| 特集名 | 腎不全患者の血液浄化療法の選択 | |
|---|---|---|
| 題名 | 日常遭遇する病態と血液浄化療法の選択 (11) 内分泌疾患 | |
| 発刊年月 | 2000年 01月 | |
| 著者 | 衣笠 えり子 | 昭和大学藤が丘病院内科 |
| 著者 | 溝渕 正英 | 昭和大学藤が丘病院内科 |
| 著者 | 新倉 一彦 | 昭和大学藤が丘病院内科 |
| 【 要旨 】 | 日常遭遇しやすい内分泌異常として副甲状腺機能異常・甲状腺疾患・性機能異常を取り上げた．副甲状腺機能亢進症(HPT)では，血清カルシウム(Ca)・リン(P)管理，活性型ビタミンD(VD)投与が基本となり，とくに高度のHPTに対するVDパルス療法では副作用防止のため，透析液Ca濃度に配慮する必要がある．副甲状腺機能低下症(Hypo)については，易高Ca血症のためやはり透析液Ca濃度を適切に設定することが肝要であり，低Ca透析液使用による副甲状腺ホルモン(PTH)分泌刺激も治療の一助となる．またアルミニウム(Al)蓄積を合併した場合，キレート剤を併用して効率良くAlを除去する．甲状腺疾患については，機能低下・亢進症とも，薬物療法が主体であり，甲状腺クリーゼなどの際には血漿交換療法も行われる．性機能障害の成因は多要素的であり，血液浄化のみでの改善は困難であるが，十分な透析に加えてrHuEPOによる貧血改善が直接的・間接的にある程度の効果を示す． | |
| Theme | The Choice of Blood Purification for the Patients with Renal Failure | |
|---|---|---|
| Title | Endocrinopathy | |
| 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. |
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