RESUMO
BACKGROUND AND OBJECTIVES: Our aim was to evaluate the growth-promoting effect of growth hormone (GH) treatment in infants with chronic renal failure (CRF) and persistent growth retardation despite adequate nutritional and metabolic management. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The study design included randomized, parallel groups in an open, multicenter trial comparing GH (0.33 mg/kg per wk) with nontreatment with GH during 12 months. Sixteen infants who had growth retardation, were aged 12+/-3 months, had CRF (GFRAssuntos
Transtornos do Crescimento/tratamento farmacológico
, Hormônio do Crescimento Humano/uso terapêutico
, Fenômenos Fisiológicos da Nutrição do Lactente
, Falência Renal Crônica/tratamento farmacológico
, Estado Nutricional
, Absorciometria de Fóton
, Ossos do Braço/diagnóstico por imagem
, Ossos do Braço/efeitos dos fármacos
, Ossos do Braço/crescimento & desenvolvimento
, Biomarcadores/sangue
, Estatura/efeitos dos fármacos
, Peso Corporal/efeitos dos fármacos
, Densidade Óssea/efeitos dos fármacos
, Distribuição de Qui-Quadrado
, Ensaio de Imunoadsorção Enzimática
, Feminino
, Taxa de Filtração Glomerular
, Transtornos do Crescimento/sangue
, Transtornos do Crescimento/etiologia
, Transtornos do Crescimento/fisiopatologia
, Hormônio do Crescimento Humano/efeitos adversos
, Humanos
, Lactente
, Falência Renal Crônica/sangue
, Falência Renal Crônica/complicações
, Falência Renal Crônica/fisiopatologia
, Masculino
, Portugal
, Estudos Prospectivos
, Radioimunoensaio
, Espanha
, Ossos do Tarso/diagnóstico por imagem
, Ossos do Tarso/efeitos dos fármacos
, Ossos do Tarso/crescimento & desenvolvimento
, Fatores de Tempo
, Resultado do Tratamento
RESUMO
The recent availability of cinacalcet has provided a possible alternative to parathyroidectomy in kidney transplant patients with persistent hyperparathyroidism, but its effect on bone mass density (BMD) is unknown. From our database containing 163 kidney transplants performed at our center from 1999 to 2007, we compared recipients who received cinacalcet for persistent hypercalcemia and hyperparathyroidism following renal transplantation (n = 8) with up to two other posttransplant patients matched for age, sex, race, and graft function (n = 15). The outcome of the study was BMD changes from baseline to 12, 24, and 36 months post-renal transplantation. Repeated-measures mixed model was used to assess the difference of BMD change between two groups. Cinacalcet therapy was started at a median of 9 (range = 1 to 24) months posttransplant with a mean dose 56 ± 29 mg/d (mean duration = 1.6; range = 1 to 2.1 years). Cinacalcet therapy was associated with significant reduction of serum calcium compared to control. Cinacalcet therapy was associated with greater BMD increase at the hip over the 36-month posttransplant period. Cinacalcet was well tolerated. Our results suggest that cinacalcet may have a small but favorable effect on bone density following kidney transplantation.
Assuntos
Densidade Óssea/efeitos dos fármacos , Calcimiméticos/uso terapêutico , Hipercalcemia/tratamento farmacológico , Hiperparatireoidismo Secundário/tratamento farmacológico , Transplante de Rim/efeitos adversos , Naftalenos/uso terapêutico , Absorciometria de Fóton , Adulto , Ossos do Braço/diagnóstico por imagem , Ossos do Braço/efeitos dos fármacos , Biomarcadores/sangue , Calcimiméticos/efeitos adversos , Cálcio/sangue , Estudos de Casos e Controles , Cinacalcete , Feminino , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/efeitos dos fármacos , Humanos , Hipercalcemia/sangue , Hipercalcemia/diagnóstico por imagem , Hipercalcemia/etiologia , Hiperparatireoidismo Secundário/sangue , Hiperparatireoidismo Secundário/diagnóstico por imagem , Hiperparatireoidismo Secundário/etiologia , Masculino , Pessoa de Meia-Idade , Naftalenos/efeitos adversos , National Institutes of Health (U.S.) , Estudos Retrospectivos , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/efeitos dos fármacos , Fatores de Tempo , Resultado do Tratamento , Estados UnidosRESUMO
BACKGROUND: Nonunions of long bone fractures are considerable therapeutic and economic problems with increasing tendency. Basic surgical options are autogenous cancellous bone grafting, rod dynamization, reamed nailing, plate fixation with compression, and bone transport techniques. If these methods fail to work, alternative treatment options are needed. MATERIAL AND METHODS: Since May 2001 treatment with recombinant human (rh) bone morphogenic protein 7 [BMP-7 or osteogenic protein 1 (OP-1)] in combination with a type one collagen carrier has gained interest. BMP 7 induces the formation of new bone by differentiation of stem cells, thereby initiating the reaction cascade of osteogenesis. Nonunions over 9 months and unsuccessful bone grafting delineate the indication. RESULTS: We report our experience with 21 patients and nonunion of long bone fractures. Between July 2002 and June 2004, 23 units of BMP 7 were implanted. The implantation sites were 7 femora, 12 tibias, 2 humeri, and 2 forearms. In ten cases BMP 7 was combined with a new osteosynthesis and bone grafting and in five patients with bone grafting alone. In contrast in eight patients BMP 7 was applied as a single procedure without any bone grafting or any change of the osteosynthesis. CONCLUSION: There were no peri- or postoperative complications. Follow-up was obtained for a minimum of 6 months. Of 23 implantations, 22 were successful with bony healing revealed by clinical and radiological evaluation. In one patient no bony consolidation of the nonunion has been seen so far. In summary, based on our results we propose BMP 7 as an additional innovative therapy of long bone nonunions.