A hemodialysis patient with bone disease after pregnancy: a case report

被引:3
作者
Sprenger-Maehr, Hannelore [1 ]
Zitt, Emanuel [1 ]
Kronbichler, Andreas [2 ]
Cejna, Manfred [3 ]
Lhotta, Karl [1 ]
机构
[1] Acad Teaching Hosp Feldkirch, Dept Internal Med 3, Carinagasse 47, Feldkirch, Austria
[2] Med Univ Innsbruck, Dept Internal Med 4, Innsbruck, Austria
[3] Acad Teaching Hosp Feldkirch, Inst Diagnost & Intervent Radiol, Feldkirch, Austria
关键词
Hemodialysis; Secondary hyperparathyroidism; Osteitis fibrosa cystica; Pregnancy; Etelcalcetide; SECONDARY HYPERPARATHYROIDISM; DIALYSIS PATIENTS; METABOLISM; CALCIUM; MILLENNIUM; CINACALCET; LACTATION;
D O I
10.1186/s12882-019-1603-8
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background Pregnancy is rare in women on hemodialysis. Recommendations for the treatment of secondary hyperparathyroidism (sHPT) and preservation of bone health in pregnant dialysis patients are lacking. Case presentation We present the case of a young woman with end-stage kidney disease (ESKD) due to lupus nephritis, who developed multiple brown tumors while on hemodialysis during her second pregnancy. During her first pregnancy sHPT was well controlled and no skeletal complications occurred. Before the second pregnancy she developed severe sHPT. During pregnancy, dialysis time was increased to 24 h per week, the patient was given oral calcitriol, and the dialysate calcium concentration was set at 1.5 mmol/l. In week 20 the patient complained about bone pain in her left hip. Magnetic resonance imaging revealed a cystic lesion compatible with a brown tumor. The baby was delivered in the 36th week by cesarean section. Further assessment identified multiple brown tumors of her skeleton, including the acetabulum, tibia, ribs, skull, thoracic spine and thumb. She required multiple orthopedic surgeries. Three months after pregnancy, etelcalcetide was started, which brought about a gradual improvement in her sHPT. Conclusions This case demonstrates that the combination of pregnancy and severe sHPT in dialysis patients can have deleterious consequences for bone health.
引用
收藏
页数:7
相关论文
共 26 条
[21]   Pregnancy in dialysis patients in the new millennium: a systematic review and meta-regression analysis correlating dialysis schedules and pregnancy outcomes [J].
Piccoli, Giorgina Barbara ;
Minelli, Fosca ;
Versino, Elisabetta ;
Cabiddu, Gianfranca ;
Attini, Rossella ;
Vigotti, Federica Neve ;
Rolfo, Alessandro ;
Giuffrida, Domenica ;
Colombi, Nicoletta ;
Pani, Antonello ;
Todros, Tullia .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 2016, 31 (11) :1915-1934
[22]   Hypercalcemia in pregnancy - a multifaceted challenge: case reports and literature review [J].
Rey, Evelyne ;
Jacob, Claude-Emilie ;
Koolian, Maral ;
Morin, Francine .
CLINICAL CASE REPORTS, 2016, 4 (10) :1001-1008
[23]   Vitamin D supplementation during pregnancy: state of the evidence from a systematic review of randomised trials [J].
Roth, Daniel E. ;
Leung, Michael ;
Mesfin, Elnathan ;
Qamar, Huma ;
Watterworth, Jessica ;
Papp, Eszter .
BMJ-BRITISH MEDICAL JOURNAL, 2017, 359 :j5237
[24]   Cinacalcet and achievement of the NKF/K-DOQITM recommended target values for bone and mineral metabolism in real-world clinical practice-the ECHO observational study [J].
Urena, Pablo ;
Jacobson, Stefan H. ;
Zitt, Emanuel ;
Vervloet, Marc ;
Malberti, Fabio ;
Ashman, Neil ;
Leavey, Sean ;
Rix, Marianne ;
Os, Ingrid ;
Saha, Heikki ;
Ryba, Miroslav ;
Bencova, Veronika ;
Banos, Ana ;
Zani, Valter ;
Fouque, Denis .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 2009, 24 (09) :2852-2859
[25]   Interactions between breast, bone, and brain regulate mineral and skeletal metabolism during lactation [J].
Wysolmerski, John J. .
SKELETAL BIOLOGY AND MEDICINE, 2010, 1192 :161-169
[26]   Brown tumor of multiple facial bones associated with primary hyperparathyroidism: A clinical case report [J].
Zou, HaixiaoY ;
Song, Li ;
Jia, Mengqi ;
Wang, Li ;
Sun, Yanfang .
MEDICINE, 2018, 97 (33)