透析患者におけるCalcific Uremic Arteriolopathyの病態と治療  [in Japanese] Clinical State and Treatment of Calcific Uremic Arteriolopathy (CUA) in Dialysis Patients  [in Japanese]

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Author(s)

    • 石井 まどか Ishii Madoka
    • 東京女子医科大学東医療センター内科 Department of Medicine, Tokyo Women's Medical University Medical Center East

Abstract

透析患者の最大の死因はcardiovascular disease である。このうち、稀ではあるが、小動脈内膜の石灰化によって引き起こされるCalcific uremic arteriolopathy(CUA)という病態がある。動脈壁に石灰化を生じた結果、組織の虚血を来たす疾患で、急速進行性の組織の潰瘍、壊死を引き起こし、きわめて予後不良である。いまだに病態も未解明な部分が多く、治療法も確立されていない。しかし近年、fetuin-A (2-Heremens-Schmid glycoprotein)、Matrix Gla Protein、OsteoprotegerinがビタミンDやビタミンKと密接に関わりながら異所性石灰化を抑制していることが示されてきている。また、シナカルセトの発売や、チオ硫酸ナトリウムが一定の効果を示しているなど、新たな展開を見せていることより、最近われわれの施設で経験した3例のCalcific uremic arteriolopathyを比較検討し、ビタミンDやワルファリンカリウムの末期腎不全患者におけるCUA発症リスクについて、今回の少数例から得た知見に言及する。

The leading cause of death in dialysis patients is cardiovascular diseases. Among them, calcific uremic arteriolopathy is a rare disease caused by calcification of the intima of small arteries. This disease arises as a consequence of calcification of the arterial wall, causing ischemia in tissues. With rapidly progressive tissue ulceration and necrosis, CUA has extremely poor prognosis. Many aspects of the disease remain unresolved, and there is no established treatment. However, recent studies have shown that fetuin-A (2-Heremens-Schmid glycoprotein), matrix Gla protein, and osteoprotegerin suppress ectopic calcification, in close association with vitamin K and vitamin D. In addition, new developments have emerged, such as the launching of cinacalcet and demonstration of some success with sodium thiosulfate treatment. With this background, we reviewed and compared three cases of calcific uremic arteriolopathy encountered recently in our institution. Based on the findings from these few cases, we discuss the risk of CUA related to vitamin D and warfarin potassium in patients with end-stage renal failure.

Journal

  • Journal of Tokyo Women's Medical College

    Journal of Tokyo Women's Medical College 82(E2), E370-E375, 2012-07-31

    Tokyo Women's Medical University

Codes

  • NII Article ID (NAID)
    110009435897
  • NII NACSIS-CAT ID (NCID)
    AN00161368
  • Text Lang
    JPN
  • ISSN
    00409022
  • Data Source
    NII-ELS 
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