Yaşlılarda Mi̇neral Ve Kemi̇k Bozuklukları
Kenan AteşKronik böbrek hastalığının (KBH) ilerlemesi sürecinde mineral ve kemik metabolizmasında, artmış kırık, kemik dışı kalsifikasyonlar, kardiyovasküler olaylar ve mortalite riskleri gibi olumsuz klinik sonuçlara yol açabilen çeşitli bozukluklar ortaya çıkar. Geçmişte inanılanın aksine basitçe bir kemik hastalığı değil de sistemik bir sorun olması nedeniyle, Kidney Disease: Improving Global Outcomes (KDIGO) çalışma grubu, 2006 yılında renal osteodistrofi yerine “KBH-Mineral ve Kemik Bozukluğu” (KBH-MKB) teriminin kullanılmasını önermiştir.1 Renal osteodistrofi terimi ise biyopsi ile ortaya konulan KBH’daki kemik morfolojisindeki değişiklikleri tanımlamak için kullanılmaktadır. KBH-MKB, aşağıdaki bozuklukların biri veya kombinasyonu ile karakterizedir:
• Kalsiyum, fosfor, paratiroid hormon (PTH), D vitamini ve fibroblast büyüme faktörü-23’ü (FGF-23) ilgilendiren biyokimyasal anormallikler,
• Kemik döngüsü, mineralizasyonu, volümü, lineer büyümesi ve dayanıklığında bozukluklar,
• Özellikle vasküler olmak üzere kemik dışı kalsifikasyonlar.
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