[Bone complication in diabetic subjects with good metabolic control and without any late complications: selected problems. Part I: calcium, phosphorus and magnesium metabolism]. / Powiklania kostne u chorych z dobrze wyrównana i niepowiklana cukrzyca typu 1 i 2--wybrane zagadnienia. Czesc I: Gospodarka wapniowo-fosforanowo-magnezowa.

The aim of the study was to evaluate whether in diabetics with good metabolic control and without any diabetic complications, disturbances of calcium, phosphorus and magnesium metabolism or hormonal regulation (parathormone/calcitonin) were present, and if they depended on type of diabetes, duration time of diabetes, kind of hypoglycaemic treatment, sex or age of patients. 83 subjects were examined, including: 14 with type 1 diabetes mellitus, 49 with type 2 diabetes mellitus and 20 healthy persons. All tests were performed in standarized low-calcium diet conditions. In basal conditions both serum concentrations and daily urine excretion of calcium, phosphorus, magnesium were estimated. Oral and intravenous calcium load tests with simultaneous parathormone, calcitonin, calcium, magnesium and phosphorus concentrations estimation were done. The final conclusions were as follow: Both in type 1 diabetes mellitus and type 2 diabetes mellitus subjects with good metabolic compensation and without advanced diabetic complications a tendency to early disturbances of calcium-phosphorus metabolism is observed. Physiological hormonal control (parathormone/calcitonin) is preserved. Correlations between mineral metabolism and type of diabetes, duration time of diabetes, daily insulin dose, body mass index and sex are observed. Kind of hypoglycaemic treatment has only slight influence on the mineral metabolism.

[Bone complications in diabetic subjects with good metabolic control and without any long-term complications--certain problems. Part III: The influence of hypertension and type 2 diabetes mellitus co-incidence of calcium, phosphorus and magnesium metabolism]. / Powiklania kostne u chorych z dobrze wyrównana i nie powiklana cukrzyca typu 1 i 2--wybrane zaganienia. Czesc III: Wplyw wspólistnienia nadcisnienia tetniczego z cukrzyca typu 2 na gospodarke wapniowo-fosforanowo-magnezowa.

Both high morbidity and potentiation of systemic complications emphasise significance of diabetes mellitus and hypertension co-incidence. The aim of the study was to analyse the influence of hypertension accompanied with type 2 diabetes mellitus on calcium phosphorus and magnesium metabolism. The study was performed in standard low-calcium diet conditions on the group of 49 patients with type 2 diabetes mellitus (among them 27 had hypertension), 14 patients with essential hypertension and 20 healthy persons. Both serum and urine concentration of creatinine, calcium, phosphorus, hydroxyproline, hydroxylysine and uric acid were analysed. Oral calcium load test was done. Serum alkaline phosphatase activity and oxalic acid urine excretion were also estimated. There were no significant differences between diabetic patients with and without hypertension as far as calcium, phosphorus or magnesium metabolism were concerned.

Increased prevalence of salt sensitivity of blood pressure in IDDM with and without microalbuminuria.

In insulin-dependent diabetes mellitus (IDDM) elevated exchangeable sodium (Na) levels are found even in the absence of hypertension, but it is not known whether this is associated with increased sensitivity of blood pressure to sodium level. To clarify this issue we compared 30 patients with IDDM (19 without and 11 with microalbuminuria, i.e. more than 30 mg albumin/day) and 30 control subjects matched for age, gender and body mass index. The subjects were studied on the 4th day of a low-salt diet (20 mmol/day) under in-patient conditions and were subsequently changed to the same diet with a high-salt supplement, yielding a total daily intake of 220 mmol Na/day. Circadian blood pressure, plasma renin activity (PRA), plasma atrial natriuretic factor (p-ANF), plasma cyclic guanosine 5'-phosphate (p-cGMP) and urinary albumin were measured. The proportion of salt-sensitive subjects, i.e. showing increment of mean arterial pressure > or = 3 mmHg on high-salt diet, was 43% in diabetic patients (50% of diabetic patients with and 37% without microalbuminuria) and 17% in control subjects (p < 0.05). Lying and standing PRA levels on low- or high-salt diet were significantly lower in diabetic patients than in control subjects. Salt-sensitive diabetic patients had significantly higher lying ANF on high-salt (38.7 +/- 4.2 pmol/l vs 20.1 +/- 2.3 pmol/l, p < 0.005) than on low-salt diet. The results suggest that (i) the prevalence of sodium sensitivity is high in IDDM (ii) sodium sensitivity is found even in the absence of nephropathy as indicated by albuminuria.

