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Ciuffreda, Matteo (2011) Iperparatiroidismo secondario persistente dopo trapianto di rene: fattori eziopatogenici e possibili interventi terapeutici. [Tesi di dottorato]

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Abstract (inglese)

A number of complications can occur after renal transplant and among them, post-transplantation bone disease is one of the most frequent. Post-transplantation bone disease is influenced by multiple factors. An important risk factor is represented by secondary hyperparathyroidism (SHPT).
In the first part of the present study (CROSS-SECTIONAL STUDY) the clinical, metabolic and genetic factors, in particular vitamin D status and Calcium Sensing receptor polymorphism (CaSR), that can influence the persistence and severity of SHPT in 125 patients (87 males and 38 females, age 51±11), who had undergone kidney transplantation 1 to 120 months before and with serum creatinine ≤ 227 μmol/L, were investigated. Vitamin D deficiency (25OH-D3 <= 30 nmol/L) was found in 40 % of the patients. 25OH-D3 levels were significant predictors of PTH levels. CaSR polymorphisms cannot play any central role as a risk factor for SHPT.
The aim of the second part of this study (LONGITUDINAL STUDY) was to evaluate the effect of a vitamin D therapy (cholecalciferol, 30 drops once a week corresponding to 7500 IU) on PTH levels in a sample of the above-mentioned population. We studied 51 patients (39 males and 12 females, age 53±11) After 8 months of therapy only in 11 (22%) patients 25OH-D3 levels had normalized (> 80 nmol/L). As far as PTH levels were concerned, we observed a slight but significant decrease. These data show that hypovitaminosis D is extremely frequent in kidney-transplanted patients and it represents an important risk factor for the persistence and severity of secondary hyperparathyroidism and thus for skeletal morbidity. Vitamin D supplementation decreases PTH levels in this setting as well.

Abstract (italiano)

Il trapianto di rene è gravato da numerose complicanze cliniche. L’osteoporosi è una delle più frequenti e rilevanti. La patogenesi dell’osteoporosi dopo trapianto di rene è multifattoriale e la persistenza di iperparatiroidismo secondario (SHPT) costituisce un ulteriore fattore di rischio di danni scheletrici di tipo osteoporotico.
La presente tesi si compone di due parti.
Nella prima parte (STUDIO TRASVERSALE) scopo dello studio è stato indagare
i parametri clinici, metabolici e genetici, con particolare riguardo allo stato vitaminico D ed al polimorfismo del recettore sensore del calcio (CaSR), che possono influenzare l’SHPT in una popolazione di 125 pazienti (87 M, 38 F, età 51±11) trapiantati di rene da 1 a 120 mesi, con creatininemia ≤227 μmol/L. Il 40 % dei pazienti è risultato carente di vitamina D (25OH-D3 <= 30 nmol/L). I livelli di 25OH-D3 rappresentano un fattore predittivo significativamente associato a persistenza di iperparatiroidismo secondario. Il polimorfismo del CaSR non sembra giocare un ruolo centrale nella patogenesi della persistenza di iperparatiroidismo.
Nella seconda parte (STUDIO LONGITUDINALE) scopo dello studio è stato quello di valutare come si modificano i livelli di PTH dopo terapia con colecalciferolo (30 gocce settimanali pari a 7500 U.I./settimana) in un sottogruppo di 51 pazienti (39 M, 12 F, età 53±11). Dopo 8 mesi di terapia solo 11 pazienti (22%) hanno raggiunto un valore di 25-idrossicalciferolo maggiore di 80 nmol/l, indicativo di un quadro di sufficienza. Per quanto riguarda i livelli di PTH sono state osservate lievi ma significative riduzioni dei valori ematici.
Questi risultati dimostrano che l’ipovitaminosi D risulta estremamente frequente nei pazienti trapiantati di rene e costituisce un ulteriore fattore di rischio per la persistenza di alti valori di PTH. La supplementazione con colecalciferolo riduce i livelli sierici di PTH.

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Tipo di EPrint:Tesi di dottorato
Relatore:Giannini, Sandro
Dottorato (corsi e scuole):Ciclo 23 > Scuole per il 23simo ciclo > SCIENZE MEDICHE, CLINICHE E SPERIMENTALI > FISIOPATOLOGIA CLINICA
Data di deposito della tesi:NON SPECIFICATO
Anno di Pubblicazione:10 Gennaio 2011
Parole chiave (italiano / inglese):Iperparatiroidismo secondario, trapianto renale, polimorfismo del Calcium Sensing Receptor, Vitamina D / secondary hyperparathyroidism (SHPT) renal transplant Vitamin D Calcium Sensing receptor polymorphism (CaSR),
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/14 Nefrologia
Struttura di riferimento:Dipartimenti > Dipartimento di Scienze Mediche e Chirurgiche
Codice ID:3275
Depositato il:19 Lug 2011 09:53
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