathyroid Hormone Measurement Resultsin Chronic Kidney Disease

Parathyroid hormone (PTH) is a polypeptide hormone produced and secreted by parathyroid glands, which plays a central role in calcium-phosphorus homeostasis. Calcium and phosphorus metabolism deteriorates in patients with chronic kidney disease (CKD) as a consequence of impairment in renal function. Deterioration in renal functions lead to an increase in serum PTH levels. Wide clinical spectrum pathologies of PTH and mineral metabolism disorders occurred in CKD is so called mineral and bone disorder of CKD (CKDMBD). CKD-MBD is diagnosed and followed up by measurement of serum PTH. However, PTH assays are not been standardized. Causes of variations in PTH measurements include different methods, PTH derived products in serum, vitamin D level, heat, factors contributing sample obtaining and processing. Therefore, there is need for standardization of PTH measurements. Also assay-specific decision limits are required.The clinical laboratories must inform nephrologists of the actual assay method in use and report any change in methods, sample source, and handling specifications to facilitate an appropriate interpretation of biochemistry data. It clearly shows a large variability among PTH measurement kits and potential limits ofthis measure. Moreover, the report must indicate the correct reference values. This paper summarizes the current state regarding the PTH measurement in CKD

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