课件：慢性肾脏病矿物质及骨代谢异常.ppt

Hyperparathyroidism caused by renal failure. There are signs of bone resorption at the level of the acromioclavicular joint and at the insertion of the coracoclavicular ligament (arrow). The head of the humerus appears elevated with consequent reduction of the subacromial space. The bone erosions of hyperparathyroidism are also caused by resorption. They can be seen in articular elements (particularly those subjected to major mechanical stress, such as the ends of the clavicle or the proximal head of the humerus) and at the level of the entheses (especially the Achilles tendon and the plantar aponeurosis) 血磷通过以下途径促进血管钙化进展： 使具有收缩性的VSMC转化为软骨原性细胞，并通过Na-P协调转运蛋白使VSMA细胞基质矿物质化； 介导VSMC细胞凋亡； 抑制单核/巨噬细胞分化为破骨样细胞； 升高FGF-23水平； * CT fistulogram showing calcification in AVF. Phosphate Binders: Summary Phosphate binders play an important role in managing hyperphosphatemia, typically reducing serum phosphorus by 2 mg/dL. This slide summarizes the advantages and disadvantages of the different types of phosphate binders, but there remains no evidence that these agents differ in their impact on outcomes. Aluminum-containing phosphate binders are highly effective, but they accumulate in patients.1 High systemic aluminum levels cause anemia, and also impact bone matrix mineralization to cause osteomalacia. High levels in the central nervous system have been associated with encephalopathy. Calcium-containing phosphate binders are widely used, but are less potent than aluminum hydroxide, thus necessitating use of large numbers of tablets.1 These agents carry risk of hypercalcemia and progressive vascular calcification. Sevelamer and lanthanum carbonate do not contain either aluminum or calcium.1,2 Sevelamer is as effective as the calcium salts in reducing serum phosphorus, but is associated with lower risk of hypercalcemia and vascular calcification. In addition, sevelamer has favorable effects on serum lipid levels. Lanthanum carbonate appears to be as potent as the aluminum salts as