Renal Osteodystrophy in Pre-Dialysis Patients: Ethnic Difference?

1999 ◽  
Vol 19 (2_suppl) ◽  
pp. 402-407 ◽  
Author(s):  
Sug Kyun Shin ◽  
Do Hun Kim ◽  
Heung Su Kim ◽  
Kyu Tae Shin ◽  
Kyung Ae Ma ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Renal Osteodystrophy ◽  
Bone Disease ◽  
Ethnic Difference ◽  
Osteitis Fibrosa ◽  
Dialysis Patients ◽  
Total Alkaline Phosphatase ◽  
Intact Pth ◽  
Western Countries ◽  
Total Alkaline

The purpose of the present study is to investigate whether an ethnic difference exists in the incidence of renal osteodystrophy between Asian and Western countries in end-stage renal disease (ESRD) patients. We evaluated bone histology in 58 pre-dialysis patients (28 male, 30 female; mean age: 47.7 years). All patients had bone biopsies with quantitative histomorphometry and sero-logical parameters such as intact PTH, osteocalcin, total alkaline phosphatase, and basal and deferoxamine-stimulated serum aluminum levels. We observed that 91.4% of all evaluated patients showed renal osteodystrophy before the start of dialytic therapy. Mild osteitis fibrosa were observed in 21 patients (36.2%), severe osteitis fibrosa in 5 patients (8.6%), mixed lesions in 7 patients (12.1 %), osteomalacia in 6 patients (10.3%), aplastic bone disease in 14 patients (24.1%), and normal bone in 5 patients (8.6%). Among the bone histomorphometric parameters, fibrosis area rate (%) showed the best correlation with intact PTH, and osteocalcin and osteoid area rate (%) with total alkaline phosphatase. Aluminum-related bone disease was not observed. Among patients with aplastic bone disease, only 14.3% showed aluminum deposition of any significance (5% < stainable bone surface aluminum < 25%). In the diabetic patients, aplastic bone disease was most common, but no case was related to aluminum intoxication. In conclusion, the distribution of renal osteodystrophy in our study was different from that of Western countries in pre-dialysis patients. Our patients tended to have more mild-form osteitis fibrosa and normal findings, and less severe-form osteitis fibrosa and aplastic bone disease. Aluminum-related bone disease was not observed.

scholarly journals The spectrum of bone disease in 200 chronic hemodialysis patients: a correlation between clinical, biochemical and histological findings

1998 ◽  
Vol 116 (5) ◽  
pp. 1790-1797 ◽  
Author(s):  
Maria Eugênia Leite Duarte ◽  
Ana Lúcia Passos Peixoto ◽  
Andréa da Silva Pacheco ◽  
Angela Vieira Peixoto ◽  
Rodrigo Dezerto Rodriguez ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Renal Osteodystrophy ◽  
Bone Disease ◽  
Bone Lesion ◽  
Clinical Manifestations ◽  
Osteitis Fibrosa ◽  
Bone Lesions ◽  
Histological Findings ◽  
Phosphate Binding ◽  
High Turnover

INTRODUCTION: Renal osteodystrophy includes the complete range of mineral metabolism disorders that affect the skeleton in patients with chronic renal failure. PATIENTS AND METHODS: 200 patients with end-stage renal disease and on dialysis were investigated regarding the clinical, biochemical and histological findings of bone disease. RESULTS: The spectrum of renal osteodystrophy consisted mainly of high turnover bone lesions (74.5%), including osteitis fibrosa in 57.5%. Patients with mild bone disease were on dialysis for shorter periods of time and were mostly asymptomatic. Patients with aluminum-related bone disease (16.5%) had the greatest aluminum exposure, either orally or parenterally, and together with patients with high turnover mixed disease, were the most symptomatic. Although on a non-regular basis, the vast majority of the patients (82.5%) had been receiving vitamin D. The incidence of adynamic bone disease was high (n=8) among parathyroidectomized patients (n=12). Significantly higher serum levels of alkaline phosphatase were observed in osteitis fibrosa. CONCLUSIONS: The use of calcitriol and phosphate-binding agents on a non-regular basis seems to be the reason for the apparent reduced response to the treatment of secondary hyperparathyroidism. Alkaline phosphatase has been shown to be a fair marker for bone turnover in patients with osteitis fibrosa. The severity of the clinical manifestations of bone disease correlates with the histological features of bone lesion and to the time spent on dialysis.

scholarly journals Bone mineral density and serum levels of 25 OH vitamin D in chronic users of antiepileptic drugs

2004 ◽  
Vol 62 (4) ◽  
pp. 940-948 ◽  
Author(s):  
Carolina A.M. Kulak ◽  
Victória Z.C. Borba ◽  
John P. Bilezikian ◽  
Carlos E. Silvado ◽  
Luciano de Paola ◽  
...  
Keyword(s):  
Bone Mineral Density ◽  
Vitamin D ◽  
Alkaline Phosphatase ◽  
Lumbar Spine ◽  
Antiepileptic Drugs ◽  
Serum Levels ◽  
Mineral Density ◽  
Total Alkaline Phosphatase ◽  
Blood Samples ◽  
Total Alkaline

