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Effects of calcitriol (rocaltrol) upon pth levels in patients under hemodyalisis (HD) treatment. A preliminary report
Abstracts from the Advances in Renal Osteodistrophy Symposium
76
RFFRCTS OF CALCITRIOL
Bone disorders caused by nluminium stores in bono is still vary important in chronicrenal failure. We therefore need a reliable method for the diagnosis of aluminium stores in the bone. The aim of this study was to compare the sensitivity and specificity of Aluminon and Solochrome Asurine stain and their correlation with bone aluminium content. The study was performsd on 2Obiup&uof iliac crest from patients on chronic haemodialysis. Aluminium content was determined by Graphite Furnace Atomic Absorption Spectrometry. The range of aluminium levels wsre from 298 w/g to aSae lJg/g and all samples were stained with both Aluminon and Solochrome Asurine. Microscopic examination was considered negative (-1 if we could not see aluminium stores, positive (+l if aluminium was present (more than 15%)and double positive (++) when the presence of aluminium wa* massive. All biopsies with Al content below P pg/g (N-7) were Aluminon negative. There were 7 biopsies in which the Al eontent was abuve 20 pg/g but the Aluminon results were negative (range 22.1-119.2~g/g). These samples showed hyperparatiroidiem with very high bone activity. The other biopsies (N=16) were either Aluminon positive (+l or double positive (++). Solochrome Asurine stain was negative when the aluminium was under !20pg/g except for one biopsy. This last sample was Perk positive too IIron stain). The biofisies with aluminiun aboveaOpg/g were all positive (hiperpsratiroidism too). Solochrome Azurine was more sendtlve than Aluminon (always poritiM ~4th A1>40 pg/g), but does not appear to be more specific. Aluminon was not sensitive enough and we were not able to detect aluminium stores when there wae a high bone activity. Iron appears to interfere with aluminium detection in both histochemical techniques. We must measure aluminium if we want to avoid these restrictions.
PARAlHVROIDECTOllV
IPTI)
IN CHROlllC
HElfODIALVSIS
PAllEWIS
TKW'YCF
ICHPi.
Veaturr,J.; lbrrlii,R.; PJtrJpliJ,A.;CJJrsi,H.;
Frrninde~,J.fl.; Aobroronr
hlrolopi~.
SscirdJd UrupuJ~Jdr
,P.
ticmbvideo.
Uru9uJy.
had undrrgonr PTI rmng lM8 prtirntrlptrl trJJtsd bstuesn198$Jnd1992.HeJs(9s “JJ.49 7sJrJ (rJs9J24 to 701. l!Jlrs * 12. Thersnrl dirrrssr chronic qlooerulonrphr~tir
Trlnt~ tro CHP
nephrorrlerosis
II),
IS),
tubuloiaterrtitiJl
nephritis
151,
kidney direrse 131, eelawn It). Pt: WI prforsed 58 sssth (rJn9sb-lo 1161rfttr the first &sdiJlyris. Boss biopsy in II pts stmwdr evidencesof hyperparethyroidiseIll1 end positive hiStOChJsiCJl strinin) for Jlwinus 191. Eight pte receivedDFIkfore PlI. Iodicrtiols for PTl wry: strletrlplan, hrPsrphosphsrnis(P ) b q/61), klteliae pbosphJtJu I 2 or polycyrtit
IOR,
subperiosteJ1
CJlcificJtioo
IvJsc
reSOoIlSe
Irp ~1,
resorptioe CJ~C),
t0 JediCJl
thtrJOv:
joint
hyptrCJkeoiJ,
CJkifiCJtipn
VJSCU~J~
IjOint
CJk),
non
UPON PM
WYJ0WYtWfW~l~IDI~WITHINT~TTMI(RPL
ECLCS ff 1,25 (CW2 M.A.
VIlPMIN D3 (vit DY).
A. Pelegri, J.A. Rcdrigez,
Galicia,
L. Piers. wital
Ca-eral
A. Olnq
A. Seqcra,
Vail d’tkbr& , Bercelore,Spain.
W?haveasseased~~withintermittentoralbolusofvitD) for 4 mmti-6 in 13 patients ( 6 de/7 fde; n’em q 53HO.5
yd with sex-&y hpqaratymidism. Eleven patients td been cn hencdialysis For 7,7U yrs ad 3 M -rat cfnmic mml failure. seNnksslirealkmMLmlsvdswsrelmsrula,zo~linall cases. In all patients rxtmrptim of pericstiun um cbserved m X ray.
