RESUMEN
In hundred patients with different stages of renal functional damage, including the controls of healthy persons we examined the disturbances of phosphate, calcium and magnesium ion metabolism during chronic renal failure (CRF) progression. We also determined the serum levels of regulatory substances, parathormone and 1.25 dihydroxyvitamin D3 in 43 pts. grouped according to their group, sex, age average and season (autumn-winter) distribution. We established actual renal compensatory mechanisms for all of substances we determined, which were involved in homeostasis preservation of those substances. Some characteristic changes in plasma substance concentration and renal mechanisms of their regulation during CRF progression, suggest the following conclusions. No substances have preserved body homeostasis, although renal compensatory mechanism were expressed by different size for any of them. Those disturbances very tightly correlate with the stage of renal functional deterioration, as well as the serum parathormone rising and serum 1.25 DHHC decreasing.
Asunto(s)
Calcio/metabolismo , Fallo Renal Crónico/metabolismo , Magnesio/metabolismo , Fósforo/metabolismo , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Secondary hyperparathyroidism is a complex pathophysiologic event which we examined in hundred patients Sixteen of them belonged to the control with normal renal function, and the rest of them were categorised into four subgroups according to the actual level of chronic renal failure, determined by GFR a.i. by endogenous creatinine clearance. We determined the serum level of parathormone (C-PTH) and plasma concentration of phosphate and calcium in all of patients. In 43 of them we measured serum level of 1.25 dihydroxycholecalcipherol and ionised calcium. Our results suggested an important parallelism between parathormone hypersecretion (GFR +/- 58.3 ml/min), 1.25 dihydroxycholecalcipherol hypovitaminosis (GFR +/- 50.7 ml/min) and hypocalcemia (GFR +/- 47.7 ml/min) which connect them in very strong relationship. Even if secondary hyperparathyroidism in chronic renal failure is caused by numerous factors, it appears that the hypovitaminosis of 1.25 dihydroxycholecalcipherol with consequent hypocalcemia and phosphate retention acts as a main movement of this complex pathophysiology mechanism.
Asunto(s)
Hiperparatiroidismo Secundario/etiología , Fallo Renal Crónico/complicaciones , Adulto , Femenino , Humanos , Hiperparatiroidismo Secundario/fisiopatología , Fallo Renal Crónico/metabolismo , Masculino , Persona de Mediana EdadRESUMEN
According to the aim of our research to find a regulatory of changes of the serum levels of 1.25 dihydroxyvitamin D3 and 25 OH D vitamin, we examined their serum concentration in 43 among 100 pts. with normal and impaired renal function with different stages of chronic renal failure (CRF). In all of 100 pts. we measured plasma phosphate and calcium concentration and endogenous creatinine clearance. The results of our research showed homeostasis abnormalities in all of parameters we examined. We found out that the serum 1.25 (OH)2 D3 levels decreased in early course of CRF, hypovitaminosis occurred when glomerular filtration rate reaches values equal or less than 50.7 ml/min. Hypovitaminosis of 25 OH D expressed in end-stage of CRF, while hyperphosphatemia was commonly seen in moderate CRF, when GFR became less than 28.6 ml/min. Hypocalcemia obtained when GFR was equal or less than 47.7 ml/min.
Asunto(s)
Calcifediol/sangre , Calcitriol/sangre , Fallo Renal Crónico/sangre , Adulto , Femenino , Tasa de Filtración Glomerular , Humanos , Fallo Renal Crónico/fisiopatología , Masculino , Persona de Mediana EdadRESUMEN
The bone disease in chronic renal failure patients with secondary hyperparathyroidism is usually termed renal osteodystrophy. Radiographic methods have been applied in renal bone disease mainly to discover lesions on long bones, hands and fee. During the evaluation of hormonal disturbances of hemodialysed chronic renal failure female patients, roentgenograms of sella turcica were taken. Findings that were detected were most probably the consequences of renal osteodystrophy. Osteoporosis of clinoid processes posteriores and dorsum sellae and intrasellar calcifications were confirmed in 25 percent of investigated patients. Lateral view of the sellae turcica demonstrated a "double floor".These pathological findings in sella turcica region could be of practical importance because of well known anatomophysiological position of this sceletal structure.
Asunto(s)
Trastorno Mineral y Óseo Asociado a la Enfermedad Renal Crónica/diagnóstico por imagen , Diálisis Renal , Silla Turca/diagnóstico por imagen , Adulto , Femenino , Humanos , Fallo Renal Crónico/diagnóstico por imagen , Fallo Renal Crónico/terapia , Persona de Mediana Edad , RadiografíaRESUMEN
Functional disturbances among different tissues and organic systems are associated with chronic renal failure. The most common problems following the disturbances in complex hemostatic changes in uremic patients are prolonged bleeding time ant the increased thrombosis tendency. As the patients vascular access is critical to the treatment of the chronic haemodialysis patient, we performed an investigation of causes of repeated vascular access thrombosis with purpose of detecting any consistent abnormality of the haemostatic system. Research has been conducted on a group of 29 patients (14 males and 15 females), age 21 to 61 (x = 45), on regular haemodialysis from 1 to 6 years (x = 2.2); 23 of them having one episode of thrombosis of vascular access, and 6 having two episodes. Partial thromboplastin time was among the normal ranges in all investigated subjects, three of them had low prothrombine time and thrombine time was prolonged in two cases. The high fibrinogen value was found in 19 patients. Mean value of platelet count was normal, though seven patients had thrombocytopenia. Absence of coagulum retraction was found in three patients. Assessment of blood coagulation in this study could not explain the development of repeated thrombotic events affecting arterio-vein fistula in chronic renal failure patients receiving haemodialysis. That points out the necessity to analyze functional status of natural coagulation inhibitors, fibrinolytic system and platelet function.