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Afleidd kalkkirtlaofvirkni hjá sjúklingum með nýrnabilun

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Authors
Ólafur Skúli Indriðason
Issue Date
1999-01-01

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Other Titles
Secondary hyperparathyroidism in patients with renal failure
Citation
Læknablaðið 1999, 85(1):25-7, 29-32
Abstract
In renal failure, several factors lead to parathyroid gland overactivity, manifested by hypersecretion of parathyroid hormone (PTH) and glandular hyperplasia eventually leading to monoclonal expansion of glandular cells in severe cases. Main factors contributing to this secondary hyperparathyroidism are increased end-organ resistance to PTH, low serum calcium and high serum phosphate concentrations and decreased production of 1,25-dihydroxyvitamin D3 by the kidneys. Treatment is directed towards correction of these underlying disturbances in mineral metabolism, however, such maneuvers are not always successful in controlling parathyroid gland activity. Functional disturbances within the parathyroid glands e.g., decrements in vitamin D or calcium sensing receptor number or function and/or increased cell mass have been implicated in therapeutic resistance. This article discusses the role of such functional derangements and details the results of a recent study demonstrating the importance of gland mass in this context.
Í nýrnabilun verða ýmsar breytingar á kalsíumbúskap líkamans sem leiða til ofvirkni kalkkirtla (parathyroid glands). Helstu áhrifaþættir eru minnkað viðbragð beina við kalkkirtlavaka (parathyroid hormone, PTH), lágur kalsíumstyrkur í blóði, minnkuð framleiðsla 1,25-díhýdroxývítamíns D3 í nýrum og hækkaður fosfatstyrkur í bóði. Þessir þættir leiða bæði beint og óbeint til aukinnar seytunar kalkkirtlavaka og ofvaxtar í kirtlunum sem getur að lokum valdið æxliskenndri fjölgun einstofna frumna. Meðferð byggist á því að leiðrétta vandann með gjöf kalsíums og D vítamínefna og með því að takmarka fosfat í mataræði, en viðbrögð við slíkri meðferð eru ekki einhlít. Talið er að starfrænar breytingar innan kalkkirtlanna, til dæmis fækkun D vitamin eða kalsíumviðtækja og/eða aukinn fjöldi frumna, tengist minnkuðu viðbragði við meðferð. Þessi grein fjallar um hlutverk starfrænna breytinga innan kalkkirtla í svörun við meðferð og fjallar sérstaklega um nýlega rannsókn sem varpar ljósi á mikilvægi kirtlastærðar í því sambandi.
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Icelandic Journal Articles (Peer Reviewed)

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