RESUMO
Fifteen children undergoing continuous ambulatory peritoneal dialysis for 0.3 to 2.4 years were evaluated longitudinally for renal osteodystrophy. Immunoreactive parathyroid hormone, 25-OHD, total and ionized calcium, inorganic phosphate, and alkaline phosphatase levels were measured regularly. Skeletal radiographic studies were performed at the onset and conclusion of CAPD and at six-month intervals during therapy. All children received 1,25(OH)2D3 and aluminum hydroxide, and nine received supplemental calcium. Plasma 25-OHD concentrations were normal to elevated, and calcium increased steadily to high normal levels despite a trend to persistent hyperphosphatemia. The increased calcium levels suppressed parathyroid hormone overactivity in only one patient. At the onset of CAPD, nine patients had hyperparathyroid bone disease seen radiographically, three of whom also had rachitic lesions. At the end of CAPD, the hyperparathyroid lesions had improved in four patients, completely resolved in three, and deteriorated in two. Rachitic lesions had completely healed in two patients and improved in the third. However, among the six children without radiographically evident lesions at onset of CAPD, hyperparathyroid bone lesions developed in two and rachitic lesions in two others during CAPD. Although CAPD and appropriate therapy benefited most patients with renal osteodystrophy, the benefits were not uniform, and bone lesions deteriorated in some.
Assuntos
Distúrbio Mineral e Ósseo na Doença Renal Crônica/etiologia , Falência Renal Crônica/terapia , Diálise Peritoneal Ambulatorial Contínua , Diálise Peritoneal , Adolescente , Fosfatase Alcalina/sangue , Osso e Ossos/diagnóstico por imagem , Calcifediol/sangue , Cálcio/sangue , Criança , Pré-Escolar , Distúrbio Mineral e Ósseo na Doença Renal Crônica/diagnóstico por imagem , Feminino , Transtornos do Crescimento/etiologia , Humanos , Lactente , Falência Renal Crônica/complicações , Masculino , Hormônio Paratireóideo/sangue , Fosfatos/sangue , RadiografiaRESUMO
Linear growth of 17 children receiving CAPD was compared with growth in 18 patients receiving hemodialysis and 20 who had undergone transplantation, as well as with the previous growth in 11 of the 17 patients. Growth was normal in 10 receiving CAPD, fair in six others, and poor in only one. Growth velocity indexes in those receiving CAPD were significantly better than those of the group receiving hemodialysis (P less than 0.01) but did not differ significantly from those of children who had undergone kidney transplant. All patients grew significantly better after beginning CAPD than before (P less than 0.01). Appropriate management of renal osteodystrophy combined with adequate energy and protein intake were important factors in the growth of patients receiving CAPD.