腎機能障害患者の周産期の骨・カルシウム代謝

Perinatal bone and calcium metabolism in the patient complicated with renal dysfunction.

　腎機能障害合併妊娠の頻度は高齢化とその管理法の進歩により増加傾向にある。通常，腎機能障害合併妊娠で妊娠が許容されるのは腎機能軽度低下までの症例であるため，妊娠中に骨粗鬆症やそれによる脆弱性骨折を起こすことは稀である。近年，管理法の進歩により透析患者や腎移植後の女性の妊娠が増えている。ある条件を満たして妊娠すれば，早産率は高いものの生児を得ることができるようになってきた。透析患者は，一般人と比較して大腿骨頸部骨折が５倍程度多いが，骨粗鬆症の治療薬の多くが妊婦禁忌であること，早産率が高いため妊娠期間が長くないことから，妊娠中に透析患者の骨粗鬆症の予防・治療が行われることは稀である。

　The incidence of pregnancy complicated with renal dysfunction has tended to increase due to aging and progress in the treatment methods. Generally, pregnancy is allowed only in women with normal renal function and in patients with mild renal insufficiency; therefore, the incidence of osteoporosis and the resulting fragile fracture is rare during pregnancy complicated with renal dysfunction. In recent years, the incidence of pregnancy in dialysis patients and in patients who have undergone kidney transplantation has been increasing due to the progress in treatment methods. Eventually, it has become possible for patients with renal dysfunction to give birth as long as they fulfill certain conditions for pregnancy; however, the rate of preterm births has remained high. The incidence of femoral neck fracture has been about 5 times more in dialysis patients than in healthy individuals; however, the prevention and treatment of osteoporosis in pregnant dialysis patients have been difficult, since many osteoporosis medications are contraindicated in pregnant women and also their pregnancy period is not long due to the higher rate of preterm births.