[Level of zinc, copper, selenium and nickel in serum of patients treated for chronic renal failure with hemodialysis--influence of erythropoietin therapy]. / Stezenie cynku, miedzi, selenu i niklu w surowicy krwi u chorych leczonych z przewlekla niewydolnoscia nerek leczonych hemiodializami--wplyw leczenia erytropoetyna.

52 patients with chronic renal failure treated with haemodialysis and 21 healthy subjects were observed. All patients were divided in 2 groups: 1. erythropoietin treated patients (+EPO), 2. patients not treated with erythropoietin (-EPO). In all patients immediately before dialysis and after dialysis the blood samples were withdrawn for estimation of creatinine, haemoglobin concentration, haematocrit value and zinc, copper, selenium, and nickel concentration. In healthy subjects such measurements we made only once. In all patients serum zinc, selenium and nickel concentrations were significantly lower than in normals. Copper concentration was insignificantly higher in normals than in patients with CRF. No significant differences were found in serum concentration of zinc, copper, selenium and nickel between +EPO and -EPO. During haemodialysis a decrease of serum zinc, copper and selenium levels in all examined group was seen. No significant changes between serum, zinc, selenium, copper and nickel concentration between patients treated with erythropoietin and without erythropoietin. Conclusions 1. Serum zinc, selenium and nickel concentration were significantly lower in patients treated with haemodialysis than in normals. 2. Serum concentration of zinc, copper and selenium decreased during haemodialysis. 3. Probably erythropoietin therapy does not influence serum zinc, selenium, copper and nickel levels in patients with chronic renal failure.

Water immersion induced alterations of plasma adrenaline and noradrenaline levels in patients with endstage renal failure (CRF) and in healthy persons.

Water immersion (WI) induced alterations of adrenaline and noradrenaline levels were examined in 20 patients with chronic renal failure (CRF) and 15 healthy persons. In patients with CRF a significantly elevated mean arterial blood pressure (MAP), a markedly elevated plasma level of adrenaline but only a slightly elevated concentration of plasma noradrenaline were observed as compared with healthy persons. In all examined groups WI induced significant decrease of mean arterial pressure and plasma adrenaline and noradrenaline levels. In patients with CRF the WI induced a decrease of MAP and of plasma adrenaline was significantly more marked, while that of plasma noradrenaline was significantly less than in healthy persons. Results presented in this study suggest the existence of an impaired function of the sympathetic nervous system, mainly of the beta-adrenergic one in CRF.

Water immersion induced alterations of atrial natriuretic peptide in patients with noninflammatory acute renal failure.

Water immersion (WI) induced alterations of plasma atrial natriuretic peptide (ANP), circulating plasma volume (PV), plasma, sodium and potassium level and mean blood pressure (MAP) were examined in 12 patients with noninflammatory acute renal failure (ARF) and in 15 healthy persons. In patients with ARF a significantly elevated basal ANP level (138.67 +/- 12.9 pg/ml versus 74.54 +/- 4.1 pg/ml in healthy persons and elevated MAP (111.9 +/- 3.5 mmHg in patients versus 87.3 +/- 1.8 mmHg in healthy persons) were found. WI induced a significant increase of plasma ANP level in both examined groups which was significantly more marked in healthy persons (152.42 +/- 12.82 pg/ml) than in patients with ARF (85.75 +/- 12.62 pg/ml). WI was accompanied by a significantly more marked reduction of MAP (22.6 +/- 2.9 mmHg) and sodium level (6.09 +/- 0.63 mmol/l) in patients with ARF than in healthy persons (12.07 +/- 1.52 mmHg and 4.2 +/- 0.11 mmol/l respectively). In contrast to healthy persons in patients with ARF WI did not induce enhanced diuresis. In patients with ARF a significantly more marked increase of PV was found than in controls. Data obtained in this study seem to prove preservation of the physiological regulatory mechanism of ANP secretion in ARF patients but reduction of ANP release induced by central volume expansion. The importance of elevated basal plasma levels in the maintenance of ARF has not been proven.