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Query: UMLS:C0033774 (pruritus)
 14,546 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between 1969 and April 1975 24 patients with severe secondary hyperparathyroidism (sHPT) clinically presenting with uremic osteopathy required either total (n=5) or subtotal (n=18) parathyroidectomies, 17 patients were already supported by maintenance hemodialysis, 6 patients suffered from terminal renal insufficiency. The leading clinical symptoms consisted of general osteoporosis, spontaneous fractures, extraosseous calcifications and histologically proven dissecting fibroosteoclasia. After operation 18 patients experienced complete relief from their complaints and repair of their skeletal lesions, 2 patients required reexploration for an undetected hyperfunctioning 4th parathyroid gland, regretfully with no success. In 4 patients with subtotal parathyoidectomy a recurrence of varying intensity with increased PTH-secretion from the remnant had to be registered after months and years.-The indication for surgical treatment of sHPT due to chronic renal failure has to be based on two sets of findings: 1) inadequate longterm suppression of increased PTH secretion by conservative measures like high dialysate calcium concentration or oral calcium intake, serum phosphorus depletion by oral intake of aluminium hydroxyde and possibly also by Vit. D; 2) persistent hypercalcemia, progressive osteodystrophy and severe complaints like bone pain and pruritus.
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PMID:[Surgical aspects of secondary hyperparathyroidism (author's transl)]. 101 8

We report here a typical case of hyperparathyroid bone disease associated with CRF on maintenance HD and review on Renal Osteodystrophy. A 39 year-old female patient was admitted because of polyarthralgia and pruritus. She had a history of HD due to CGN for about 13 years. Laboratory data showed an increase in serum PTH and Alkaline phosphatase level. The evidence of osteitis fibrosa was revealed by bone Xp and scintigraphy. Enlarged solid masses were found in her neck by echogram and parathyroid scintigraphy. She was diagnosed as hyperparathyroid bone disease and total parathyroidectomy c autoplantation was done. Shortly after the surgical treatment, subjective symptoms were relieved and PTH level was normalized. The bone Xp findings improved gradually.
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PMID:[A case of hyperparathyroid bone disease and the review of renal osteodystrophy]. 139 25

From April 1983 to September 1991 total parathyroidectomy (PTX) and parathyroid autotransplantation were carried out in 27 patients for secondary hyperparathyroidism. Of these patients, 13 were males and 14 were females. Their average age was 43 years old and their mean duration of dialysis was 126.4 months. As preoperative clinical symptoms, bone pain was observed in 19 cases, joint pain in 18, decrease of height in 7, pruritus in 3, muscle pain in 2, red eyes in 2 and others in 2. As roentgenographic findings, subperiosteal bone resorption and skull-salt and pepper were demonstrated in 26 cases, rugger jersey spine in 15, soft tissue calcification in 11, and pathological fractures in 4. Four parathyroid glands were removed in 23 cases, three glands in 4. Serum calcium level decreased remarkably within 24 hours after parathyroidectomy in all cases. The average total weight of parathyroid glands was 4.48 g. The preoperative diagnostic accuracy of echogram was 94% and that of CT scan was 90%. The clinical improvement after PTX was excellent in 12 cases and good in 11. The roentgenographic improvement of skull and/or finger bone more than one year after PTX was excellent in 11 cases and good in 11. Judging from histopathological findings of the bone, the clinical and roentgenographic improvement was observed better in the osteitis fibrosa group than in mild group. A significant correlation was found between the level of preoperative c-PTH and the weight of resected parathyroid glands. The level of preoperative ALP correlated with intact-PTH and was higher in the osteitis fibrosa group than in the mild group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical study of total parathyroidectomy and autotransplantation for secondary hyperparathyroidism]. 147 16

The number of mast cells in the skin was evaluated in 25 patients with end-stage renal failure on different treatment modality (conservative, hemodialysis and peritoneal dialysis). According to the presence of pruritus, uremic patients were divided into two groups: group A, 13 patients with diffuse pruritus, and group B, 12 patients without pruritus. Controls were 6 age- and sex-matched healthy subjects. In comparison with patients without pruritus, patients with pruritus had mainly degranulated, diffusely spread and more numerous mast cells in the skin; significantly higher levels of plasma middle molecular weight substances, serum histamine and PTH and significantly lower serum iron levels. However, no differences were noted in observed parameters between groups on different treatment modalities. Favorable therapeutic effects in patients with pruritus were achieved either with iron supplementation in those with hypoferremia or with antihistamines, mast cell membrane stabilizers and high-permeability membranes.
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PMID:Uremic pruritus and skin mast cells. 152 40

