Monitoring of PTH, vitamin D, calcium and phosphorus in patients with endemic nephropathy on chronic hemodialysis treatment

Uvod: Endemska nefropatija je bubrežna kronična tubulointersticijska bolest. Bolest je progresivnog tijeka i završava zatajenjem oba bubrega. U Hrvatskoj se bolest pojavljuje u 14 sela Brodsko-posavske županije. Uzročnik endemske nefropatije je vučja stopa, biljka koja se nalazi u poljima žita, a toksičnost dolazi od aristolohične kiseline. Cilj istraživanja: Cilj istraživanja je praćenje metaboličkih promjena koštane pregradnje kod bolesnika sa endemskom nefropatijom. Praćenjem serumskih koncentracija kalcija, fosfora, vitamina D i PTH, utvrđuju se korelacije između mjerenih koncentracija. Kod dijaliziranih pacijenata PTH je obično povišen, vitamin D snižen, a kalcij i fosfor se održavaju u granicama referentnih vrijednosti uz pomoć medikamentozne terapije. Nacrt istraživanja: Istraživanje parova. Ispitanici i metode: Svi bolesnici su sa područja Brodsko-posavske županije, a dijaliziraju se u Općoj bolnici Slavonski Brod. Uzorak oboljelih od endemske nefropatije je 27, a kontrolne grupe 60 bolesnika s drugim kroničnim bubrežnim bolestima. Rezultati: Prosječna dob svih bolesnika je 65 godina te su oba spola jednako su zastupljena. Kod oboljelih statističkim metodama je potvrđeno da se dužom dijalizom povisuje koncentracija kalcija, a kod kontrolne skupine koncentracija vitamina D. Duže trajanje dijalize proporcionalno je povišenim vrijednostima PTH. Viša prosječna dob povezana je sa nižom koncentracijom fosfora.. Zaključak: Endemska nefropatija je bolest koja je specifična za Brodsko-posavsku županiju. Rezultati ovog istraživanja imaju statistički značaj, ali ograničavajući čimbenik je mali uzorak od 27 oboljelih. Duže trajanje dijalize potvrđuje da mjerene koncentracije seruma pokazuju veći stupanj sekundarnog hiperparatireoidizma. Jako su snižene vrijednosti vitamina D. Nadomjesnom terapijom uspješno se održava koncentracija kalcija i fosfora u granicama normale.Monitoring PTH, vitamin D, calcium and phosphorus in patients with endemic nephropathy hemodialysis. Introduction: Endemic nephropathy is a chronic kidney tubulointerstitial disease and it has a progressive course and leads to chronic renal failure. In Croatia, the disease occurs in 14 villages of Brod-Posavina County. The causative agent of endemic nephropathy is Aristolochia lutea, the plant, which is located in the fields of wheat and whose toxicity originates from aristolochic acid. Objectives: The objective of the research is monitoring the metabolic changes of bone turnover in patients with endemic nephropathy. The monitoring of calcium, phosphorus, vitamin D, and PTH serum concentrations determines the correlations between the measured concentrations. In dialysis patients, PTH is usually increased while vitamin D levels are decreased, on the other hand, calcium and phosphorus are held within the reference value due to appropriate drug therapy. Study Design: Case control study Participants and methods: All patients are from the Brod-Posavina County area, and they are treated by dialysis at the General Hospital in Slavonski Brod. The group with endemic nephropathy included 27 patients, and the control group comprised 60 patients with other renal diseases.. Results: The average age of the patients is 65 years and both sexes are equally represented. In group of patients with endemic nephropathy, statistical methods have confirmed that longer dialysis treatment heighten the concentration of calcium, where in the control group longer dialysis treatment was related to vitamin D concentration. The longer duration of dialysis is proportional with increased PTH values. Higher average age is associated with a lower concentration of phosphorus. Conclusion: Endemic nephropathy is a disease specific to the Brod-Posavina County. These results have statistical significance, but the limiting factor is a small sample of 27 patients with endemic nephropathy. Longer duration of dialysis confirms that the measured serum concentrations show a higher degree of secondary hyperparathyroidism. Vitamin D values are significantly decreased. Replacement therapy successfully maintains the concentration of calcium and phosphorus within normal parameters