Das Syndrom der renalen Osteopathie

Zusammenfassung

Das Syndrom der renalen Osteopathie ist komplex und führt zu einer erheblichen Zunahme der Morbidität und Mortalität dieser Patienten. Primär sollte der Entstehung eines sekundären Hyperparathyreoidismus (sHPT) präventiv begegnet werden. Hier gilt es, frühzeitig und dauerhaft einen Vitamin-D-Mangel auszugleichen und dann bei Einschränkung der GFR unter 60 ml/min zusätzlich mit niedrigen Dosen aktiver Vitamin-D-Metabolite die fehlende renale Aktivierung von Calcitriol zu ersetzen. In diesem Stadium der Niereninsuffizienz sollte die Hyperphosphatämie bereits behandelt werden. Die Vitamin-D-Therapie hat aufgrund ihrer pleiotropen und wahrscheinlich antiatherogenen Effekte auch einen Stellenwert in der Langzeittherapie. Neue Medikamente wie das Kalzimimetikum Cinacalcet, das aktive Vitamin-D-Analogon Paricalcitol und die kalziumfreien Phosphatbinder Sevelamer und Lanthanumkarbonat haben die Therapie der renalen Osteopathie entscheidend verbessert und tragen dazu bei, dass bei mehr Patienten die in den Leitlinien empfohlenen Referenzwerte für PTH, Serumkalzium und Phosphat erreicht werden können. Dadurch wird die Notwendigkeit der Parathyroidektomie, die bei Patienten mit autonomem HPT immer noch indiziert ist, in den nächsten Jahren noch weiter zurückgehen.

Summary

Renal osteopathy isa complex syndrome which leads to a considerable increase in morbidity and mortality of patients with chronic kidney disease (CKD). Prevention of secondary hyperparathyroidism (sHPT) should be considered in all CKD patients. Vitamin D deficiency should be corrected. With declining renal function (GFR below 60 ml/min) active vitamin D metabolites should additionally be applied. Hyperphosphatemia should also be corrected. Vitamin D therapy exerts pleiotropic effects and antiatherogenic effects and should be therefore considered as a longterm therapy. Therapy of renal osteopathy had considerably improved by new drugs such as the calcimimetic cinacalcet, the active vitamin D analogue paricalcitol and the calcium-free phosphate binders sevelamer and lanthanum with more patients achieving the recommended target values of PTH, serum calcium and phosphate. The frequency of parathyroidectomy which is still indicated in autonomous HPT will decline in the future years.

Schlüsselwörter

Renale Osteopathie - sekundärer Hyperparathyreoidismus - Osteoporose - Kalziphylaxie - kardiovaskuläre Verkalkungen - Vitamin D - Kalzimimetika - Phosphatbinder

Keywords

Renal osteopathy - secondary hyperparathyreoidism - osteoporosis - calciphylaxis - cardiovascular calcification - vitamin D - calcimimetics - phosphate binders

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