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Query: UMLS:C0005940 (bone disease)
 7,459 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Uremic women on hemodialysis with metabolic bone disease (hyperparathyroidism, osteomalacia resulting from defective vitamin D metabolism) and anemia (erythropoietin deficiency) are known to give birth to infants without bone disease or anemia. Therefore, skeletal development (enchondral and desmal bone formation) and hepatic erythropoiesis were evaluated in fetuses of uremic rats. These fetuses failed to show defective mineralisation or evidence of bone disease. Bolus injection of high doses of exogenous PTH into the maternal or fetal organism did not affect fetal bone histology. In addition, no apparent defect of bone mineralisation or bone formation was found in fetuses of ricketic rats. Normal mineralisation in the offspring of uremic rats may be explained by fetal hyperphosphatemia and/or insensitivity of fetal (woven) bone mineralisation to vitamin D. Absence of fetal anemia (normal hematocrits, normal density of hematopoietic cells in the liver) in the presence of maternal anemia is presumably due to the insensitivity of fetal erythropoiesis to erythropoietin.
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PMID:Fetal development in experimental uremia. 14 12

While awaiting renal transplantation, patients with end-stage renal failure frequently have to spend a period of time on dialysis. Although dialysis controls uraemia, the patient undergoing dialysis still faces problems related to the continuing uraemic state such as anaemia, renal bone disease, malnutrition and cardiovascular complications. Apart from the problems related to uraemia, patients on dialysis are also exposed to problems that are peculiar to the mode of dialysis. In haemodialysis, patients face complications related to the use of heparin and dialyser related problems such as air embolism and haemolysis. Patients on continuous ambulatory peritoneal dialysis (CAPD) are exposed to complications such as infection, hernias and hypertriglyceridaemia. The introduction of hormone therapy with erythropoietin and vitamin D and recent advances in dialysate solutions and biocompatibility of membranes in haemodialysis and in control of infection and a better understanding of peritoneal kinetics in CAPD have helped to overcome some of the problems in dialysis patients.
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PMID:Medical problems in dialysis patients awaiting renal transplantation. 179 67

Careful investigation of the clinical conditions of patients on maintenance hemodialysis for about 20 years in a single dialysis unit was of great interest for evaluation of the pathological consequences in long-term survivors of insufficient correction of uremia and of the dialysis treatment "per se". We analyzed the outcomes for a cohort of 116 patients who started RDT before 1976 and the clinical conditions of the 24 patients still on RDT in our unit at the end of 1991 (average duration of treatment = 222 +/- 23 months). Actuarial survival was 72% at 10 years and 43% at 20 years. Rehabilitation of the 24 survivors was rather good: 13 were able to work, 8 were retired or unable to work, but able to care for most personal needs. Actual body weight, anthropometric parameters and biochemical parameters revealed a well-preserved nutritional status. Anemia improved from 23 +/- 7 at the start of RDT to 31 +/- 8 in the 21 patients never treated with erythropoietin. Blood pressure was normal without therapy in 18 patients and elevated in 6. Mild-to-moderate left ventricular hypertrophy was present in all the 6 patients with arterial hypertension and in only 6 of the 18 normotensive patients. The ratio of early diastolic filling to filling during atrial contraction (E/A ratio) was < 1 in 16 patients: it was 1.05 +/- 0.43 in 9 patients with stable intradialysis blood pressure and significantly lower (0.73 +/- 0.15) in 12 patients with recurrent intradialysis hypotension. Supraventricular arrhythmias were detected by Holter monitoring in 41% and ventricular arrhythmias in 35% of patients. Extensive vascular calcifications were present (in 100% of patients in the abdominal aorta), but only 4 patients showed clinical signs of peripheral vascular disease. Subperiosteal resorption was detected radiologically in the hands of 59% of patients. Bone histology, interpretable for only 20 patients, revealed no bone lesions in 1 case (5%), mild mixed osteodystrophy in 3 cases (15%), advanced mixed osteodystrophy in 5 cases (25%), osteodystrophy with predominant hyperparathyroidism in 2 cases (10%), osteodystrophy with predominant osteomalacia in 6 cases (30%), and aplastic bone disease in 3 cases (15%). Moderate aluminum staining was found in only 4 patients and was more marked in earlier biopsies taken before withdrawal of the aluminium-containing phosphate-binding drugs.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Clinical features of 24 patients on regular hemodialysis treatment (RDT) for 16-23 years in a single unit. 852 16