We examined the predictive value of urea kinetics for patient outcomes in CAPD by measuring dialysis index (DI; a means of quantifying CAPD dose using urea kinetics), KT/V and normalized protein catabolic rate (PCRN) on 222 occasions in 76 new patients at the time of starting CAPD and at subsequent six month intervals. We investigated how these indices altered with time and in relation to each other, and how they correlated with a wide range of subsequent patient outcomes. DI, KT/V and PCRN all tended to decrease with time on CAPD (P less than 0.0004, less than 0.0001 and 0.0005, respectively). DI and KT/V were highly correlated with each other (r = 0.89, P less than 0.0001) and both correlated with PCRN (r = 0.57, P less than 0.0001 and r = 0.60, P less than 0.0001, respectively). DI and KT/V both correlated inversely with subsequent values for serum creatinine (P less than 0.0001), urea (P less than 0.0002), potassium (P less than 0.02) and phosphate (P less than 0.002), and directly with bicarbonate (P less than 0.0001). PCRN correlated inversely with serum creatinine (P less than 0.0002) and directly with urea (P less than 0.0001) and with the number of blood transfusions received (P less than 0.03). None of these indices correlated with levels of hemoglobin, PTH, alkaline phosphatase or albumin, or with nerve conduction velocity or any other subsequent clinical outcomes including death, technique failure, hospital days, peritonitis rate and subjective indices of fatigue, pruritus and insomnia. We conclude that the urea kinetic model is predictive of some biochemical outcomes but not of clinical outcomes in CAPD patients.
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PMID:Lack of correlation between urea kinetic indices and clinical outcomes in CAPD patients. 205 26

The appropriate use of phosphate binders, calcium supplements and especially calcitriol therapy has significantly decreased the incidence of overt secondary hyperparathyroidism in dialysis patients. Nevertheless some patients may still need parathyroidectomy, especially in the event of severe clinical signs and symptoms such as persistent hypercalcemia, pruritus, calcifilaxis, or extensive extra-skeletal calcification. Since aluminum-induced bone disease may resemble hyperparathyroidism in dialysis patients, whenever parathyroidectomy is contemplated the diagnosis of secondary hyperparathyroidism must be firmly established. Thus, a bone biopsy is mandatory prior to parathyroidectomy. It is our experience that once the patient goes to surgery the most important factor in the surgical approach is the presence of a skilled surgeon who has extensive experience in parathyroid gland surgery. The data comparing subtotal parathyroidectomy with total parathyroidectomy and autotransplantation are similar. The most important shortcoming is the lack of long-term follow-up. Recently, new data by several investigators has been advanced reintroducing total parathyroidectomy. Long-term observations in patients who despite total parathyroidectomy still have normal PTH levels are of special interest. In addition, long-term follow-up of these patients has shown that normal plasma calcium and phosphorus levels may be maintained without the use of Vitamin D; this occurred in the presence of active mineralization. However, our major objection to this procedure is the risk of aluminum-induced bone disease. At the present time we feel that the relative high incidence of recurrent hyperparathyroidism following subtotal parathyroidectomy is a reasonable trade off for the risk of aluminum bone disease which may develop in absence of PTH.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Parathyroidectomy in chronic renal failure: indications, surgical approach and the use of calcitriol. 221 49

The effect of oral Cimetidine compared to a classic antihistaminic and to a placebo was evaluated, under the double hypothesis of its anti-PTH and anti-pruritus action, in a population of patients recently included in Hemodialysis that were asked about the incidence and intensity of pruritus according to a scored questionnaire made for this purpose. No different efficacy of Cimetidine versus the antihistaminic classic and the placebo was observed in our study.
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PMID:Dialysis pruritus: effect of cimetidine. 720 12

Twenty-seven patients, eighteen females and nine males, with chronic renal failure and secondary hyperparathyroidism, were treated by subtotal parathyroidectomy. Bone pain, in 24 patients, hypercalcemia in 2 and severe pruritus in 1 were the main indications to surgery. Result evaluation was possible in twenty four patients. Bone pain disappeared or was reduced in 20/22 patients. Serum alkaline phosphatase and PTH returned to normal in 21/24 patients. There patients had persistent hyperparathyroidism because of inadequate surgical exploration. Another group of seven patients with secondary hyperparathyroidism recalcitant to medical therapy or relapsing after subtotal parathyroidectomy was treated with calcitriol ev. After nine months of follow-up PTH and alkaline phosphatase serum levels were reduced to normal value in all patients.
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PMID:[Hyperparathyroidism resulting from chronic renal insufficiency. Diagnosis and therapy]. 850 46

