| 特集名 | 維持透析患者の整形外科的疾患―手術の適応と非適応 | |
|---|---|---|
| 題名 | ［総論］透析医からみた骨・関節障害 | |
| 発刊年月 | 2010年 06月 | |
| 著者 | 栗原 怜 | 慶寿会さいたまつきの森クリニック |
| 著者 | 安田 文彦 | 慶寿会さいたまつきの森クリニック／日本医科大学腎臓内科 |
| 【 要旨 】 | 腎不全患者の骨・関節疾患は，慢性腎臓病・ミネラル骨代謝異常（CKD-MBD），β2ミクログロブリン（β2MG）由来のアミロイド症，加齢に伴う退行性疾患などが原因となる．CKD-MBDは骨折のみならず血管壁石灰化からの心・血管系死亡のリスクを高める．透析医は血清P，Ca，PTH が設定目標値に入るよう細かなコントロールが求められる．透析アミロイド症に対してはハイパフォーマンス膜透析器，血液濾過，血液濾過透析，β2MG吸着カラムなどを適宜用い，β2MG濃度を可能なかぎり低値に維持する努力が大切である．高齢，骨密度低下など骨折リスクの高い患者に対しては薬物療法，栄養状態の改善などを積極的に進めていく必要がある． | |
| Theme | Orthopedic Diseases Seen in Maintenance Dialysis Patients -- Surgical Indication and Non-indication | |
|---|---|---|
| Title | Physician management of bone and joint disease in dialysis patients | |
| Author | Satoshi Kurihara | Saitama-Tsukinomori Clinic |
| Author | Fumihiko Yasuda | Saitama-Tsukinomori Clinic/Department of Nephrology, Nippon Medical School |
| [ Summary ] | The causes of bone and joint disease in uremic patients are primarily abnormal metabolism of components such as inorganic phosphate, calcium, vitamin D, or parathyroid hormone induced disorders (CKD-MBD), dialysis-related amyloidosis originating from β2microglobulin (β2MG), and age-related disorders of the bones and joints also play roles in these conditions. CKD-MBD, increases the risk of death not only due to fractures, but also due to cardiovascular events associated with accelerated arterial wall calcification. Mortality risk is especially high in patients on long-term dialysis. To avoid these conditions, physicians should strictly control the serum levels of inorganic phosphorus (3.5-6.0 mg/dl), calcium (8.4-10.0 mg/dl), calcium phosphorus products (below 55 mg2/dl2), and intact-parathyroid hormone (60-180 pg/ml), per the JSDT guideline of 2006. Dialysis related forms of amyloidosis such as carpal tunnel syndrome, bone cysts in the hip and knee joints, and destructive spondyloarthropathy of the vertebral bone inflict a great deal of suffering on long term dialysis patients. Physicians should endeavor to keep serum levels of β2MG low through the use of dialysis techniques, employing high-performance membrane dialyzers, hemofiltration, hemodiafiltration and β2MG adsorption columns. In elderly patients with decreased bone mineral density, effective drug and nutritional treatments should be administered to protect against fractures. |
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