1/4. Parenteral calcitriol for treatment of severe renal osteodystrophy in children with chronic renal insufficiency.renal osteodystrophy is a common and incapacitating complication of chronic renal failure in children. Standard therapy with oral calcium supplements, phosphate binders, and vitamin d preparations is often inadequate to control progressive bone disease. We report the use of parenteral calcitriol therapy in two children, aged 2 and 15 years, respectively, with chronic renal failure. This treatment effectively suppressed secondary hyperparathyroidism in both patients, causing a nearly 50% reduction in circulating parathyroid hormone level and a parallel decline in serum alkaline phosphatase activity. In the younger patient, therapy was associated with healing of subperiosteal bone resorption and accelerated growth velocity. These findings indicate that parenteral administration of calcitriol may be an effective treatment option in some patients with refractory renal osteodystrophy and secondary hyperparathyroidism.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
2/4. Brown tumor in secondary hyperparathyroidism causing acute paraplegia.The first known case of a "brown tumor" associated with secondary hyperparathyroidism causing paraplegia is described. A 69-year-old white woman with chronic renal failure due to hypertension was admitted for back pain, and while she was under observation, paraplegia developed. A complete block was demonstrated by myelography. Computed tomography confirmed a mass at the level of obstruction, and results of biopsy were consistent with "brown tumor." Neurologic symptoms were markedly improved with high-dose corticosteroids and a debulking procedure. This entity is important to recognize because prompt treatment of the hyperparathyroidism or decompression of the tumor mass by surgical means or corticosteroid administration can provide marked improvement in symptoms.- - - - - - - - - - ranking = 1keywords = administration (Clic here for more details about this article) |
3/4. Predialysis calcitriol administration: effects on pre- and post-transplant renal osteodystrophy.twins with parallel loss of kidney function and moderate hyperparathyroid bone disease were participants in a double-blind study where twin A was given placebo and twin B calcitriol. After 8 months. A's bone disease had not improved, while B's bone had normalized. Thereafter, both received calcitriol until kidney transplantation 11 months later, when both had normal bone structure. Two years after transplantation, both twins had hyperparathyroid bone disease, but A had more pronounced changes. This report illustrates our findings in larger series: When started early in the course of renal failure, calcitriol can reverse pre-transplant hyperparathyroid bone disease and also influence post-transplant bone disease.- - - - - - - - - - ranking = 4keywords = administration (Clic here for more details about this article) |
4/4. Regression of massive tumoral calcinosis of the ischium in a dialysis patient after treatment with reduced calcium dialysate and i.v. administration.BACKGROUND: Tumoral calcinosis, an inherited metabolic disorder, has been described with increasing frequency over the last 20 years [Drueke 1966]. It is characterized by massive calcium phosphate deposits in periarticular tissues, usually around large joints, especially the hips, knees and elbows (editorial in Lancet 1987). PATIENT AND METHOD: We describe a 58-year-old male patient with tumoral calcinosis of the ischium and severe hyperparathyroid bone disease, successfully treated with reduced calcium dialysate and vitamin d. CONCLUSION: We believe that in cases of tumoral calcification with histologically proven hyperparathyroid bone disease, lowering the calcium dialysate concentration together with careful administration of vitamin analogs and monitoring of serum calcium, phosphate and parathyroid hormone levels, may be the ideal therapeutic approach. Control of hyperphosphatemia would be best achieved with measures other than administration of aluminium phosphate binders if one wishes to avoid the induction of adynamic bone.- - - - - - - - - - ranking = 6keywords = administration (Clic here for more details about this article) |