Sekundarni hiperparatireoidizam

master's thesis

• Title (english): Secondary hyperparathyroidism
• Author: Antonella Dropulja
• Mentor: Nikolina Bašić Jukić (mentor)
• Committee member: Ingrid Prkačin (predsjednik povjerenstva)
• Committee member: Jasenka Markeljević (član povjerenstva)
• Committee member: Nikolina Bašić Jukić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2022-09-26, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences

Abstract

Sekundarni hiperparatireoidizam (SHPT) je izazov s kojim se često susrećemo u liječenju bolesnika s kroničnom bubrežnom bolešću (KBB). Poremećena regulacija paratireodnog hormona, vitamina D i receptora za osjet kalcija predstavljaju kritične korake koji dovode do abnormalnosti u metabolizmu minerala: visok sadržaj fosfata, nizak kalcij i manjak vitamina D. Posljedica je hiperplazija paratireodnih žlijezda uz razvoj vaskularnih kalcifikacija.
Nove studije su utvrdile središnju ulogu faktora rasta fibroblasta 23 (FGF-23) u regulaciji homeostaze fosfata i vitamina D. Koncentracija FGF-23 raste u kroničnoj bubrežnoj bolesti i pridonosi razvoju hiperparatireoidizma.
Postizanje trenutačnih ciljeva za ključne mineralne parametre u upravljaju SHPT-om postavljenim smjernicama za poboljšanje globalnih ishoda bolesti bubrega (KDIGO) može biti izazovno.
Ako se loše kontrolira, SHPT napreduje i može dovesti do bolesti kostiju, kalcifikacija mekog tkiva i vaskularnih kalcifikacija, što nepovoljno utječe na mortalitet i morbiditet.
Tradicionalne terapije koje ciljaju na razine vitamina D i fosfora nisu bez nedostataka. Pojava kalcimimetika i bolje razumijevanje prednosti i ograničenja prirodnih i aktivnih spojeva vitamina D poboljšali su mogućnosti liječenja pacijenata sa SHPT. Paratireodoktomija je učinkovita kod prikladnih kandidata otpornih na medicinsku terapiju i standard prema kojima bi se trebali određivati novi pristupi. Buduće strategije mogle bi se usredotočiti na stimulaciju apoptotičke aktivnosti hiperplastičnih paratiroidnih stanica.

Abstract (english)

Secondary hyperparathyroidism (SHPT) is a challenge frequently encountered in the management of patients with chronic kidney disease (CKD). Downregulation of the parathyroid hormone, vitamin D and calcium-sensing receptors represent critical steps that lead to abnormalities in mineral metabolism: high phosphate, low calcium, and vitamin D deficiency. These imbalances result in parathyroid hyperplasia and contribute to vascular calcification.
New studies have established a central role for fibroblast growth factor 23 (FGF-23) in the regulation of phosphate-vitamin D homeostasis. FGF-23 concentration increases in CKD and contributes to SHPT.
Achieving current targets for the key mineral parameters in the management of SHPT set by the Kidney Disease Improving Global Outcomes (KDIGO) guidelines can be challenging.
If poorly controlled, SHPT progresses and can lead to bone disease, soft tissue calcification, and vascular calcification, all of which adversely influence morbidity and mortality.
Traditional therapies targeting vitamin D and phosphorous levels are not without drawbacks. The emergence of the calcimimetics and a better understanding of the strengths and limitations of native and active vitamin D compounds have improved the treatment options for patients with SHPT.
Parathyroidectomy is effective in suitable candidates refractory to medical therapy and the standard against which new approaches should be measured. Future strategies may focus on the stimulation of apoptotic activity of hyperplastic parathyroid cells.

• Keywords: sekundarni hiperparatireoidizam; kronična bubrežna bolest; KDIGO.
• Keywords (english): secondary hyperparathyreoidism; chronic kidney disease; KDIGO
• Language: croatian
• URN:NBN: urn:nbn:hr:105:713932
• Study programme: Title: Studies in Nursing; Study programme type: university; Study level: graduate; Academic / professional title: magistar/magistra sestrinstva (magistar/magistra sestrinstva)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2024-03-25 13:42:36