Bone disease and hyperparathyroidism in chronic renal failure

the effect of 1α-hydroxyvitamin D3

Munro Peacock, J. E. Aaron, G. S. Walker, A. M. Davison

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Plasma biochemistry, iliac crest bone biopsy and calcium and phosphate absorption were performed in ninety patients with chronic renal failure, forty-one of whom were on maintenance haemodialysis. The studies were repeated in a number of these patients after at least 6 months treatment with 1α-hydroxyvitamin D3 (1α-OHD3). Before 1α-OHD3 treatment all patients had some abnormality in bone histology; there was an increase in the osteoid volume, the osteoid and resorbing surfaces and a decrease in the calcification fronts. There was no difference between those on and those not on haemodialysis, although the amount of osteoid increased with the length of dialysis. Plasma parathyroid hormone (PTH) was increased in all patients in the presence of hypo-normo- or hypercalcaemia, but the plasma calcium was higher in the haemodialysed patients. Malabsorption of calcium and phosphorus was present but it was significantly worse in the non-dialysed patients. Hyperphosphataemia was more marked in the non-dialysed patients and plasma alkaline phosphatase was raised in a number of patients. Plasma PTH correlated positively with plasma alkaline phosphatase and plasma calcium but was unrelated to any of the bone histology parameters. Treatment with 1α-OHD3 corrected the malabsorption of calcium and phosphorus and cured the proximal myopathy. There was a rise in plasma calcium and phosphate, but the rise in phosphate could be prevented with aluminium hydroxide in most patients. Only in 56% of patients was a rise in plasma calcium associated with a suppression of PTH, which did not fall into the normal range. In twenty-six patients repeat biopsies on 1α-OHD3 showed improvement in histology. It is concluded that 1α-OHD3 corrects the malabsorption and improves the bone histology and the myopathy of renal failure. Tertiary or autonomous hyperparathyroidism occurred in 44% of patients.

Original languageEnglish (US)
JournalClinical Endocrinology
VolumeVol 7, suppl.
StatePublished - 1977
Externally publishedYes

Fingerprint

Hyperparathyroidism
Bone Diseases
Chronic Kidney Failure
Calcium
Histology
Parathyroid Hormone
Bone and Bones
Muscular Diseases
Phosphorus
Alkaline Phosphatase
Renal Dialysis
Biopsy
Aluminum Hydroxide
Hypercalcemia
Biochemistry
Renal Insufficiency
Dialysis
Reference Values
Therapeutics
Phosphates

ASJC Scopus subject areas

  • Endocrinology

Cite this

Bone disease and hyperparathyroidism in chronic renal failure : the effect of 1α-hydroxyvitamin D3. / Peacock, Munro; Aaron, J. E.; Walker, G. S.; Davison, A. M.

In: Clinical Endocrinology, Vol. Vol 7, suppl., 1977.

Research output: Contribution to journalArticle

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