Ultrasardexaniratimshwd ale or mxe pscatyruid
in 7lEof
tJ-epatients md
Before entering the st& thzrqy
.
(ROCALTROL)
LF%ELSIN PATIENTSUNDER HBYODYALISIS (iiD) TREATMENT.A PRELIMINARYREPORI!. P.L. Santa Crtiz; J.L. Cadenas; P.E. Rangel; M.C. Lebn; B. Mtialich; X. Gil; A. Castell. M. Ascunce Teaching Hospital. CamagUey and Nephrology Institute. Havana. CUBA. In order to evaluate supressive effects of calcitriol upon PTH oversecretion a clinical trial with ROCALTROL(H.La ROCHE) 0,25 - 0,5 mcg/day in 8 patients under maintennance ED was performed. They were selected from dyali sis program patients with primary pephropethy and non lesser than 6 months of treatment by means of randomized methods. At the beginning (to) and 90 (tl) and 60 (tp) days intact-PTH (IPTH) -RIA- was measured (normal range 20-9Opg/ml) besides total calcium and phosphourus and serum albumina and alkaline phosphatase (AF) were also measured. iPTH levels among themselves and with the values get from a control group of patients with similar status at to were compared. Data were submmited to statistical analysis in a PC In the contrcl group iFl’H mean level was 209,97 ?: 56,17pg/ml and in the experimental group it was 212,78 2 84,84pg/ml both values at to. In the last one IPTR level showed a significant fall (p
(
11-k
scinti~
11 patients were m
0,75-1,75 m&uxk,.
gkck
in&Pnoftkcases. daily lcw &se
vit D3
The study WBS started by ahiniste-
rirg1qthbrceeldy,prcgressivelyircrekqtlxbeesb 1,5rncgthriceW!ekly.ReslltsareprSGtedtelol:
Prtreatr stoletrl P
prin
) b rqldl
RJ:sp CJ
tid
res
) II
q/d1
Qd
vJSc CJlc @ml
CJk
JOid Suitotrl
PTX
prrrthyroid hrd
diffuse
chief
g irrnqe
1.4
nearly
us
perforoed
in
17 pts
JutotrJorplJntJtioa cell
in
5
hyperplJsiJf
to 8.3).
After
md
th
plJIIdUlJr
oeln
k
md
@eight P VJlUeS
v~lurr, trJssisst hypCJlCesiJIJS observed
noroll
sl
forerre IJS 3.4 fill in
to
lhke
@IS relief
J
underrent
second
hyprrpJrJthyrOidieo; stressed Jed
the
11 reverrll
of bone
irproveunt Ot
pJin
eubtotrl loo ptr of
bone
ml
'9@0,6
lM,S
6#1,2
6,61,5
Wx),3
-
819t8)4
687UU2
;urC
= =z;W'
m2
m3
10,14,7
m4
10,3@,8
l&UO,9 6,%1,7
6,)11,5
6,2*1,7
6,341,6
-
-
37,7i27,T
-
53li503
54)t75~
4,%6
4,@1,7
6591723
63WU5
10
WE-;$$_
-
-6g7-4,lQ6
Jnd
isprOVis9of rJdiOlopiCJ1 Signs m 13 Jnd 12 pk rsSPKtiVely. I(stJStJSiCvJrcul~r CJlCifiCJtiMsdiSJp)JJrJdin 6 wntb ltrrr II 211, o&r soft tirsusr crlcifirtisss isprowd or rssJi& unchmqed. Two pts
ptr.
day15
10,2to,7
pts. All the glandsreenved oeJn
PlK
PTI with
totrl
Baseline
bJCJuSJ
PlX died direrrr,
persistent hyperlo. It
Ireprir, seruo
JrtJriJl CJlCifiCJtlonS Jfter
CJ PIX.
IS
JndP values
Asteadyckcrmzofo&ccalcin,PPadintsctPTHlevelsvrs~ ssrved,sltku$witJukrw&iqststisticalsi~@ficerce.~rcalEmisvaerutcbsecbserued.ItiscrncludadU8t~withintsrmitt&
hi@
&es
of vit 03 mi#t
ba effimzias
in spunky
hypeqe&~idisn,adthzreforebxldbeccrsideredapotmtial elternetibetreebnent.
