vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2014-1-47-53vtio-65Research ArticleКлинические наблюденияClinical CasesЦИНАКАЛЦЕТ В ЛЕЧЕНИИ ГИПЕРПАРАТИРЕОЗА У РЕЦИПИЕНТОВ ПОЧЕЧНОГО ТРАНСПЛАНТАТАCINACALCET IN TREATMENT OF HYPERPARATHYROIDISM IN RECIPIENTS OF RENAL GRAFTВетчинниковаО. Н.VetchinnikovaO. N.

 

ЩербаковаЕ. О.ShcherbakovaE. O.ПоляковаЕ. Ю.PolyakovaE. Y.Кафедра трансплантологии, нефрологии и искусственных органов факультета усовершенствования врачей ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского», Москва, Российская ФедерацияChair of Transplantology, Nephrology and Artificial Organs, Faculty of Postgraduate Medical, M.F. Vladimirsky Moscow Regional Clinical and Research Institute, Moscow, Russian FederationОтдел лучевой диагностики ГБУЗ МО «Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского», Москва, Российская ФедерацияDepartment of Radiology, M.F. Vladimirsky Moscow Regional Clinical and Research Institute, Moscow, Russian Federation201414052014161ВЕСТНИК ТРАНСПЛАНТОЛОГИИ И ИСКУССТВЕННЫХ ОРГАНОВ том XVI No 1–20144753Copyright © Ветчинникова О.Н., Щербакова Е.О., Полякова Е.Ю., 20142014Ветчинникова О.Н., Щербакова Е.О., Полякова Е.Ю.Vetchinnikova O.N., Shcherbakova E.O., Polyakova E.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/65

Цель. Оценить эффективность и безопасность цинакалцета в лечении гиперпаратиреоза (ГПТ) у реципиен- тов ренального трансплантата. Материалы и методы. В течение года 3 пациенткам с удовлетворительно функционирующим почечным трансплантатом (скорость клубочковой фильтрации – СКФ 44–80 мл/мин) и ГПТ (паратиреоидный гормон – ПТГ 320–348 пг/мл), резистентным к лечению активными формами вита- мина D и гиперкальциемией (2,6–3,1 ммоль/л), проводилось лечение цинакалцетом (начальная доза – 30 мг/ сут, поддерживающая – 60–15 мг/сут) с присоединением через 2–3 мес. альфакальцидола (0,25–0,75 мкг/сут). Исследованы сывороточные концентрации и почечная экскреция кальция и фосфора, ПТГ, функция почеч- ного трансплантата (креатинин крови, СКФ, плазменная концентрация такролимуса), минеральная плот- ность костной ткани (МПКТ) в различных отделах скелета (двухэнергетическая рентгеновская абсорбци- ометрия). Результаты. Через месяц уровень кальция в крови нормализовался, уровень ПТГ снизился в 1,2–3,2 раза. Через год у двух пациенток уровень в крови ПТГ нормализовался, у одной составил 142 пг/мл. Почечная экскреция кальция изменялась неодинаково – у двух пациенток постепенно увеличивалась, не выходя за пределы физиологической нормы, и у одной оставалась стабильной. Общей закономерности в ди- намике сывороточной концентрации и мочевой экскреции фосфора не отмечено. Функция почечного транс- плантата сохранялась стабильной – СКФ 46–76 мл/мин. МПКТ в дистальном отделе костей предплечья, шейке бедренной кости и поясничном отделе позвоночника у двух пациенток осталась прежней, у одной увеличилась соответственно на 14, 6 и 7%. Нежелательные явления отсутствовали. Заключение. Применение цинакалцета перспективно для коррекции ГПТ у реципиентов ренального трансплантата. 

Aim. Evaluate the efficacy and safety of cinacalcet in the treatment of hyperparathyroidism (HPT) in renal transplant recipients. Materials and methods. During the year, three patients with satisfactory functioning kid- ney transplant (glomerular filtration rate − GFR 44–80 ml/min) and HPT (parathyroid hormone − PTH 320– 348 pg/ml), resistant to treatment with active forms of vitamin D and hypercalcemia (2,6–3,1 mmol/l) were treated with cinacalcet (initial dose of 30 mg/day, supporting − 60–15 mg/day) with the added in 2–3 months alfacalcidol (0,25–0,75 μg/day). Investigated the serum concentrations and renal excretion of calcium and phos- phorus, PTH, renal transplant function (blood creatinine, GFR, plasma concentrations of tacrolimus), bone mine- ral density (BMD) in different parts of the skeleton (dual energy X-ray absorptiometry). Results. A month later, the level of calcium in the blood to normal, PTH levels decreased by 1,2–3,2 times. A year later, in two patients, blood levels of PTH was back to normal, one − up − 142 pg/ml. Renal excretion of calcium varied differently − in two patients increased gradually, without exceeding the physiological norm, and in one − remained stable. Gene- ral pattern in the dynamics of serum concentration and urinary excretion of phosphorus was not observed. Renal graft function remained stable − GFR 46–76 ml/min. BMD of the distal forearm, femoral neck and lumbar spine in two patients remained the same, in one − increased by 14, 6 and 7%. Adverse events were absent. Conclusion. Application of cinacalcet is promising for the correction of HPT in renal transplant recipients. 

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The authors declare that there are no conflicts of interest present.