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      Assays for Parathyroid Hormone and Their Use in Patients with End-Stage Renal Disease

      Blood Purification

      S. Karger AG

      Parathyroid hormone, Assay, Renal osteodystrophy, End-stage renal disease, Bone disease

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          Abstract

          New second-generation immunometric PTH assays have been developed. The assays measure full-length biologically active PTH(1–84) exclusively and do not detect amino-terminally-truncated PTH fragments, a feature that distinguishes them from first-generation immunometric PTH assays. Although few studies have been done thus far, second-generation immunometric PTH assays have not been shown to be superior to first-generation assays for the diagnostic assessment of patients with renal osteodystrophy. Plasma PTH levels obtained using first-generation-immunometric PTH assays continue to provide the most definitive guide to the management of renal bone disease because they are supported by abundant bone histology data. Additional work is needed to further characterize the utility of second-generation immunometric PTH assays as predictors of bone histology in patients with ESRD.

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          Most cited references 4

          • Record: found
          • Abstract: not found
          • Article: not found

          Intact parathyroid hormone overestimates the presence and severity of parathyroid-mediated osseous abnormalities in uremia

           L D Quarles (1992)
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            PTH 1-84 and PTH "7-84" in the noninvasive diagnosis of renal bone disease.

            The intact parathyroid hormone (PTH) assay evaluates levels of serum 1-84 PTH and other N-terminally truncated PTH fragments, mainly PTH "7-84." This PTH molecule has been found experimentally to interfere with biological activity of PTH 1-84, perhaps through its binding to the PTH receptor complex. Therefore, assuming that high levels of PTH 7-84 are a cause of bone resistance to PTH, it has been hypothesized that a decreased 1-84 to 7-84 PTH ratio caused by a relative increase in PTH 7-84 level might help in the noninvasive diagnosis of low-turnover osteodystrophy (LTO). This study was performed in 35 patients with chronic renal failure on hemodialysis therapy who underwent bone biopsy for a histological, histomorphometric, and histodynamic study. In addition, blood samples were obtained for intact PTH, 1-84 PTH, and total PTH assays. PTH 7-84 level was obtained from the difference between total and 1-84 PTH assay results. Nine patients had LTO (8 patients, adynamic bone disease; 1 patient, osteomalacia), 12 patients had hyperparathyroidism (HP), and 14 patients had mixed osteodystrophy (MO). On average, 1-84 PTH levels were approximately 60% of mean values for intact PTH. The two assays were strictly correlated. Average 1-84 to 7-84 PTH ratios were 1.57 +/- 0.85, 1.73 +/- 1.31, and 1.95 +/- 2.1 in the three histological groups (LTO, HP, and MO, respectively), with no significant difference. Contrary to previous expectations, results do not favor the hypothesis of a role of 7-84 PTH in bone resistance in renal osteodystrophy. The 1-84 to 7-84 PTH ratio is not a marker of LTO and is of no use in noninvasive histological diagnosis. Copyright 2002 by the National Kidney Foundation, Inc.
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              • Record: found
              • Abstract: not found
              • Article: not found

              Accumulation of a non-(1-84) molecular form of parathyroid hormone (PTH) detected by intact PTH assay in renal failure: importance in the interpretation of PTH values

               J H Brossard (1996)
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                Author and article information

                Journal
                BPU
                Blood Purif
                10.1159/issn.0253-5068
                Blood Purification
                S. Karger AG
                978-3-8055-7535-5
                978-3-318-00939-2
                0253-5068
                1421-9735
                2003
                2003
                22 January 2003
                : 21
                : 1
                : 118-123
                Affiliations
                Division of Nephrology, Department of Medicine, UCLA School of Medicine, Los Angeles, Calif., USA
                Article
                67857 Blood Purif 2003;21:118–123
                10.1159/000067857
                12596757
                © 2003 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 1, References: 40, Pages: 6
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                Self URI (application/pdf): https://www.karger.com/Article/Pdf/67857
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