Die renale Osteopathie

Zusammenfassung

Die renale Osteopathie stellt eine schwierige Herausforderung bei der Behandlung niereninsuffizienter Patienten dar. Sie bildet keine einheitliche Entität. Man unterscheidet High- und Low-Turnover-Osteopathien sowie gemischte Formen. Die Prophylaxe und Therapie dieser Erkrankung ist auf diese pathogenetisch unterschiedlichen Formen abzustimmen. Darüber hinaus ist ein erhöhtes Serum-Kalzium-Phosphat-Produkt als Risikofaktor für eine verstärkte Kalzifikation von Gefäßen zu berücksichtigen. Wesentliche La-borparameter im Rahmen der Steuerung der Therapie sind Serum-Phosphat und -Kalzium sowie der Parathormon-Spiegel. Für deren Zielwerte in Abhängigkeit der Nierenfunktion geben die so genannten K-DOQI Richtlinien einen Anhalt. Das therapeutische Spektrum wird durch neue Präparate wie neue Vitamin-D-Analoga, Kalzimimetika und Phosphatbinder wie Lanthankarbonat erweitert.

Summary

Renal bone disease is a difficult challenge in the treatment of patients with chronic renal insufficiency. It represents not an uniform entity. One has to discriminate between high-and low-turnover osteopathies and mixed forms. These pathogenetic different forms have to be taken into account in the prophylaxis and treatment of this disorder. Furthermore, an increased serum calcium x phosphate product has to be considered as a risk factor for vascular calcification. Important laboratory parameters in the management of this disease are serum-phosphate and calcium and the PTH-level. The optimal range of these parameters, which depends on renal function, is defined in the so-called K-DOQI guidelines. The therapeutic options in this disorder have recently become wider by new preparations such as new vitamin D analogues, calcimimetics and lanthanum carbonate.

Schlüsselwörter

Niereninsuffizienz - Osteopathie - Kalzium - Phosphat - Hyperparathyreoidismus - Phosphatbinder - Kalzimimetika - vaskuläre Kalzifikation

Keywords

Renal insufficiency - osteopathy - calcium - phosphate - hyperparathyroidism - phosphate binder - calcimimetics - vascular calcification

• Literatur

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