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OSTEOPATHY IN CHRONIC KIDNEY DISEASE
Nadirova Yulduz Isomovna
Bobosharipov Feruz Gofurjonovich
Tashkent Medical Academy. Tashkent. Uzbekistan
https://doi.org/10.5281/zenodo.15349746
Relevance: About 10% of the world's population suffers from chronic
kidney disease (CKD). The prevalence of CKD is increasing due to the increasing
incidence of diabetes mellitus, which is the leading cause of CKD, as well as due
to the aging of the population. About 10% of the world's population suffers from
chronic kidney disease (CKD). The prevalence of CKD is increasing due to the
increasing incidence of diabetes mellitus, which is the leading cause of CKD, as
well as due to the aging of the population [1, 2]. Osteopathy is one of the main
complications of CKD, and historically it was believed that secondary
hyperparathyroidism (CGPT) and calcium-phosphorus metabolism disorders
are the main causes of renal osteodystrophy (AML). The generally accepted
definition of AML implies a violation of bone morphology in patients with CKD,
which was established using histomorphometry of a bone biopsy [3-5].
Objective:
Currently, osteopathy in patients with CKD is considered in the
context of mineral and bone disorders associated with CKD (MCD-CKD). The
term MCH-CKD was first proposed in 2006 by S. Moe et al., This concept
appeared as a result of the evolution of ideas about the pathophysiology of bone
pathology in patients with CKD [8-10].
Materials and methods:
The results of an esophagogastroduodenoscopy
study in 72 patients with acute pancreatitis admitted to Tashkent City Clinical
Hospital No. 1 from 2020 and 2023 are presented. There were 47 (65.2%) men
and 25 (34.8%) women among the admitted patients. At the age of 30, there
were 9 (12.5%) patients aged 30 to 40, 28 (38.9%) aged 40 to 60, 32 (44.5%)
aged 60 and older 3 (4,1%). [11-15]. According to the severity of the disease, all
patients were divided into 3 groups: 1 - mild form, 2 - moderate form, 3 – severe
form, osteoporosis
Results:
Endoscopy was performed during the first three days after
hospitalization. The following data was obtained. In the edematous form of acute
pancreatitis (n - 28), esophagitis was found in 8 patients, accounting for 28.5%,
the disease in 5 (17.9%), AEUL (acute erosive and ulcerative lesions) in 5
(17.9%), in 4 (14.2%). With moderate pancreatic necrosis (n - 21), esophagitis
was detected in 9 patients (42.8%), disease in 6 (28.5%), AEUL in 8 (38.1%),
duodenal reflux in 3 (14.2%). In severe (n - 23) cases, esophagitis was diagnosed
in 13 (56.5%), 6 (26%), and AEUL 15 (65, 2%), 6 (26%). Total esophagitis was
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detected in 30 (41.6%), 17 (23.6%) cases, and AEUL 28 (38,9%), 13 (18%).[16-
19].
Conclusion:
Since the publication of the first WHO consensus on the
diagnosis of osteoporosis in 1994, the FRAX fracture risk assessment model has
been developed, which includes general risk factors for osteoporosis, as well as a
number of secondary causes of osteoporosis, but does not include CKD.
olevaniya. The accumulated results allow us to conclude that the assessment of
bone health using such tools as the determination of BMD by the DRA method
and the FRAX risk assessment is relevant for patients with CKD. The presence of
CKD probably contributes more to the increased risk of fractures than is
accounted for by FRAX, and it should be considered as an independent risk
factor for fractures. A number of studies have demonstrated an inverse
correlation between osteoporosis and calcification of the coronary arteries both
in the general population and in patients with end-stage CKD. The coexistence of
vascular risk factors and bone disorders poses a double threat, affecting both the
quality and life expectancy of patients with CKD.
Chronic kidney disease (CKD)
Chronic kidney disease (CKD) is an international public health problem
affecting 5–10% of the world population, as it is responsible for high morbidity
and mortality particularly affecting population over 60 years of age. [
]. CKD is
defined as abnormal renal function or structure [
Stages in CKD
As classified by National Kidney Foundation [
] and Kidney disease
improving global outcome (KDIGO) [
] CKD has 5 stages based on e GFR
(estimated glomerular filtration rate) and markers of kidney damage. CKD is
diagnosed when e GFR is consistently <60ml/min/1.73
2
on at least two separate
occasion separated by a period of more than 3 months. Stage 3 is further sub
classified into 3a (45 to 59ml/min) and 3b (30 to 44ml/min) and includes
albuminuria in the classification. eGFR ≥30-60ml/min/1.73
2
or stage 3 is
referred as “early CKD” and eGFR <30 or stage 4-5 is referred as “late CKD”.
Stage 5 or e GFR <15 is also referred as end stage renal disease (ESRD).
Bone mineral disruption in CKD
As kidney function declines, there is a progressive deterioration in mineral
homeostasis, with a disruption of normal serum concentrations of calcium and
phosphorus. The disturbance in mineral homeostasis is due to changes in
circulating levels of hormones such as parathyroid hormone (PTH), 25-
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hydroxyvitamin D [25 (OH) D), 1,25-dihydroxyvitamin D [1,25 (OH) D)or
calcitriol and fibroblast growth factor (FGF-23] [
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