腎と骨代謝 Vol.27 No.4(9)


特集名 CKD-MBD臨床研究
題名 移植後のCKD-MBD
発刊年月 2014年 10月
著者 藤井 直彦 Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine University of Pennsylvania
【 要旨 】 慢性腎臓病における骨ミネラル代謝異常(chronic kidney disease - mineral and bone disorder;CKD-MBD)は腎障害の初期から始まる一連の病態で,近年,移植期においてもその臨床的意義が注目されている.わが国では2012年に「透析患者における二次性副甲状腺機能亢進症治療ガイドライン」が改訂され,保存期や小児期とともに移植期が新たに加わり「慢性腎臓病に伴う骨・ミネラル代謝異常の診療ガイドライン」となった.透析期に比べると,移植後CKD-MBDに関するエビデンスはまだまだ不足しているが,徐々に新しい知見も増えてきている.本稿では,新たな臨床知見についても一部触れながら,CKD-MBDを構成する3大要素である,検査値異常,骨の異常,異所性石灰化という局面に分けて,CKD-MBDが移植臨床に与えるインパクトについて再考した.
Theme Clinical research in the field of CKD-MBD
Title CKD-MBD in kidney transplant recipients
Author Naohiko Fujii Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine University of Pennsylvania
[ Summary ] CKD-MBD, or chronic kidney disease ‒ mineral and bone disorder, is a sequential pathophysiology that starts in the very early stages of CKD, and continues to cause notable clinical problems even in the post-transplant period. The revised version of the Japanese guidelines for secondary hyperparathyroidism in dialysis patients was published in 2012. The new version includes chapters on kidney transplant recipients as well as predialysis and pediatric patients. There is little evidence available concerning posttransplant CKD-MBD as compared to that available for patients on dialysis. However, increasing numbers of clinical studies on post-transplant CKD-MBD have recently been conducted and published. In this review, I would like to discuss the pathophysiology and clinical impacts including those noted in recently published reports. These include highlighs of three major aspects of CKD-MBD ; laboratory abnormalities, bone abnormalities, and vascular calcification.
戻る