The optimal surgical procedure for severe renal secondary hyperparathyroidism (sHPT) is still a point of controversy. Total parathyroidectomy (PTX) without auto-transplantation was abandoned for fear of an adynamic bone condition; however, in the case of autotransplantation recurrent sHPT is frequent and promotes atherosclerosis. We studied 11 hemodialysis patients (age 59+/-12 years) on dialysis for 18 (12-30) years in whom total PTX was performed due to severe sHPT (group I; intact PTH: 1,240+/-230 pg/ml), and 5 patients (age 55+/-10 years) without renal insufficiency who inadvertently received total PTX during thyroid surgery (group II). After total PTX (group I, 26+/-18 [9-59] months; group II, 252+/-188 [22 480] months) both groups showed no measurable intact PTH levels. Calcium homeostasis was maintained by oral substitution with calcium (group I, calcium dialysate of 2.0 mmol/l), vitamin D and calcitriol (serum parameters in groups I and II: calcium 2.4 and 2.2 mmol/l; phosphate 1.8 and 1.1 mmol/l; 25(OH)-vitamin D(3) 21 and 34 ng/ml; 1,25(OH)(2)-vitamin D(3) 32 and 41 pg/ml, respectively). In group I, after total PTX there was a rapid and sustained improvement in bone pain with markedly enhanced physical activity and endurance. High turnover osteopathy markedly improved as indicated by declining levels of native osteocalcin (90+/-17 vs. 26+/-18 ng/ml), bone alkaline phosphatase (74+/-12 vs. 12+/-6 ng/ml), and carboxyterminal cross-linked telopeptide of type-I collagen (65+/-16 vs. 40+/-21 ng/ml) but increasing levels of carboxyterminal propeptide of type-I procollagen (120+/-36 vs. 148+/-41 ng/ml). Recalcification of bone was excellent as demonstrated by X-ray and confirmed by bone histology. Itching extravascular calcific deposits and calcifications of blood vessel and cardiac valves immediately stopped after total PTX. Moreover, 6 sHPT patients suffered from severe atherosclerotic lesions such as thoracic aortic aneurysm (n = 3) or abdominal aortic aneurysm (n = 3) which showed size progression before but not after total PTX when annually controlled by ultrasonography. In group II, even long after total PTX, there was no clinical, radiological, histological or biochemical evidence for low turnover osteopathy. In conclusion, our data indicate that substitution with vitamin D(3) metabolites and calcium can prevent deleterious bone effects of hypoparathyroidism in hemodialysis patients and in patients with normal kidney function and may compensate for the missing PTH action. Over this, a better survival rate is expected as a consequence of the beneficial effect of total PTX on the progression of atherosclerotic lesions. We suggest reconsideration of total PTX without autotransplantation in dialysis patients with severe sHPT who are not eligible for renal transplantation.
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PMID:Long-term results of total parathyroidectomy without autotransplantation in patients with and without renal failure. 1043 1

Uremic itching is an "orphan" symptom, almost equally frustrating patients and physicians. It is an unpleasant sensation and a subjective experience which is difficult to qantitate. Studying the frequency of itching among the chosen group of chronic dialysis patients, there were two questions to be answered: 1) Does the itching correlate causatively to the standard laboratory parameters? and 2) Does the itching disappear with only supplementary treatment? At the commencement of the research a sequence of laboratory parameters, presence and intensity of itching were determined, and the presence of itching 3 months afterwards. Itching of the 3rd, 4th and 5th grade was present in 44 patients (37.9%) at the beginning. Patients with itching did not differ from those without itching regarding mean predialysis values of urea, creatinine, uric acid, hematocrit, calcium, phosphorus, alkaline phosphatase, i-PTH, ALT, bilirubin, Kt/V and total heparin doses received during single dialysis procedure. Among those with itching there were not significantly more patients older than 60 years of age (chi 2 = 0.273; p > 0.05). Three months afterwards itching disappeared without particular treatment in 8 of 44 patients (22.7%), and appeared in 14 of 72 (19.5%) patients without itching at the beginning of the investigation. In conclusion, no correlation was found between uremic itching and standard laboratory parameters. Itching in chronic dialysis patients is considered to be a temporary symptom that often disappears without supplementary treatment.
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PMID:[Does uremic pruritus in hemodialyzed patients disappear only with replacement therapy?]. 1043 54


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