Vnitřní lékařství 5/2021

HLAVNÍ TÉMA Kostní nemoc při selhání ledvin – renální i non-renální komponenta | 263 / Vnitř Lék 2021; 67(5): 258–263 / VNITŘNÍ LÉKAŘSTVÍ www.casopisvnitrnilekarstvi.cz je však potřeba cíleně rozlišit suplementaci od supresivní léčby aktivním vitaminem D s cílem léčby SHPT. Obě cesty, suplementaci i supresi, lze opatrně kombinovat (31). Při zpětném ohlédnutí lze konstatovat, že podrobné a skutečně velmi početné studie mnoha vědeckých týmů nás přivedly k součas- ným již velmi podrobným poznatkům o SHPT při selhání ledvin a jejích souvislostech včetně moderní farmakoterapie, a rozšířily poznatky o dalších kostních změnách, včetně těch, které se selháním ledvin nemusí nijak souviset. Přesto problém kostního onemocnění a jeho důsledků pro celý organismus přetrvává. K příčinám patří velmi složitá patogeneze i terapeutická úskalí a je nepochybné, že téma zůstává stále velmi aktuální. Podpořeno programy MZ ČR – RVO (FNHK, 00179906) a PROGRES Q40/14 Poděkování: Autoři děkují kolegům z Radiologické kliniky FN Hradec Králové za cenné vyšetření zobrazovacími metodami (přednosta prof. MUDr. Antonín Krajina, CSc.), kolegům z Kliniky otorinolaryngologie a chirurgie hlavy a krku za vynikající spolupráci v programu parathyreoidektomií (přednosta prof. MUDr. Viktor Chrobok, CSc., Ph.D.). LITERATURA 1. Moe S, Drüeke T, Cunningham J et al. Kidney Disease: Improving Global Outcomes (KDIGO). Definition, evaluation, and classification of renal osteodystrophy: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2006; 69(11): 1945–1953. 2. Ketteler M, Block GA, Evenepoel P et al. Diagnosis, Evaluation, Prevention, and Treat­ ment of Chronic Kidney Disease-Mineral and Bone Disorder: Synopsis of the Kidney Di- sease: Improving Global Outcomes 2017 Clinical Practice Guideline Update. Ann Intern Med. 2018; 168(6): 422–430. 3. 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