Increasing use of medications designed specifically for intravenous administration during hemodialysis has dramatically improved the treatment of many comorbid conditions accompanying end-stage renal disease. Recombinant human erythropoietin has resulted in definitive treatment of the hypoproliferative anemia of uremia, while sustained response to this hormone has been facilitated by treatment with intravenous iron dextran. Simple and effective therapies for many gram-positive infections in end-stage renal disease patients have been realized through the favorable pharmacokinetics and low toxicity of vancomycin when administered during hemodialysis. Major improvements in the therapy of high-turnover bone disease have resulted from the increasing use of intravenous calcitriol during dialysis as well. The contributions of these four medications in improving patient care and the benefits of their administration during the dialysis procedure are reviewed.
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PMID:Injectable medications for hemodialysis patients. 871 68

We report a male patient with primary hyperoxaluria from childhood who survived more than 21 years on conventional haemodialysis. Despite the severity of his bone disease, he was married and actively employed up until 2 years before his death. His condition really worsened a few months before his death. He presented with only renal and bone involvement and had hardly any cardiovascular complications, that was probably a reason for his prolonged survival. Such an evolution is very unusual and we speculate that the length of haemodialysis sessions in addition to the large surface of the membrane probably contributed to such an outcome. During the time period on HD, anemia was transiently controlled by recombinant erythropoietin despite oxalate involvement of the marrow. He was refused a liver-kidney transplant and died from malnourishment at 43 years of age. To our knowledge, such an outcome has not yet been reported. It shows that careful prolonged hemodialysis sessions should be helped in admet patients without severe cardiovascular involvement.
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PMID:[Twenty one years of hemodialysis in a patient with primary hyperoxaluria]. 876 56

The availability of recombinant human erythropoietin (rhuEPO) has dramatically improved the care of children with chronic renal failure (CRF). Its use provides the opportunity to determine the relative contribution of anemia to the morbidity of CRF. Growth retardation, one of the most significant complications of CRF in children, is the consequence of several inter-related processes, including decreased protein and energy intake, metabolic bone disease, endocrine abnormalities, and anemia. The literature on the use of rhuEPO in children and data from a United States phase III double-blind, placebo-controlled study of rhuEPO in pediatric dialysis patients are reviewed to determine the effect of rhuEPO treatment on the nutritional status and growth of children with CRF. Despite subjective increases in appetite, there were no consistent improvements in dietary intake or anthropometric measures observed during rhuEPO treatment. Children gained weight during rhuEPO treatment; however, this was not generally associated with increased weight standard deviation scores. There was an improvement in growth velocity in some children; however, improvements in height standard deviation scores were infrequently seen. On review of the available literature, correction of anemia with rhuEPO has not been shown to improve the growth of children with CRF.
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PMID:The effects of recombinant human erythropoietin on growth and nutritional status. 879 97

Studies in rats with renal ablation indicate that anemia lessens, whereas its vigorous correction with recombinant human erythropoietin (r-HuEPO) worsens systemic and glomerular hypertension, factors known to promote progression of chronic renal failure (CRF). However, in human studies, use of r-HuEPO in predialysis patients has not been associated with worsening renal function, provided blood pressure control is achieved. Histological evidence of bone disease is common in early renal failure, and deficits in calcitriol synthesis seem to be an important factor in the pathogenesis of secondary hyperparathyroidism (HPTH) in early CRF. Reports to data, on the use of low dose active vitamin D metabolites in predialysis patients, indicate either a reversible decline or no decline in renal function. Adynamic bone disease, however, may ensure during such therapy if excessive reductions in serum intact parathyroid hormone concentrations occur. Recent data suggest that chronic metabolic acidosis decreases albumin synthesis, increases muscle proteolysis, and induces negative nitrogen balance in patients with CRF. Despite these experimental data, the clinical relevance of correction of metabolic acidosis in end-stage renal disease (ESRD) is still not defined. Even though therapy of metabolic acidosis in the adult patient with CRF remains conjectural at this time, reports indicate that its correction might lead to healing of osteomalacia and osteopenia, and possibly may decrease protein degradation and improve growth in children with CRF.
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PMID:Use of erythropoietin, active vitamin D3 metabolites, and alkali agents in predialysis patients. 924 13

