Smjernice za prevenciju, praćenje i liječenje poremećaja koštano-mineralnog metabolizma u bolesnika s kroničnom bubrežnom bolesti [Guidelines for the prevention, monitoring and therapy of chronic kidneydisease-metabolic bone disease in patients with chronic kidney disease]

Bašić-Jukić, Nikolina and Pavlović, Draško and Šmalcelj, Ružica and Tomić-Brzac, Hrvojka and Orlić, Lidija and Radić, Josipa and Vujičić, Božidar and Lovčić, Vesna and Pavić, Eva and Klarić, Dragan and Gulin, Marijana and Spasovski, Goce and Ljutić, Dragan and Đanić, Davorin and Prgomet, Drago and Resić, Halima and Ratković, Marina and Kes, Petar and Rački, Sanjin (2016) Smjernice za prevenciju, praćenje i liječenje poremećaja koštano-mineralnog metabolizma u bolesnika s kroničnom bubrežnom bolesti [Guidelines for the prevention, monitoring and therapy of chronic kidneydisease-metabolic bone disease in patients with chronic kidney disease]. Liječnički vjesnik, 138 (5-6). pp. 107-120. ISSN 0024-3477

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Abstract

Chronic kidney disease (CKD) is a systemic disease with numerous complications associated with increased morbidity and mortality. Chronic kidney disease-metabolic bone disease (CKD-MBD) starts at early stages of CKD with phosphorus accumulation and consequent initiation of numerous events that result with the development of secondary hyperparathyroidism with changes on bones and extraskeletal tissues. The most important and clinically most relevant consequences of CKD-MBD are vascular calcifications which contribute to cardiovascular mortality. Patients with the increased risk for the development of CKD-MBD should be recognized and treated. Prevention is the most important therapeutic option. The first step should be nutritional counseling with vitamin supplementation if necessary and correction of mineral status. Progression of CKD requires more intensive medicamentous treatment with the additional correction of metabolic acidosis and anemia. Renal replacement therapy should be timely initiated, with the adequate dose of dislaysis. Ideally, preemptive renal transplantion should be offered in individuals without contraindication for immunosuppressive therapy.

Abstract in Croatian

Kronična bubrežna bolest (KBB) sistemska je bolest povezana s nizom komplikacija koje naposljetku dovode do povećanog pobolijevanja i smrtnosti bolesnika. Poremećaj koštano-mineralnog metabolizma (CKD-MBD) počinje u ranim stadijima KBB-a nakupljanjem fosfora u organizmu s posljedičnim pokretanjem niza zbivanja koja rezultiraju razvojem sekundarnog hiperparatiroidizma s promjenama na kostima i izvankoštanim tkivima. Najvažnija i klinički najbitnija posljedica CKD-MBD-a jesu vaskularne kalcifikacije koje pridonose povećanju smrtnosti od srčano-krvožilnih bolesti. Potrebno je prepoznati bolesnike s povećanim rizikom od razvoja CKD-MBD-a i terapijski intervenirati. Prevencija je najbolji ­pristup zbrinjavanju bolesnika. Prvi korak u liječenju jest nutritivno savjetovanje uz nadoknadu vitamina i ispravljanje poremećaja minerala. Napredovanjem KBB-a prema završnom stadiju povećava se potreba za medikamentnom terapijom. Istodobno treba liječiti i ostale probleme poput anemije i acidoze. Potrebno je pravodobno započeti s nadomještanjem bubrežne funkcije uz osiguranje odgovarajuće doze dijalize. Idealno je omogućiti preemptivnu transplantaciju u bolesnika koji nemaju kontraindikacija za primjenu imunosupresijske terapije.

Item Type: Article
MeSH: Bone Diseases, Metabolic/diagnosis ; Bone Diseases, Metabolic/etiology ; Bone Diseases, Metabolic/prevention & control ; Bone Diseases, Metabolic/therapy ; Croatia ; Disease Progression ; Early Diagnosis ; Humans ; Monitoring, Physiologic/methods ; Patient Care Management/methods ; Patient Care Management/organization & administration ; Renal Insufficiency, Chronic/complications ; Renal Insufficiency, Chronic/diagnosis ; Renal Insufficiency, Chronic/therapy
Departments: Katedra za internu medicinu
Katedra za otorinoloringologiju s audiologijom i fonijatrijom
Depositing User: Anja Majstorović
Status: Published
Creators:
CreatorsEmail
Bašić-Jukić, NikolinaUNSPECIFIED
Pavlović, DraškoUNSPECIFIED
Šmalcelj, RužicaUNSPECIFIED
Tomić-Brzac, HrvojkaUNSPECIFIED
Orlić, LidijaUNSPECIFIED
Radić, JosipaUNSPECIFIED
Vujičić, BožidarUNSPECIFIED
Lovčić, VesnaUNSPECIFIED
Pavić, EvaUNSPECIFIED
Klarić, DraganUNSPECIFIED
Gulin, MarijanaUNSPECIFIED
Spasovski, GoceUNSPECIFIED
Ljutić, DraganUNSPECIFIED
Đanić, DavorinUNSPECIFIED
Prgomet, DragoUNSPECIFIED
Resić, HalimaUNSPECIFIED
Ratković, MarinaUNSPECIFIED
Kes, PetarUNSPECIFIED
Rački, SanjinUNSPECIFIED
Date: May 2016
Date Deposited: 18 Mar 2019 11:12
Last Modified: 10 Aug 2020 07:53
Subjects: /
Related URLs:
URI: http://medlib.mef.hr/id/eprint/3140

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