Relationship between plasma level of parathyroid hormone and carboxymethyllysine in hemodialyzed patients--does it exist?

AIMS: Both parathyroid hormone and advanced glycated end products (AGEs) are uremic toxins. The present study aimed to examine the likely interrelationship between these compounds. METHODS: Seventy-four hemodialyzed patients (41 female, 33 male; mean age 47 +/- 2 years, mean duration on hemodialysis 36 +/- 6 months) were enrolled in this study. In all subjects, the body mass index (BMI) was calculated and total lean mass (TLM) and total fat mass (TFM) were assessed by dual X-ray absorptiometry. Blood samples for estimation of plasma calcium, phosphorus, carboxymethyl lysine (as marker of AGEs) and PTH-1-84 were obtained after overnight fasting, before subsequent hemodialysis session. RESULTS: BMI, TFM and TLM were 23.6 +/- 0.5 kg/m2, 16.3 +/- 1.0 kg and 46.3 +/- 1.1 kg, respectively. PTH plasma level (223 +/- 32 pg/ml) and plasma CML (1,837 +/- 84 ng/ml) were markedly elevated as compared with reference values. A significant positive correlation was found between TLM and CML levels (tau = 0.225; p = 0.04) and between plasma PTH and CML levels (tau = 0.224; p = 0.04). CONCLUSION: It seems likely that PTH and AGEs are interrelated. The pathophysiological relevance of this finding in the pathogenesis of uremic toxicity remains to be elucidated.

[Levels of carnitine and homocysteine in plasma of long-term hemodialysis patients with chronic renal failure]. / Stezenie karnityny i homocysteiny w osoczu u poddawanych hemodializie chorych na przewlekla niewydolnosc nerek.

Homocysteine and carnitine are the metabolic products of exogenous amino acids. Increased plasma concentration of homocysteine but decreased or normal carnitine concentration are usual findings in haemodialysis patients with chronic renal failure. This study aimed to evaluate the interrelationship (if any) between the above mentioned metabolites in haemodialysis uraemic patients. 44 haemodialyzed patients with chronic renal failure--HD (25 female, 19 male, mean age 47 +/- 12 years) were enrolled into this study. Blood samples for estimation of plasma glucose, cholesterol, triglycerides, albumin, folic acid, vitamin B12, homocysteine (HC), total (TC) and free (FC) carnitine were withdrawn after overnight fasting before subsequent haemodialysis session. In all subjects whole body total fat mass (TFM) and lean mass (TLM) were assessed by dual X-ray absorptiometry (DEXA). Hyperhomocysteinaemia was found in 90.9% patients, while carnitine deficiency in 22.7% of all analysed subjects. Both hyperhomocysteinaemia and carnitine deficiency was found in 18.2% of haemodialysis patients. Folic acid deficiency regardless of prescribed supplementation was observed in 9.5% patients. A significant positive correlation was found between plasma concentration of TC or FC and TLM (tau = 0.332, p < 0.001; tau = 0.298, p < 0.01 respectively). A negative correlation was observed between plasma concentration of folic acid and homocysteine (tau = -0.201, p < 0.05). No significant relationship was noted between homocysteinaemia, total and free plasma carnitine levels and anthropometrical parameters. In conclusion, plasma concentration of homocysteine and carnitine are independent indicators of abnormal amino acid metabolism in uraemic patients.

[Influence of gluten free diet on bone mineral density (BMD) in children with celiac disease]. / Wplyw diety bezglutenowej na gestosc mineralna kosci (BMD) u dzieci chorych na celiakie.

UNLABELLED: In children with celiac disease (CD) bone metabolism and mineralization are frequently disturbed. The present study aimed to assess the influence of gluten free diet (GFD) on bone mineral density (BMD) in 73 children with CD, mean age of 12.4 +/- 0.4 years and mean body mass index (BMI) 17.9 +/- 0.4 kg/m2 (mean +/- SEM). Diagnosis of CD was established according to ESPEGAN criteria. Compliance to the GFD was verified on the basis of interview and by estimation of antiendomysial antibodies (IgAEmA/IgGEmA) in blood serum. BMD was measured by dual energy X-ray absorptiometry (DEXA). Plasma calcium (Ca) and phosphorus (P) concentrations, alkaline phosphatase (AP) and its bone fraction (BAP) were estimated before BMD measurement. All children were divided into two groups. Group A consisted of 33 children where gluten free diet was strictly respected for 11.7 +/- 0.6 years. The second group (Group B) comprised 40 children without strictly respected GFD. Children who strictly followed GFD showed statistically higher BMI, AP-spine BMD and total body BMD in comparison with children without GFD (BMI 19 +/- 0.52 kg/m2 vs 17.3 +/- 0.4 kg/m2; p < 0.01, AP-spine BMD 0.951 +/- 0.04 g/cm2 vs 0.767 + 0.03 g/cm2; p < 0.005, Total Body BMD 1.013 +/- 0.02 g/cm2 vs 0.933 +/- 0.01 g/cm2; p < 0.05) respectively. No significant differences were found in plasma Ca, P, AP, BAP between both groups. A statistically significant positive correlation (p < 0.001) was found between duration of GFD and AP-spine BMD and total body BMD, respectively. A statistically significant positive correlation (p < 0.05) was also found between duration of GFD and BMI. CONCLUSION: Long-term GFD significantly improves BMD and BMI in children with CD.

