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The Problem for Kidney Disease Patients

Kidney disease* (before or during the dialysis stage) can cause many severe side effects and other conditions within the body. One of those side effects is an unhealthy change in the condition of the body’s bones.

The Bones and ABD

Healthy bones are constantly changing—building up and breaking down. Kidney disease may cause the process to slow down or stop altogether, creating a condition called “Adynamic Bone Disease*” or “ABD”. 50% of dialysis patients have ABD, and this makes the bones unable to use calcium and phosphate—normal bone building substances. Since the bones cannot use the calcium and phosphate normally, the body piles it up in unusual places like the organs (heart, liver, etc.), veins, muscles and joints. This often causes joints to form huge, bulb-like swellings (nodules) on the hands and feet. It can cause destruction of skin and muscle tissue. Most important of all, it can cause hardened (calcified*) organs (often the heart) which will no longer do their job.

Your Doctor Needs to Know

Because of the seriousness of this “secondary condition*”, it is important for your doctor to know the condition of your bones at all times. The currently-used blood test which is ordered by your doctor, measures the amount of a hormone produced in the parathyroid glands*, which are located in the thyroid gland* in the neck. (See Figure 1). This hormone is called “parathyroid hormone*” or “PTH*”. Measuring the complete string of 1-84 molecules of the hormone, or measuring molecules 7-84 + 1-84 of the PTH hormone, does not provide reliable bone information and cannot help the doctor accurately diagnose ABD. Until recently, the only sure method to detect bone disease was bone biopsy*. For this test, the doctor would remove a sample of bone from the patient’s hip bone (iliac crest*) and analyze it to see what was happening within the bone. While a bone biopsy is still the foolproof way to determine what bones are doing; now there is a new, simpler, less expensive way.

A New and Better Way to Test PTH

Scantibodies Clinical Laboratory has discovered a new way of testing a blood sample that is called the “PTH Accuratio™ -- 1-84 PTH/7-84 PTH ratio.*” By using an improved variety of the PTH test, the 1-84 PTH hormone is correctly measured and the value of the 7-84 PTH hormone can be easily calculated. Then a ratio is formed which gives the doctor a value he/she can use to diagnose bone disease with 94% accuracy. This allows your physician to order the proper supplements and medications to give you healthier bones and less side effects from kidney disease or bone disease.

What About My Insurance?

This new procedure is covered by most payer sources including Medicare. Speak to your doctor or clinician to learn more about your PTH testing and how it affects your treatment. More information for your physician and clinician are available on this site for their reference.

Some terms we used in this information:

Kidney: two organs located on either side of the spine, above the waist. We think of them as being in our “back”. Their function is to clean the body of waste materials and maintain a balance of fluids by the making of urine.

Kidney Disease: is diagnosed when the kidney organs in the body lose their normal function. If they stop working altogether, kidney failure is diagnosed.

Adynamic Bone Disease (ABD): is the name of the condition that develops in kidney failure situations and in bone disease patients, where the bones slow or stop their normal building up and breaking down process. It is sometimes referred to as “Low Bone Turnover”.

Secondary Condition: is a health problem or condition which develops because of another condition. An example would be: Renal Failure (kidney failure) often results in hyperparathyroidism—a secondary condition, where the parathyroid hormone is being produced in excess by the thyroid gland, resulting in excess calcium in the body and not enough phosphorus, with both being excreted in larger amounts in the urine. The body’s calcium balancing mechanism (metabolism) is out of balance.

Parathyroid Glands: (see diagrams above) Four tiny glands which are inside the thyroid gland (see below) which produce parathyroid hormone that regulates calcium within the body.

Thyroid Gland: a gland which is located in front of the neck’s spinal vertebrae, and produces thyroid hormone for the body. This gland is home to the parathyroid glands defined above.

Bone Biopsy: A surgical procedure which involves the insertion of a special needle to withdraw a sample of bone (usually taken from the Iliac crest, or top of the large hip bones within the pelvis) from patients who need to have the density and condition of their bones analyzed. The sample is then analyzed to determine the patient’s bone status. This is considered the “gold standard” in diagnosis of bone conditions.

Iliac Crest: The larger, curved surface of the top of the pelvic bones, from which bone biopsies are frequently taken.

Calcified: Hardened by excess amounts of calcium - often to the point of destroying the function of the organ or tissue itself.

PTH Accuratio™ -- 1-84 PTH/7-84 PTH ratio: The new type of PTH testing offered by Scantibodies Clinical Laboratory, which provides all of the values the physician needs to determine bone status and the presence of adynamic bone disease. This includes a Total (intact) PTH value, a 1-84 PTH Whole CAP Assay value, and the 1/84 PTH/7-84 PTH ratio—which is the determining factor.

For a complete dictionary for dialysis and transplant patients, go on-line at the following address: www.esrdnetwork6.org, or request by email at info@nw6.esrd.net, or call the Southeastern Kidney Council, Inc. at 1-800-524-7139 for the book: ESRD from A to Z – A dictionary for dialysis and transplant patients. (A glossary of terms often used when talking about dialysis, transplantation and End-Stage Renal Disease.)

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