The aim of this cross sectional study was to evaluate bone mineral density (BMD) and serum levels of 25-hydroxy vitamin D (25OHD) in a group of patients taking antiepileptic drugs (AED) for a seizure disorder. Between May-2001 and January-2003, we evaluated 58 patients (40 women/18 men), 34.4±6 years old living in Curitiba or in its metropolitan area, on antiepileptic therapy for 2 to 38 years (10 on monotherapy /48 on multiple drugs regime). The group was matched by age, gender, and bone mass index to 29 healthy subjects (20 women/ 9 men); 34.2±5.9 years old. Medical history and physical exam were performed on all subjects with particular information sought about fractures and risks factors for osteoporosis. Blood samples were collected for total serum calcium, albumin, phosphorus, creatinine, total alkaline phosphatase, and liver function tests. BMD of the lumbar spine, femur and forearm was determined by dual energy X-ray absorptiometry (DXA, Hologic QDR 1000). Between February and April-2003, other blood samples were collected to measure 25OHD, intact paratohormone (PTH) and calcium. Unemployment and smoking history were more frequent among patients than among controls (p<0.05). Fifteen patients had a fracture history, all of which occurred during a seizure. The BMD of the lumbar spine (0.975±0. 13 g/cm² vs. 1.058±0.1 g/cm²; p<0.03) and of the total femur (0.930±0.1 g/cm² vs. 0.988±0.12 g/cm²; p<0.02) was lower in patients than in controls. In 63.5% of patients and in 24.1 % of controls a T-score < -1.0 in at least one site was seen. The AED users had higher total alkaline phosphatase and lower 25OHD (p<0.02). No correlations between BMD and 25OHD were found. The use of phenytoin was correlated with a greater incidence of fractures (RR: 2.38). We conclude that patients on chronic use of AED have alterations in bone metabolism characterized in this study by lower BMD of the lumbar spine and total femur and lower serum concentrations of 25OHD.

Metabolic Bone Disease in the CAPD Patient

1983 ◽  
Vol 3 (1_suppl) ◽  
pp. 24-26 ◽  
Author(s):  
Francisco Llach
Keyword(s):  
Vitamin D ◽  
Renal Osteodystrophy ◽  
Bone Disease ◽  
Metabolic Bone Disease ◽  
Osteitis Fibrosa ◽  
Prospective Evaluation ◽  
Metabolic Bone ◽  
Capd Patient

It seems that CAPD may improve some patients with osteomalacia but may be similar to hemodialysis in regard to osteitis fibrosa. However, long-term prospective evaluation of the incidence of bone disease in CAPD patients is necessary before we can determine how CAPD may alter the incidence and expression of renal osteodystrophy. We need more information before we can conclude that CAPD may improve pure osteomalacia. Finally, the data available are insufficient to clarify the role of vitamin D analogues in these patients.

A New Fluorometric Method for the Estimation or Detection of Total and Fractionated Alkaline Phosphatase

1969 ◽  
Vol 15 (2) ◽  
pp. 108-123 ◽  
Author(s):  
Roy B Johnson
Keyword(s):  
Alkaline Phosphatase ◽  
Relative Activity ◽  
Normal Serum ◽  
Starch Gel Electrophoresis ◽  
Total Alkaline Phosphatase ◽  
Fluorometric Method ◽  
Highly Sensitive ◽  
Starch Gel ◽  
Alpha Beta ◽  
Total Alkaline

Abstract A highly sensitive fluorometric method for the assay of total alkaline phosphatase and the detection of its components is described. The commercially available substrate naphthyl AS-MX phosphate, combined in 1 M 2-amino-2-methyl-1-propanol buffer, pH 9.8, is cleaved to the highly fluorescent naphthol AS-MX. Fluorometry requires filters passing 405 mµ primary and 505 mµ secondary. As little as 20 µl. of normal serum per 3 ml. of reaction mixture can be assayed. Alkaline phosphatase components, separated by vertical starch gel (or other methods of) electrophoresis, produce yellow fluorescence under ultraviolet light when incubated at 37° with the same buffer-substrate. After vertical starch gel electrophoresis, all normal serums exhibit at least one component (β-globulin region), but six distinct areas of activity have been located. These correspond to Taswell and Jeffers’ origin, beta-lipoprotein, alpha-2, alpha-beta, and beta (5). Few serums contain all of these; rather there appears to be a correlation between the ones present, their relative activity, and the disease state.

scholarly journals Release of alkaline phosphatase from membranes by a phosphatidylinositol-specific phospholipase C.

1977 ◽  
Vol 167 (1) ◽  
pp. 281-284 ◽  
Author(s):  
M G Low ◽  
J B Finean
Keyword(s):  
Staphylococcus Aureus ◽  
Alkaline Phosphatase ◽  
Phospholipase C ◽  
Mammalian Species ◽  
Salt Solutions ◽  
Total Alkaline Phosphatase ◽  
Total Alkaline Phosphatase Activity ◽  
Wide Range ◽  
Releasing Effect ◽  
Total Alkaline

Purified phosphatidylinositol-specific phospholipase C from Staphylococcus aureus released a substantial proportion of the total alkaline phosphatase activity from a wide range of tissues from several mammalian species. Co-purification of the phospholipase C and alkaline phosphatase-releasing activities and the inhibition of both these activities by iso-osmotic salt solutions suggested that the releasing effect was unlikely to be due to a contaminant.

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