[Effect of spa therapy on the endocrine system. I. Stress reaction hormones]. / Wp-yw leczenia uzdrowiskowego na uk-ad endokrynny. I: Hormony reakcji stresowej.

UNLABELLED: The present study aimed to assess a.) the influence of spa treatment in Wysowa on the circadian rhythm of plasma concentration of ACTH, cortisol, growth hormone and prolactin, and b.) the influence of kind of pathology on the hormonal profile of the above mentioned hormones. Four groups of patients were examined. The first one comprised 48 patients with essential hypertension, the second one--47 patients with inflammatory renal disease with normal excretory renal function, the third one--39 patients with gastrointestinal diseases and cholelithiasis and the fourth one--41 patients with neurovegetative neurosis. The hormonal parameters were assessed during a clinical check-up, and after 4 and 20 days of spa therapy in Wysowa respectively. In all examined groups spa treatment was accompanied by a significant increase of serum concentrations of all examined hormones. Spa treatment did not influence the circadian rhythm of ACTH, cortisol, growth hormone and prolactin plasma concentration in all examined groups of patients. CONCLUSION: spa therapy shows a marked influence on secretion of "stress" hormones, but does not influence the circadian rhythm of plasma concentration of these compounds.

[The influence of spa therapy on the endocrine system. II. Erythropoietin]. / Wp-yw leczenia uzdrowiskowego na uk-ad. Endokrynny. II: Erytropoetyna.

UNLABELLED: The stimulatory effect of spa therapy on erythropoiesis is well documented. The present study aimed to elucidate the pathogenesis of this effect. The influence of spa therapy on plasma erythropoietin and erythropoiesis was studied in four groups of patients: 35 patients with essential hypertension, 35 patients with inflammatory renal diseases at a stabilized stage and normal excretory renal function. 25 patients with gastrointestinal pathology or cholelithiasis and 33 patients with neurovegetative neurosis. Spa therapy for 20 days in Wysowa was accompanied by a significant increase of plasma erythropoietin, iron, ferritin and saturation of transferrin with iron and by an increase of blood haemoglobin and haematocrit value. These alterations were especially marked in patients with essential hypertension. CONCLUSIONS: 1. Spa therapy exerts a stimulatory effect on erythropoiesis caused, among other factors, by increased erythropoietin secretion and iron mobilization. 2. This stimulatory effect is especially marked in patients with essential hypertension.

[Concentrations of B2-microglobulin and Tamm-Horsfall protein in cyst fluid and urinary excretion of these proteins in patients with simple renal cysts]. / Stezenie beta 2-mikroglobuliny i bialka Tamma-Horsfalla w plynie z torbieli oraz wydalanie tych bialek z moczem u chorych z torbielami prostymi nerek.

The existing classifications of simple renal cysts are based on cyst fluid sodium concentration or cyst fluid/plasma sodium ratio. The present study aimed to assess: 1) the usefulness of cyst fluid concentrations of beta-2-microglobulin (beta-2-MG) as a marker of proximal tubules function and Tamm-Horsfall protein (THP) as a marker of distal tubules function to define the origin of renal cysts (proximal or distal); and 2) the function of proximal and distal tubules in patients with simple renal cysts. 31 patients with simple renal cysts and 10 healthy subjects were examined. Basing on the cyst fluid/plasma sodium ratio, 25 cysts were classified as of proximal origin and 6 as of undetermined origin. In all patients cyst fluid and plasma concentrations of beta-2-MG, erythropoietin, sodium, potassium and total protein were assessed. Urinary excretion of beta-2-MG and THP was also estimated and fractional excretion of beta-2-MG was calculated. The concentration of beta-2-MG in fluid obtained from cysts of proximal origin were significantly higher than in fluid from cysts of undetermined origin (2.26 +/- 0.36 vs. 0.65 +/- 0.13 mg/l, p = 0.0004). Concentrations of THP (6.85 +/- 1.21 vs. 3.14 +/- 1.06 micrograms/ml, p < 0.05), erythropoietin (500.6 +/- 176.8 vs. 42.0 +/- 17.7 mU/ml, p < 0.05) and potassium (4.39 +/- 0.07 vs. 3.13 +/- 0.44 mmol/l, p < 0.05) were also higher in fluid from proximal cysts than in fluid from cysts of undetermined origin.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effects of furosemide, propranolol and nifedipine on urinary excretion of Tamm-Horsfall protein in patients with arterial hypertension]. / Wplyw furosemidu, propranololu i nifedypiny na wydalanie bialka Tamma-Horsfalla z moczem u chorych na nadcisnienie tetnicze.

