The renal function is not complete Must guard against abusing active VD

The renal function is not complete Must guard against abusing active VD
Capital University of Medical Sciences fits the professor of internal medicine of kidney of loyal hospital in subsidiary Beijing Chen presents the uncut jade
Chronic the intersection of renal function and the whole patient should offer active vitamin D3 ' Active VD) And calcium pharmaceutical? No! In this way, will cause drug abuse, bring the serious bad consequence to patient. Doctor must employ indication to be clear and reasonable norm use when terms possess.
What osteopathy is active VD suitable for
The chronic renal function is not complete (CRI) The patient often presents supersession disorder of mineral - bone, cause 3 kinds of osteopathy: Fiber osteitis, osteopathy and richetsing.
Fiber osteitis continue the intersection of gland and hyperfunction function by the first form of taking place etc. ' Overbearing by hereafter referred to as firsting) Cause, there is not motive force osteopathy that is that the gland function causes low by first form, but richets is the active VD scarce result. Bone examine materials, reveal fiber most common osteitis while being living, have power osteopathy takes second place, richets is rare. Because domestic bone live, examine, launch seldom at present, can only use, measure serum whole the intersection of parathormone and (iPTH) at being clinical , 25 - the intersection of hydroxy and the intersection of vitamin and D3 and the intersection of alkaline phosphatase and level come on, distinguish tentatively.
Which kind of osteopathy is active VD suitable for the aforesaid?
1.The overbearing fiber osteitis by first: Because active VD can inhibit the gland by first form.
2.The scarce richets of active VD: Because active VD can be supplemented in the body directly scarcely.
Attention: Too low to have motive force osteopathy gland function by first form, it is often a result of abusing active VD and calcium pharmaceutical. This disease is not not only the active VD therapeutic adaptation card, should avoid instead. So indiscriminately, use active VD it treats to be wrong by all the intersection of CRI and patient.
When will the treatment of active VD be begun
It is rare because of richets, only introduce the overbearing and application in fiber osteitis is prevented and cured by first of active VD now. To these patients, when to begin the treatment of active VD, to what extent is treated to stop medicines? The domestic and foreign guide is proposed: The third, 4, 5 issues of chronic kidney trouble (CKD) When the patient's iPTH level is differentiated> 70 pg/ml, 110 pg/ml and 300 pg/ml, should begin the treatment of active VD; And should stop medicines while dropping to 35 pg/ml, 70 pg/ml and 150pg/ml separately.
Normal serum iPTH levels of people are in 15- 65 pg/ml range. Why not just increase and use at iPTH level? And why does not CKD the 4th, 5th patient need to treat to iPTH normally to anchor medicines? This because of parathormone(PTH) at the CRI The corresponding receptor quantity on the target organ is reduced, so need higher PTH density and maintain the normal bone supersession. This uses medicine indication should be carried out strictly, otherwise excessive application active VD, will bring out by first form the gland function is low and does not have motive force osteopathy.
What condition is needed to employ active VD
Can the above-mentioned level that so long as iPTH reach begin the treatment of active VD? No. At the same time also must qualified to employ active VD, the more important thing is, think blood phosphorus competence and serum calcium phosphorus product, meet the qualification. Because high blood phosphorus can stimulate the cell hyperplasia of gland by first form, strengthen PTH gene expression and PTH to secrete; High blood phosphorus still can inhibit kidney 1 - hydroxy enzyme activity and active VD from formating, and resist the active VD inhibitory activity on PTH short of moneyly. So, blood phosphorus can reduce active VD curative effect to increase notably. In addition, use active VD when serum calcium phosphorus product is too high, will also promote the soft tissue, including cardiovascular calcification, cause the serious consequence.
How to reduce phosphorus and calcium phosphorus product of high blood? CRI patient's blood calcium water is not high usually, so it is to reduce high blood phosphorus to reduce the key to the product of calcium phosphorus. This includes the following measure: 1. Low protein diet, reduce phosphorus to take in. It will be following taking in 15mg phosphorus to eat 1g protein each time. 2.Take phosphorus and combine pharmaceuticals, promote phosphorus to discharge from intestine. Use most suck aluminium phosphorus, combine pharmaceutical in the past ' If hydrogen oxidizes aluminium) ,It caused chronic aluminium to be poisoned that aluminium can be accumulated in the body when finding CRI later, so already used few. Combine it lower the intersection of blood and the intersection of phosphorus and result, most fast, should abandon it totally in the pharmaceutical in phosphorus. Guide propose in the intersection of blood and very much high phosphorus ' >7.0mg/L) When, must first choose to include aluminium phosphorus and combine pharmaceuticals, but only employ for 4 weeks. Forefront that use most now lower the intersection of blood and the intersection of phosphorus and medicine, include the intersection of calcium and phosphorus, combine pharmaceutical ' Such as calcium and calcium acetic acid) carbonic acid ,Comparatively speaking, they are good and cheap in reducing high blood phosphorus, but still risk bringing out hypercalcemia disease. 3.Dialyse and remove blood phosphorus. The blood of the regular dosage is dialysed and the peritoneum can not totally remove phosphorus that the diet took in to dialyse, need the above-mentioned every measure of cooperation and strengthen and dialyse the dosage to produce the best result. The guide points out, only when serum phosphorus drops to <4.6mg/dl and serum calcium to drop to <9.5mg/dl, should employ active VD.
Avoid curing source hypercalcemia disease
Here need, combine use of pharmaceutical, emphasize a few words including the intersection of calcium and phosphorus, namely must avoid bringing out hypercalcemia disease while employing and including calcium phosphorus and combining pharmaceuticals. Calcium phosphorus product that high blood calcium can increase, aggravate the calcification of soft tissue. The guide points out, every day should not exceed 1500mg to combine element taken in in pharmaceuticals calcium from including calcium phosphorus, the total intaking amount of daily calcium should not exceed 2000mg. So employ, include the intersection of calcium and phosphorus, must calculate the intersection of element and the intersection of calcium and content (the intersection of carbonic acid and calcium content of element of calcium account for 40% conscientiously combine pharmaceutical, calcium acetic acid accounts for 25%) ,Many clinicians are careless with this at present, it is too high in dosage to often use calcium pharmaceuticals, this is an important reason to cause hypercalcemia disease.
The intaking amount of compatriot's diet calcium is relatively low, only daily about 500mg. The diet can not cause high blood calcium, but the domestic CRI patient often takes ketoacid preparation of compound and carries on nutrition treatment, this medicine includes calcium too ' Ketoacid calcium and hydroxy acid calcium) ,Each scene of elements calcium content 50mg, the patient often takes 12 slices or more every day, will then take in element calcium 600mg or more every day, this quantity can't be ignored! Ask the clinician to notice, CRI patient's hypercalcemia disease often comes from curing the source.
Make sure to keep in mind: It may cause two serious bad consequences to abuse active VD and calcium pharmaceutical: Kindling soft tissue and cardiovascular vessel calcification, cause the difficult curing not to have motive force osteopathy. Must avoid!
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