| 特集名 | 長期血液透析患者における破壊性脊椎関節症 | |
|---|---|---|
| 題名 | 慢性透析患者の骨・関節障害 -- 透析医の観点から | |
| 発刊年月 | 1998年 01月 | |
| 著者 | 大平 整爾 | 日鋼記念病院腎センター |
| 著者 | 伊丹 儀友 | 日鋼記念病院腎センター |
| 【 要旨 】 | 腎不全に伴う骨・関節病変は透析療法の開始と継続でさまざまに修飾されて，多彩な様相を呈する．アルミニウム骨症はアルミゲルの投与激減で透析性骨障害の主要な部分ではなくなっている．PTH分泌異常に関わる現況は往時と異なり，血液透析でもCAPDでも低PTH血症の症例が過半数を占めるに至り，低回転骨が脚光を浴びている．しかし，上皮小体摘出術を要する続発性上皮小体機能亢進症(高回転骨)が皆無とはなっていない．透析期間の延長で漸増する血清β-microg1obulinに関連する透析アミロイド骨・関節障害は，このところ手根管症候群のほかに各部位の骨嚢胞形成や破壊性脊椎関節症を招来して，透析患者のADL,QOLを低下せしめる要因となっており，その対策は急務である． | |
| Theme | Destructive Spondyloarthropathy in Long-term Hemodialysis Patients | |
|---|---|---|
| Title | Bone and joint involvements in chronic dialysis patients -- From view points of a dialysis doctor | |
| Author | Seiji Ohira | Kidney Center, Nikko Memorial Hospital |
| Author | Noritomo Itami | Kidney Center, Nikko Memorial Hospital |
| [ Summary ] | Bone and joint involvements related to chronic renal failure have been modified lately by long-term dialysis therapy, resulting in variable and complicated manifestations. Aluminum-related bone disease decreased remarkably chiefly because the dangers of aluminum toxicity in the form of osteomalacia, anemia and encephalopathy are well recognized and aluminum-containing phosphate binders are now contraindicated. Nation-wide analyses revealed that about 70% of dialysis patients showed low serum PTH, which strongly suggested low bone turnover (osteomalacia/adynamic bone disease; ADB). Detailed analyses of ADB remain as future problems to be solved. High bone turnover diseases such as secondary hyperparathyroidism are well controlled by pulse therapy, and so on, with active vitamin D. Nonetheless, parathyroidectomy may be necessary in some cases. Dialysis-related amyloidosis, which results from increased serum PTH levels, is characterized by generalized arthralgia, bone cysts, pathological fractures, carpal-tunnel syndrome, destrucive spodylarthropathy, and so on. Several means of decreasing serum beta2-MG have been tried, somewhat successfully, by modified HDF with specific membranes and beta2-MG adsorption columns. Long-term clinical trials are mandatory for evaluating the effectiveness of these therapies. |
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