UNLABELLED: In 65 hypertensive patients the influence of 10 day treatment with furosemide (24 subjects), nifedipine (21 subjects) and propranolol (20 subjects) respectively on urinary Tamm-Horsfall protein (U-THP), sodium and potassium excretion, 24 hour urinary volume and blood pressure was determined. In 23 control subjects the above mentioned parameters were assessed only under basal conditions. In hypertensive patients urinary THP excretion was not different from controls. In all examined groups a significant positive correlation was found between urine volume and urinary THP excretion under basal conditions. Such a correlation was absent after nifedipine or propranolol therapy respectively, but still existed after furosemide administration. No correlation was found between urinary THP and Na and K excretion respectively. In contrast to nifedipine and propranolol, a 10 day treatment with furosemide caused a significant increase in U-THP. CONCLUSIONS: Urinary THP excretion in hypertensive patients did not differ from U-THP in healthy subjects. In contrast to propranolol and nifedipine, treatment with furosemide caused an increase in THP urinary excretion.

[Essential hypertension. Treatment with nifedipine and levels of insulin, glucagon, gastrin and prolactin]. / Nadcisnienie tetnicze samoistne. Leczenie nifedypina a poziom insuliny, glukagonu, gastryny i prolaktyny.

In 40 patients (pts) with essential hypertension (EH) the plasma levels of insulin, glucagon, gastrin and prolactin during 2 week therapy with nifedipine were evaluated. In pts with EH there were higher levels of hormones than in control subjects. During nifedipine therapy there was no elevation of the plasma hormone levels although the blood pressure was lowered. This study shows that there are other than hypertension factors in the pathogenesis of elevated hormone levels in EH.

[Effect of nifedipine treatment on the renin-aldosterone system and secretion of cortisol and growth hormone in patients with essential hypertension]. / Wplyw leczenia nifedypina na uklad renina-aldosteron oraz wydzielanie kortyzolu i hormonu wzrostu u chorych na samoistne nadcisnienie tetnicze.

The effect of treatment of hypertension with nifedipine on plasma renin activity, blood serum level of aldosterone in the course of renin test, and cortisol and growth hormone concentrations after stimulation with insulin hypoglycemia was followed during two weeks of treatment in 40 patients with essential hypertension. No significant differences in the secretion of the hormones studied, as compared to the patients with the normal arterial blood pressure, were found. After nifedipine treatment no significant changes in the secretion of aldosterone, cortisol and growth hormone were observed despite a significant fall in the arterial blood pressure while there was a moderate stimulatory effect on renin secretion. The results obtained indicate that nifedipine has only small effect on the hormonal system of patients with essential hypertension.

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.

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.

Role of keto acids in the prophylaxis and treatment of renal osteopathy.

KA administration given in addition to a low-protein diet leads to a reduction of PTH secretion followed by diminishing of osteofibrosis. Osteomalacia will also be reduced by a better control of the calcium-phosphate metabolism, an increase of 1,25-(OH)2-D levels, and a lower burden of aluminum. Therapeutic levels of 25-OH-D and calcitonin (caused by simultaneous administration of vitamin D) are probably necessary to achieve this effect. KA are not only the optimum form of substitution in the nutritional treatment of chronic renal failure, but they seem to be very effective in the treatment of renal osteodystrophy.

Influence of keto acid (KA) treatment on renal osteodystrophy.

A marked improvement of renal osteodystrophy was achieved after a combined treatment with keto acids and vitamin D in patients with chronic renal failure. Results were checked by histological investigations. The biochemical background of the successful treatment was analysed. A regression of hyperparathyroidism and improvement in vitamin D status are the cause of this phenomenon.

Water immersion-induced endocrine alterations in women with EPH gestosis.

In 12 healthy pregnant women, 14 women with mild or moderate late pregnancy gestosis (EPH) and in 12 non-pregnant women, the influence of head out water immersion (WI) on mean blood pressure (MAP), the renin-aldosterone system, vasopressin (AVP) and atrial natriuretic hormone (ANF) was examined. WI induced a prompt fall in MAP in all examined groups. This decrease of MAP was maximal after 1 h WI, showing a tendency to rise later on in pregnant women. Simultaneously a decrease of plasma renin activity (PRA), plasma aldosterone, AVP and an increase of ANF was noted. The WI induced endocrine reaction pattern was qualitatively similar, but quantitatively different in the examined groups. In contrast to the response of non-pregnant women, healthy pregnant women and women with EPH gestosis showed a significantly smaller increase in ANF secretion induced by WI. No correlation was found between PRA, plasma AVP, aldosterone and ANF respectively. In addition changes in PRA, aldosterone, AVP and ANF did not correlate with WI-induced changes in MAP. From data obtained in this paper it seems, that WI-induced MAP changes are not related significantly to changes of the above mentioned hormonal factors.

Some hormones, minerals and vitamin D in continuous ambulatory peritoneal dialysis.

The concentrations of insulin (IRI), parathormone (PTH), calcitonin (CT), some electrolytes (Ca, Mg, P), vitamin D and glucose were determined in 6 patients with terminal renal insufficiency treated by CAPD.