Calcium, Vitamin D. Adynamic Normal Bone Osteotitis. Osteomalacia Functions Fibrosa. Al 3+ Mixed Lesion

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1 * ** ** * ** (mineralization) (Renal Bone Disease) (renal osteodystrophy) D (Osteoporosis) (Amyloidosis) ( 1) [1] 1. (high turnover bone disease) 2. (lower turnover bone) 3. (mix type) D [2,3] Calcium, Vitamin D Low turnover Intact PTH High turnover <150 pg/ml pg/ml > pg/ml Adynamic Normal Bone Osteotitis mild Osteomalacia Functions Fibrosa Al 3+ Mixed Lesion 1. [1]

2 trade-off (glomerular filtration rate) 70 ml/min D 25 ml/min [4] D D D (secondary hyperparathyroidism) [3] (osteoblast) (osteoclast) (osteoclast-stimulating factor) (woven bone) (osteoid) (osteotitis fibrosa cystica) D (adynamic bone disease) (osteomalacia) [1] D3 (remodeling) [5] D (mineralization) (unmineralized osteoid) (uncalcified bone) (rickets) ( 1) [18] 1. ( ) D β

3 (Ca P) (metastatic calcification) X 40 3% 38% 1% [19] X β2 (amyloid deposit) X (cystic bone lesions) β 2 (MRI) (Alkaline-phosphatase) Intact PTH (ipth) amino-terminal PTH ipth ipth ipth ipth ipth [6,7] (iliac crest bone biopsy with double tetracycline labeling) 1. ( ) 2. Intact PTH pg/ml 3. (osteoporosis) DEXA (dual energy X ray absorptionetry) (Bone Mineral Density, BMD) [9]

4 ipth 400 pg/ml ipth ipth ipth 2 [8,9] mg/dl mg/dl ipth pg/ml ipth pg/ ml ( ) ipth pg/ml ( 3) [8] (phosphate binder) 6.5 mg/dl 27% (90 95%) 10.5 mg/dl [20] 2. ( ) D3 3. ( ) (mg/dl) (mg/dl) < 55 < 55 < 55 (pg/ml)

5 ( ) 10.2 mg/dl ipth 150 pg/dl 7.0 mg/dl ( ) Renagel Fosrenol Renagel Fosrenol 5.5 mg/dl [10,11] Renagel Fosrenol 1998 (Food and Drug Administration; FDA) Renagel ( sevelamer hydrochloride) Renagel Renagel Renagel Renagel [12] (Fosrenol Lanthanum carbonate) FDA EMEA (Lanthanum) (B.B.B.), (Ca P) 55 ( mg/dl) 10.2 mg/dl Renagel Fosrenol D (1.5 to 2.0 meq/l)

6 1998 Black AJKD 6.5 mg/dl 27% 65 34% 60% ipth 25-hydroxyvitamin D25-hydroxyvitamin D 30 ng/ml D2 (ergocalciferol) 25-hydroxyvitamin D 30 ng/ml ipth 300 pg/ml D D3 Calcitriol D3 Alfacalcidol D2 Paricalcidol (Zemplar) Zemplar 9.5 mg/dl4.6 mg/ dl D3 ipth 9.5 mg/dl4.6 mg/dl ipth D3 9.5 mg/dl 4.6 mg/dl ipth D3 [13,14] D paricalcitol or doxercalciferol (calcium sensing receptor) (calcimimetics) Cinacalcet ipth pg/ml D3(Calcitriol) μgd3 D3 ipth 150 pg/ml D3 ipth pg/ml D μg D ( Paricalcitol Doxercalciferol) D3 ipth 1200~1800 pg/ml D μg ipth 1800 pg/ml μg D3 D D3 60 ( 2) [8]

7 Ca >10.2 mg/dl 9.5< Ca <10.2 mg/ dl Ca <9.5 mg/ dl D 9.5mg/ dl (1) <5.5 D (2) 5.5< <6.0 (3) >6.0 D ipth ipth <150 pg/ml 150<iPTH <300 pg/ml ipth>300 pg/ml ipth>800 pg/ml D D ipth D D ipth ipth 2. D

8 D pg/ml D (nodular hyperplasia) D3 D ipth 800 pg/ml ipth mg/dl (Calcium gluconate) 1 2 mg/kg/hr D μg i P T H Chvostek s Trousseau s signs D3 (renal tubular acidosis) D (citrate salts) D 20 μ g/l μ g/l deferoxamine (DFO) DFO 5 DFO 50 μg/l 200 μ g/l DFO 5 μ g/l deferoxamine D D ipth [16,17] HCO3 30 ml/min IGF

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