Diagnosis and Conservative Treatment of Patients with Vitamin-D-Dependent Rickets
The results of clinical and laboratory examination of 35 patients with vitamin D-dependent rickets type I and II are considered in order to develop criteria for the diagnosis of disease and selection of the optimal therapy of existing violations of calcium and vitamin D metabolism. All patients underwent clinical examination and, in connection with the similarity of the clinical picture of I, II and types of the disease and rickets, laboratory examination was performed with a mandatory determination of the level of metabolites of vitamin D, calcium, phosphorus of blood serum and urine, parathyroid hormone, bone metabolism markers (P1NP, β-Cross Laps, osteokaltsin) and vitamin D receptor gene (if needed). The features of the clinical picture of both types of the disease were determined and it was found that the main thing in the diagnosis and differentiation of D-dependent rickets types is a laboratory study of vitamin D metabolites and bone metabolism markers of 4th generations. Vitamin D-dependent rickets type I is characterized by a high level of calcidiol in low calcitriol level against increased bone metabolism indices, D-dependent rickets type II is characterized by vitamin D receptor gene polymorphism at low rates of bone metabolism and high or normal level of 25-(ОН)D3 and 1.25-(ОН)2D3 in the blood. Treatment should be pathogenetically conditioned and based on the administration of vitamin D metabolites.
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