维持性透析患者的管理.ppt

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2024-11-05 发布于广东
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维持性透析患者的管理.ppt

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*InitiallytheparathyroidglandsrespondtothealteredmineralmetabolisminCKDbyincreasingPTHsecretionandsynthesis.However,asthealteredlevelsofcalcium,phosphorus,andvitaminDpersist,theparathyroidglandsrespondbyincreasingthenumberofcells(cellproliferation),whichresultsinanincreaseinglandsize(hypertrophy/glandenlargement).ThisresultsinanincreaseinthenumberofcellsavailabletoproducePTH.1Afterthisinitialincreaseinthenumberofactivechiefcells,diffusehyperplasiamaydevelopfollowedbynodularhyperplasia.1,2Nodularcellsareassociatedwithmonoclonalgrowthandaggressiveproliferation.3Inadvancedcases,nodulesmayfusetoformasinglelargetumor,althoughthisisunusual.1,2Imagesonthisslidewereproducedwithultrasonography,asimple,cheap,andnon-invasivemethodtoassessparathyroidglandhyperplasia,ashyperplasticglandswithdiffusehyperplasiaarehypoechogenic.Incontrast,normalparathyroidglandsarenotdetectablebyultrasound.2 References:RodriguezM,NemethE,MartinD.Thecalcium-sensingreceptor:akeyfactorinthepathogenesisofsecondaryhyperparathyroidismAmJPhysiolRenalPhysiol.2005;288:F253-F264.PavlovicD,TomicBrzacH.Ultrasonographicevaluationofparathyroidhyperplasiaindialysispatients.SciWorldJ.2006;6:1599-1608.TominagaY,TanakaY,SatoK,NagasakaT,TakagiH.Histopathology,pathophysiology,andindicationsforsurgicaltreatmentofrenalhyperparathryoidism.SeminSurgOncol.1997;13:78-86.*Inastudyof129patientsinitiatingdialysis(incidentpatients),ameasurementofcoronaryvascularcalcificationbyelectroncomputedtomographydemonstratedthatthemajority(63%–69%)ofpatientsalreadyhadsignsofvascularcalcificationatbaseline.1Thebaselinecoronaryvascularcalcificationmeasurementsweretakenpriortoinitiationofanopen-labeltrialtestingsevelamerorcalcium-containingphosphatebinders(RINDs