[Dialysis osteopathy with spontaneous fractures, progressive demineralization and therapy resistance].
In 25 (33.8%) of 74 chronically haemodialysed patients a distinct osteopathy with bone pain, spontaneous fractures, arthralgias and weakness of the muscles due to dialysis was present. In comparison to a group without complaints the duration of the dialysis was longer by 6 months, the mineral contents of the bones was decreased in 38%, in the comparative group in 22%. A progressive demineralisation was found in 46%, in the comparative group in 20%. Hypercalcaemias under vitamin D2 caused a therapy resistance. In 1 exemplary case (type IIc, PTH 0.3 micrograms/l) in the 3rd year of dialysis a fracture of the neck of the femur took place and an endoprosthesis was implanted. There was a progressive demineralisation of about 16%. The suspicion of a typical combination with an encephalopathy due to dialysis did not confirm itself. A pseudocyst in the brain was found. The differential diagnosis to the hypercalcaemia-induced psychosis in the osteopathy due to dialysis is discussed. In a prophylactic application dihydrotachysterine proved favourable for avoidance of an osteopathy due to dialysis. Parallel to the clinical progressing of the osteopathy due to dialysis a progressive demineralisation could be demonstrated at the peripheral mineral contents of the bones. Extreme losses of minerals appeared from the 4th to the 59th month of dialysis from - 16% to - 37% and from the 22nd to the 87th month from plus 11% to minus 14% of the age-and-sex-specific normal values. Successful transplantations led to the stagnation of the progressive demineralisation, unsucessful transplantations increase them. The influence of the non-refined water for the production of dialysate by possible aluminium intoxications on the development of the osteopathy due to dialysis is discussed.
D000536:Aluminum Hydroxide / Q000627:therapeutic use; D001842:Bone and Bones / Q000378:metabolism; D002117:Calcitriol / Q000627:therapeutic use; D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000628:therapy*; D004097:Dihydrotachysterol / Q000627:therapeutic use; D004872:Ergocalciferols / Q000627:therapeutic use; D005598:Fractures, Spontaneous / Q000628:therapy*; D006801:Humans; D016030:Kidney Transplantation; D008903:Minerals / Q000378:metabolism*; D011379:Prognosis; D006435:Renal Dialysis; D014467:Ultraviolet Therapy
D004872:Ergocalciferols; D008903:Minerals; D000536:Aluminum Hydroxide; D002117:Calcitriol; D004097:Dihydrotachysterol
Zum Problem der Dialyseosteopathie mit Spontanfrakturen, progressiver Demineralisierung und Therapieresistenz.