Abstract
A 6-month protocol of oral pulse calcitriol was used in nine uraemic children (2–14 years old) on dialysis who presented with renal osteodystrophy. Calcitriol was administered twice a week, 4 μg per dose for patients over 30 kg and 3μg for patients less than 30 kg. Plasma levels of parathyroid hormone, calcium, phosphorus and alkaline phosphatase were carefully controlled during the study. Parathyroid hormone levels decreased by 68% and 56% by the 2nd and 6th months of treatment in seven patients, while they remained unchanged in two patients with focal segmental glomerulosclerosis and massive proteinuria. Eight hypercalcaemic episodes from 77 determinations were observed, all of them recovered after 1 week of vitamin D withdrawal. We conclude that oral calcitriol pulse therapy is a good alternative for renal osteodystrophy in uraemic children. Careful monitoring of plasma parathyroid hormone and calcium is needed during follow-up when using this approach in paediatric patients.
References
Coburn JW, Slatopolsky E (1986) Vitamin D, parathyroid hormone and renal osteodystrophy. In: Brenner BM, Rector FC (eds) The kidney. Saunders, Philadelphia, pp 1657–1729
Malluche HH, Faugere MC (1990) Effects of 1,25(OH)2D3 administration on bone in patients with renal failure. Kidney Int 38 [Suppl 29]:48–53
Coburn JW (1980) Renal osteodystrophy. Kidney Int 17:677–679
Salusky IB, Coburn JW, Brill J, Foley J, Slatopolsky E, Fine R, Goodman W (1988) Bone disease in pediatric patients undergoing dialysis with CAPD or CCPD. Kidney Int 33:975–982
Silver J, Naveh-Many T, Mayer H, Schmelzer H, Popovtzer M (1986) Regulation by vitamin D metabolites of parathyroid hormone gene in vivo by the rat. J Clin Invest 78:1296–1301
Rusell J, Lettieri D, Sherwood LM (1986) Suppression by 1,25(OH)2D3 of transcription of the parathyroid hormone gene. Endocrinology 119:2864–2866
Saiusky IB, Fine RN, Hooshang K, Gold R, Paunier L, Goodman W, Brill J, Gilli G, Slatopolsky E, Coburn J (1987) “High dose” calcitriol for control of renal osteodystrophy in children on CAPD. Kidney Int 32:89–95
Slatopolsky E, Weerts C, Thielan J, Horst R, Harter H, Martin K (1984) Marked suppression of secondary hyperparathyroidism by intravenous administration of 1,25dihydroxycholecalciferol in uremic patients. J Clin Invest 74:2136–2143
Tsukamoto Y, Nomura M, Takahashi Y, Takagi Y, Yoshida A, Nagaoka T, Togashi K, Kikawada R, Marumo F (1991) The “oral 1,25-dihydroxyvitamin D pulse therapy” in hemodialysis patients with severe secondary hyperparathyroidism. Nephron 57:23–28
Martin K, Ballal S, Domoto D, Blalock S, Weindel M (1992) Pulse oral calcitriol for the treatment of hyperparathyroidism in patients on CAPD: preliminary observations. Am J Kidney Dis 19: 540–545
Andress DL, Endres DB, Maloney NA, Kopp JB, Coburn JW, Sherrard DJ (1986) Comparison of parathyroid hormone assays with bone histomorphometry in renal osteodystrophy. J Clin Endocrinol Metab 63:1163–1169
Brown AJ, Finch JL, Lopez-Hilker S, Dusso A, Ritter C, Pernalete N, Slatopolsky E (1990) New active analogues of vitamin D with low calcemic activity. Kidney Int 38:S22-S27
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Cano, F., Delucchi, A., Wolff, E. et al. Calcitriol oral pulse therapy in children with renal osteodystrophy. Pediatr Nephrol 9, 606–608 (1995). https://doi.org/10.1007/BF00860951
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DOI: https://doi.org/10.1007/BF00860951