| Theme | The Choice of Blood Purification for the Patients with Renal Failure | |
|---|---|---|
| Title | Endocrinopathy | |
| Publish Date | 2000/01 | |
| Author | Eriko Kinugasa | Internal Medecine, Showa University, Fujigaoka Hospital |
| Author | Masahide Mizobuchi | Internal Medecine, Showa University, Fujigaoka Hospital |
| Author | Kazuhiko Niikura | Internal Medecine, Showa University, Fujigaoka Hospital |
| [ Summary ] | Though most of patients under renal replacement therapy (RRT) show various endocrinological abnormalities, RRT itself can hardly correct them. So medical treatment along with adequate RRT has become the basic modality in management of these endocrinopathies. In this text, therapeutic approach to the management of parathyroid, thyroid and sexual disturbances will be briefly mentioned. To regulate parathyroid function, it is mandatory to control serum calcium (Ca) and phosphate (P) with vitamin D (VD) supplementation and Ca carbonate as a P-binder. When severe hyperparathyroidism (HPT) has developed in spite of these treatment, oral VD pulse therapy is indicated taking care of the appearance of hypercalcemia. Hypercalcemia is also problematic in case of hypoparathyroidism (Hypo) because of low bone turnover. To avoid and treat hypercalcemia, dialysate with low Ca content is often utilized in both HPT and Hypo situations, However, it should be carefully monitored parathyroid hormone levels, because long-standing use of low Ca dialysate has a potential risk of progression of HPT and osteoporosis. Hormone replacement or anti-thyroid therapy is the first choice of treatment in either hypo- or hyperthyroidism. In case of thyroid crisis, plasma exchange would have beneficial effect. Sexual disturbance, especially erectile dysfunction (ED), is often encountered among male RRT patients. Although several factors are involved in causes of ED, it has been reported that correction of anemia with rHuEPO directjy and indirectly improves ED through the increment in blood viscosity and/or amelioration of the responsiveness of hypothalamopituitary-sexual organ axis. |
|