76
RFFRCTS OF CALCITRIOL
Bone disorders caused by nluminium stores in bono is still vary important in chronicrenal failure. We therefore need a reliable method for the diagnosis of aluminium stores in the bone. The aim of this study was to compare the sensitivity and specificity of Aluminon and Solochrome Asurine stain and their correlation with bone aluminium content. The study was performsd on 2Obiup&uof iliac crest from patients on chronic haemodialysis. Aluminium content was determined by Graphite Furnace Atomic Absorption Spectrometry. The range of aluminium levels wsre from 298 w/g to aSae lJg/g and all samples were stained with both Aluminon and Solochrome Asurine. Microscopic examination was considered negative (-1 if we could not see aluminium stores, positive (+l if aluminium was present (more than 15%)and double positive (++) when the presence of aluminium wa* massive. All biopsies with Al content below P pg/g (N-7) were Aluminon negative. There were 7 biopsies in which the Al eontent was abuve 20 pg/g but the Aluminon results were negative (range 22.1-119.2~g/g). These samples showed hyperparatiroidiem with very high bone activity. The other biopsies (N=16) were either Aluminon positive (+l or double positive (++). Solochrome Asurine stain was negative when the aluminium was under !20pg/g except for one biopsy. This last sample was Perk positive too IIron stain). The biofisies with aluminiun aboveaOpg/g were all positive (hiperpsratiroidism too). Solochrome Azurine was more sendtlve than Aluminon (always poritiM ~4th A1>40 pg/g), but does not appear to be more specific. Aluminon was not sensitive enough and we were not able to detect aluminium stores when there wae a high bone activity. Iron appears to interfere with aluminium detection in both histochemical techniques. We must measure aluminium if we want to avoid these restrictions.
PARAlHVROIDECTOllV
IPTI)
IN CHROlllC
HElfODIALVSIS
PAllEWIS
TKW'YCF
ICHPi.
Veaturr,J.; lbrrlii,R.; PJtrJpliJ,A.;CJJrsi,H.;
Frrninde~,J.fl.; Aobroronr
hlrolopi~.
SscirdJd UrupuJ~Jdr
,P.
ticmbvideo.
Uru9uJy.
had undrrgonr PTI rmng lM8 prtirntrlptrl trJJtsd bstuesn198$Jnd1992.HeJs(9s “JJ.49 7sJrJ (rJs9J24 to 701. l!Jlrs * 12. Thersnrl dirrrssr chronic qlooerulonrphr~tir
Trlnt~ tro CHP
nephrorrlerosis
II),
IS),
tubuloiaterrtitiJl
nephritis
151,
kidney direrse 131, eelawn It). Pt: WI prforsed 58 sssth (rJn9sb-lo 1161rfttr the first &sdiJlyris. Boss biopsy in II pts stmwdr evidencesof hyperparethyroidiseIll1 end positive hiStOChJsiCJl strinin) for Jlwinus 191. Eight pte receivedDFIkfore PlI. Iodicrtiols for PTl wry: strletrlplan, hrPsrphosphsrnis(P ) b q/61), klteliae pbosphJtJu I 2 or polycyrtit
IOR,
subperiosteJ1
CJlcificJtioo
IvJsc
reSOoIlSe
Irp ~1,
resorptioe CJ~C),
t0 JediCJl
thtrJOv:
joint
hyptrCJkeoiJ,
CJkifiCJtipn
VJSCU~J~
IjOint
CJk),
non
UPON PM
WYJ0WYtWfW~l~IDI~WITHINT~TTMI(RPL
ECLCS ff 1,25 (CW2 M.A.
VIlPMIN D3 (vit DY).
A. Pelegri, J.A. Rcdrigez,
Galicia,
L. Piers. wital
Ca-eral
A. Olnq
A. Seqcra,
Vail d’tkbr& , Bercelore,Spain.
W?haveasseased~~withintermittentoralbolusofvitD) for 4 mmti-6 in 13 patients ( 6 de/7 fde; n’em q 53HO.5
yd with sex-&y hpqaratymidism. Eleven patients td been cn hencdialysis For 7,7U yrs ad 3 M -rat cfnmic mml failure. seNnksslirealkmMLmlsvdswsrelmsrula,zo~linall cases. In all patients rxtmrptim of pericstiun um cbserved m X ray.