Conventional chemotherapy for multiple myeloma results in low complete response rates, and disease progression usually occurs within a couple of years. High-dose chemotherapy with autotransplantation, which has been shown to result in encouraging complete remission rates over several years in phase II studies, was recently shown in a randomized study to be superior to conventional therapy. Eventual tumor recurrence is a problem after autografting, and the development of novel maintenance chemotherapy or immunotherapy strategies is necessary to eliminate minimal residual disease. Although allogeneic transplantation cures a small proportion of patients, high transplant-related mortality and relapse rates hamper survival. Development of novel conditioning regimens and means to harness the graft-versus-myeloma effect without the associated morbidity of graft-versus-host disease are necessary to improve success rates. Supportive therapy, mainly bisphosphonates to delay progression of bone disease and improve bone density and erythropoietin to improve hemoglobin levels, also plays an important role in the overall management. This article reviews therapeutic advances in multiple myeloma from the 1996 literature.
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PMID:Advances in the treatment of multiple myeloma. 926 58

In the past several years significant attention has been directed to the study of adynamic bone disease in uremic patients. Several reports have provided additional information about the prevalence of adynamic bone disease in different countries. It has now become clear that the pathogenesis of adynamic bone disease cannot be ascribed to one single aetiological factor, but rather to a host of complex factors. From recently published papers we have learned about the mechanism of downregulation of the parathyroid hormone/parathyroid hormone-related peptide receptor on osteoblast-like cells, which may be a very important step in the pathogenesis of adynamic bone disease. A provocative hypothesis attempts to link the widespread use of erythropoietin to the emergence of adynamic bone disease-lacking excessive aluminium accumulation. It appears from some studies that bone-specific alkaline phosphatase might become a valuable tool in differentiating high turnover from low/normal turnover bone disease; however, further studies are needed to establish the role of this marker in the diagnosis of adynamic bone disease. Several papers discussed the pros and cons of lowering the calcium concentration of the dialysate in order to prevent adynamic bone disease. The results of these studies help us to understand the pathogenesis and the clinical relevance of this lesion in attempts to provide better care for our patients.
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PMID:Adynamic bone disease: pathogenesis, diagnosis and clinical relevance. 926 84

Very few patients have undergone long-term peritoneal dialysis (PD). We report a case of a female patient on PD since 26 May 1979. Suffering from malignant hypertension, she developed renal failure in April 1979. The renal biopsy showed a severe vascular nephropathy. She was 50 years old, her body weight (BW) was 45 kg, and her height was 1.49 m. She refused hemodialysis. A Tenckhoff catheter was installed, and 12-hour intermittent PD (IPD), three times a week, was started in the dialysis center. Ten months later, she began nightly home IPD. In March 1985 she started continuous ambulatory PD (CAPD); she was nearly anuric. During the following years, she developed renal osteodystrophy and suffered from repeated hyperparathyroidism requiring multiple surgical interventions, osteomalacia, pseudotumoral calcinosis, and, finally, adynamic bone disease. She is now 67.5 years old, her BW is 34 kg, and she is still using CAPD. This patient has the same Tenckhoff catheter. She never developed peritonitis or an exit-site or tunnel infection. She used acetate dialysis solution for nearly six years and then lactate solution. Presently her peritoneal permeability is of the high-average type; dialysis adequacy (weekly Kt/V: 2.15, weekly peritoneal clearance: 58 L/1.73 m2) as well as nutritional parameters are satisfactory. She has moderate anemia without erythropoietin treatment. She maintains a good quality of life. Although the patient lost 11 kg in 17 years, she has maintained good nutritional status. Dialysis adequacy could be achieved despite anuria for more than 11 years. Small body size, absence of infection and catheter-related problems, healthy peritoneal membrane, good acceptance of the technique, and vigilance towards dietary habits may be the keys for satisfactory long-term PD.
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PMID:More than 17 years of peritoneal dialysis: a case report. 936 Jun 59


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