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Einfluß der Vitamin-D3-Therapie auf die renale Osteodystrophie im Kindesalter

Influence of vitamin D therapy on renal osteodystrophy in children

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Summary

Growth arrest and renal osteodystrophy is a major problem in renal insufficiency of children. The present report describes our experiences in managing renal osteodystrophy by using vitamin D3 for 24 months. Values in plasma of Ca, Mg, alkaline phosphatase, iPTH, 25-OH-D were determined regularly. Skeletal X-rays and analysis of iliac crest bone biopsies were obtained in each child.

In treatment with vitamin D3 no hypercalcemia was seen despite high serum levels of 25-OH-D. Plasma-Ca, alkaline phosphatase, and iPTH normalized nearly. Radiographic abnormalities improved. Bone biopsies showed improvement in signs of secondary hyperparathyroidism and ostitis fibrosa, whereas osteomalacia remained unchanged. Osteoblast population showed a small reduction. No real increment in body growth was seen.

Zusammenfassung

Eine Therapiestudie mit Vitamin D3 in pharmakologischen Dosen bei 27 Kindern in der progredienten Niereninsuffizienz bzw. unter intermittierender Dauerdialysebehandlung über 24 Monate zeigte, daß weder die Vitamin-D3-Behandlung unterstützt durch orale Calciumsupplementation alleine noch in Kombination mit Dialysebehandlung eine renale Osteodystrophie heilen oder verhindern kann. Es gelang zwar in 34,0% der Fälle mit progredienter Niereninsuffizienz und 50% der Fälle unter Hämodialysebehandlung den sekundären Hyperparathyreoidismus für einige Zeit zu suppremieren, eine Suppression auf Dauer konnte allerdings nicht erreicht werden. Das Ausmaß der Mineralisationsstörung und der Wachstumsverzögerung blieb unverändert, die Osteoblastenzahl erlitt mit Suppression des sekundären Hyperparathyreoidismus eine Reduktion, die eine Verminderung des Knochenanbaues und der Knochenmasse unter Dauertherapie mit Vitamin-D3 in pharmakologischen Dosen befürchten läßt. Hypercalcämien und extraossäre Verkalkungen wurden nicht beobachtet.

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Authors and Affiliations

  1. Universitäts-Kinderklinik Kinderdialyse, J.-Stelzmann-Str. 9, D-5000, Köln 41, Bundesrepublik Deutschland

    M. Bulla, G. -J. Stock, G. Delling, H. Hofmann & G. Offermann

  2. Institut für Pathologie der Universität Hamburg, Germany

    M. Bulla, G. -J. Stock, G. Delling, H. Hofmann & G. Offermann

  3. Radiologisches Institut der Universität Köln, Germany

    M. Bulla, G. -J. Stock, G. Delling, H. Hofmann & G. Offermann

  4. Medizinische Klinik und Poliklinik der Freien, Germany

    M. Bulla, G. -J. Stock, G. Delling, H. Hofmann & G. Offermann

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  1. M. Bulla
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  2. G. -J. Stock
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  3. G. Delling
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  4. H. Hofmann
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  5. G. Offermann
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Mit Unterstützung des Sonderforschungsbereiches 34 „Endokrinologie“

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Bulla, M., Stock, G.J., Delling, G. et al. Einfluß der Vitamin-D3-Therapie auf die renale Osteodystrophie im Kindesalter. Klin Wochenschr 58, 237–247 (1980). https://doi.org/10.1007/BF01476970

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  • DOI: https://doi.org/10.1007/BF01476970

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