Ultrasardexaniratimshwd ale or mxe pscatyruid
in 7lEof
tJ-epatients md
Before entering the st& thzrqy
.
(ROCALTROL)
LF%ELSIN PATIENTSUNDER HBYODYALISIS (iiD) TREATMENT.A PRELIMINARYREPORI!. P.L. Santa Crtiz; J.L. Cadenas; P.E. Rangel; M.C. Lebn; B. Mtialich; X. Gil; A. Castell. M. Ascunce Teaching Hospital. CamagUey and Nephrology Institute. Havana. CUBA. In order to evaluate supressive effects of calcitriol upon PTH oversecretion a clinical trial with ROCALTROL(H.La ROCHE) 0,25 - 0,5 mcg/day in 8 patients under maintennance ED was performed. They were selected from dyali sis program patients with primary pephropethy and non lesser than 6 months of treatment by means of randomized methods. At the beginning (to) and 90 (tl) and 60 (tp) days intact-PTH (IPTH) -RIA- was measured (normal range 20-9Opg/ml) besides total calcium and phosphourus and serum albumina and alkaline phosphatase (AF) were also measured. iPTH levels among themselves and with the values get from a control group of patients with similar status at to were compared. Data were submmited to statistical analysis in a PC In the contrcl group iFl’H mean level was 209,97 ?: 56,17pg/ml and in the experimental group it was 212,78 2 84,84pg/ml both values at to. In the last one IPTR level showed a significant fall (p
(
11-k
scinti~
11 patients were m
0,75-1,75 m&uxk,.
gkck
in&Pnoftkcases. daily lcw &se
vit D3
The study WBS started by ahiniste-
rirg1qthbrceeldy,prcgressivelyircrekqtlxbeesb 1,5rncgthriceW!ekly.ReslltsareprSGtedtelol:
Prtreatr stoletrl P
prin
) b rqldl
RJ:sp CJ
tid
res
) II
q/d1
Qd
vJSc CJlc @ml
CJk
JOid Suitotrl
PTX
prrrthyroid hrd
diffuse
chief
g irrnqe
1.4
nearly
us
perforoed
in
17 pts
JutotrJorplJntJtioa cell
in
5
hyperplJsiJf
to 8.3).
After
md
th
plJIIdUlJr
oeln
k
md
@eight P VJlUeS
v~lurr, trJssisst hypCJlCesiJIJS observed
noroll
sl
forerre IJS 3.4 fill in
to
lhke
@IS relief
J
underrent
second
hyprrpJrJthyrOidieo; stressed Jed
the
11 reverrll
of bone
irproveunt Ot
pJin
eubtotrl loo ptr of
bone
ml
'9@0,6
lM,S
6#1,2
6,61,5
Wx),3
-
819t8)4
687UU2
;urC
= =z;W'
m2
m3
10,14,7
m4
10,3@,8
l&UO,9 6,%1,7
6,)11,5
6,2*1,7
6,341,6
-
-
37,7i27,T
-
53li503
54)t75~
4,%6
4,@1,7
6591723
63WU5
10
WE-;$$_
-
-6g7-4,lQ6
Jnd
isprOVis9of rJdiOlopiCJ1 Signs m 13 Jnd 12 pk rsSPKtiVely. I(stJStJSiCvJrcul~r CJlCifiCJtiMsdiSJp)JJrJdin 6 wntb ltrrr II 211, o&r soft tirsusr crlcifirtisss isprowd or rssJi& unchmqed. Two pts
ptr.
day15
10,2to,7
pts. All the glandsreenved oeJn
PlK
PTI with
totrl
Baseline
bJCJuSJ
PlX died direrrr,
persistent hyperlo. It
Ireprir, seruo
JrtJriJl CJlCifiCJtlonS Jfter
CJ PIX.
IS
JndP values
Asteadyckcrmzofo&ccalcin,PPadintsctPTHlevelsvrs~ ssrved,sltku$witJukrw&iqststisticalsi~@ficerce.~rcalEmisvaerutcbsecbserued.ItiscrncludadU8t~withintsrmitt&
hi@
&es
of vit 03 mi#t
ba effimzias
in spunky
hypeqe&~idisn,adthzreforebxldbeccrsideredapotmtial elternetibetreebnent.