Renal osteodystrophy treatment

Osteitis fibrosa cystica Renal osteodystrophy Osteosclerosis Anticonvulsant treatment... 

In the treatment of diseases where the metaboUtes are not being deUvered to the system, synthetic metaboUtes or active analogues have been successfully adrninistered. Vitamin metaboUtes have been successfully used for treatment of milk fever ia catde, turkey leg weakness, plaque psoriasis, and osteoporosis and renal osteodystrophy ia humans. Many of these clinical studies are outlined ia References 6, 16, 40, 51, and 141. The vitamin D receptor complex is a member of the gene superfamily of transcriptional activators, and 1,25 dihydroxy vitamin D is thus supportive of selective cell differentiation. In addition to mineral homeostasis mediated ia the iatestiae, kidney, and bone, the metaboUte acts on the immune system, P-ceUs of the pancreas (iasulin secretion), cerebellum, and hypothalamus. 

The treatment of the complications of CRF may occur before or during dialysis. They include pericarditis, congestive heart failure, hypertension, hemopoietic abnormalities and renal osteodystrophy. 

Vitamin D analog of choice for prevention and treatment of renal osteodystrophy less expensive than calcitriol... 

In mild forms of malabsorption, vitamin D (25,000-50,000 units three times per week) should suffice to raise serum levels of 25(OH)D into the normal range. Many patients with severe disease do not respond to vitamin D. Clinical experience with the other metabolites is limited, but both calcitriol and calcifediol have been used successfully in doses similar to those recommended for treatment of renal osteodystrophy. Theoretically, calcifediol should be the drug of choice under these conditions, because no impairment of the renal metabolism of 25(OH)D to l,25(OH)2D and 24,25(OH)2D exists in these patients. Both calcitriol and 24,25(OH)2D may be of importance in reversing the bone disease. However, calcifediol is no longer available. 

Anticonvulsant treatment Fibrogenes imperfecta ossium Osteitis fibrosa cystica Osteomalacia Osteoporosis Osteopenia Osteosclerosis Renal osteodystrophy Rickets... 

Hypercalcemia persists for many months after the cessation of excessive intakes of vitamin D, because of the accumulation of the vitamin in adipose tissue and its slow release into the circulation. The introduction of calcitriol and 1 a -hydroxycalcidiol for the treatment of such conditions as hypoparathyroidism, renal osteodystrophy, hypophosphatemic osteomalacia, and vitamin D-dependent rickets has meant that hypercalcemia is less of a problem than when high doses of vitamin D were used in the treatment of these conditions. Because calcitriol has a short half-life in the circulation, the resultant hypercalcemia is of shorter duration than after cholecalciferol, and adjustment of the dose is easier. 

There is controversy about whether the long-term use of Cl-hydroxylated vitamin D analogues in non-dialysed patients with chronic renal insufficiency is associated with an impairment of glomerular filtration rate (SEDA-9, 639) (49). Treatment with these drugs should be restricted to patients with severe renal osteodystrophy. A proper dose should be administered in order to avoid a deleterious effect on renal function. Serum calcium and creatinine concentrations should be monitored carefully. The treatment should be withdrawn if hypercalcemia develops. 

Hodson EM, Evans RA, Dunstan CR, Hills E, Wong SY, Rosenberg AR, Roy LP. Treatment of childhood renal osteodystrophy with calcitriol or ergocalciferol. Clin Nephrol 1985 24(4) 192-200. 

Martin KJ, Olgaard K, Coburn JW, et al. Diagnosis, assessment, and treatment of bone turnover abnormalities in renal osteodystrophy. Am J... 

Dihydrotachysterol, a vitamin-D analog with antihypocalce-mic properties, is indicated in the treatment of familial hypophosphatemia hypocalcemia associated with hypoparathyroidism and pseudohypoparathyroidism and renal osteodystrophy in chronic uremia (see also Figure 66). 

The application of 1,2S- OH)2D3, its analog la-OH-D3, and 25-OH-D3 to these diseases is, therefore, evident. Certainly l,25-(OH)2D3 or la-OH-D3 would be effective in renal osteodystrophy, hypoparath3 oidism, vitamin D dependency rickets, and drug induced osteomalacia. It is very promising as a treatment for various forms of osteoporosis. A review of the clinical literature related to this is beyond the scope of this chapter, but interested readers are directed elsewhere for this information... 

Klaus G, Watson A, Edefonti A et al (2006) Prevention and treatment of renal osteodystrophy in children on chronic renal failure European guidelines. Pediatr Nephrol 21 151-159... 

Rigamonti W, Capizzi A, Zacchello G et al (2005) Kidney transplantation into bladder augmentation or urinary diversion long-term results. Transplantation 80 1435-1440 Rigden SPA (1996) The treatment of renal osteodystrophy. Pediatr Nephrol 10 653-655... 

During recent years it has become evident that the 1-hydroxylation of vitamin D or 25-hydroxyvitamin D in the kidney is essential for its biological activity. It was therefore conceivable that treatment with synthetic vitamin D analogues with a hydroxyl group in the 1 position would be effective in the treatment of renal osteodystrophy. Both la,25-dihydroxyvitamin D (57 ) and la-hydroxy vitamin D (58, 59 ) have been used succesfuUy, but careful monitoring of serum calcium is necessary since sudden hypercalcaemia can occur. 

The steroid hormone l/ ,25-dihydroxyvitamin D3 (l/ ,25-(OH)2-D3, calcitriol, 158) is the bioactive metabolite of vitamin D3. This B-ring-seco-steroid plays an important role in the regulation of mineral metabolism and finds application in the treatment of osteodystrophy due to renal failure, rickets, osteoporosis, and psoriasis. The bromoolefin 156 was subjected to sequential metallation and transmetallation to give the corresponding... 

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