肾性骨病医学课件.pptVIP

肾性骨病 Renal Osteodystrophy(ROP) 肾性骨病的定义 分为狭义肾性骨病和广义肾性骨病。狭义肾性骨病是指慢性肾衰竭伴发代谢性骨病。广义肾性骨病是指和肾脏相关的疾病。 The ROP has the narrow sense definition and the broad sense definition. The narrow sense definition of ROP is referred to chronic renal failure with metabolism bone diseases. The broad sense definition of ROP is referred to diseases related to the kidney. 肾性骨病的分类： 高转化性骨病High tumover bone disease 低转化性骨病：Low tumover bone disease 1、非动力性骨病；Adynamic bone disease 2、骨软化症；Osteomalacia 混合型骨病 Mix renal osteodystrophy β2-微球蛋白淀粉样变　β2-microglobulin amyloidosis 　肾性骨病的定义 一：高转化性骨病（囊性纤维性骨炎Osteitis fibrosa）　以甲状旁腺机能亢进，成骨细胞和破骨细胞增殖活跃及骨小梁周围纤维化为特征。 二：低转化型肾性骨病：骨软化指新形成类骨质矿化缺陷，常由铝沉积所致。非动力性骨病指骨形成降低，多与高钙血症，维生素D过度抑制PTH分泌等有关。 三：β2-微球蛋白淀粉样变 β2-微球蛋白在关节处沉积引起疼痛和骨折。 发病机制Pathogenesis 高转化性骨病（囊性纤维性骨炎） 1 低钙血症，肾功能减退时，肾脏合成1，25（OH）2D3和排磷能力降低,导致低钙血症，而低钙血症增加PTH的分泌 2 高磷血症，抑制1ａ羟化酶的活性，增加骨骼对ＰＴＨ的抵抗，刺激PTH的分泌。 Hypocalcaemia, with reduced kidney function. The low synthesis of 1,25( OH)2 D3 and hyperphosphatemia will cause hypocalcaemia, and hypocalcaemia increase the secretion of the PTH. Hyperphosphatemia, hyperphosphatemia will repress the activity of the 1-αhydroxylase , increasing the resistance ability of the bone to the PTH and increase the secretion of the PTH. 发病机制Pathogenesis 3 活性维生素Ｄ3的变化，肾功能减退时，近端肾小管细胞内磷含量增高抑制线粒体1ａ羟化酶，使1，25（OH）2D3合成减少，PTH基因转录和表达增加。 4 骨骼对PTH的抵抗 5 甲状旁腺自主性增生。 Changes of the active form of Vit D. The impression of the activity of the 1-αhydroxylase causes the low synthesis of 1,25( OH)2 D3. The resistance ability of the bone to the PTH The independent hyperplasia of the parathyroid gland 低转化性骨病 Low tumover bone disease 1 非动力性骨病；机制尚未阐明，多与糖尿病、甲状旁腺切除抑制PTH分泌有关 2 骨软化症；多与1，25（OH）2D3缺乏和铝中毒有关。 The pathogenesis is still not very clear, but mainly related to the impression of the secretion of the PTH It has something with the deficit of 1,25( OH)2 D3 and the aluminium intoxication. β2-微球蛋白淀粉样变。正常人每日产生β2-微球蛋白150-200毫克，当肾功能衰竭时β2-微球蛋白排泄减少在血