[Idiopathic hypercalciuria: can the diuretics be avoided?] / Hipercalciuria idiopática ¿Se pueden evitar los diuréticos?

Idiopathic hypercalciuria is defined as calcium excretion greater than 220 and 300 mg/day in women and men respectively, or greater than 4 mg/kg body weight. In women with osteoporosis it is observed in 19% of cases, while in kidney stones cases varies between 50 and 70%. We selected 206 hypercalciuric patients from our database, with and without renal lithiasis, to whom a restricted diet had been indicated. We divided them, according to the response, into a dependent diet and an independent diet. We considered 122 patients with diagnosis of hypercalciuria diet dependent (105 women and 17 men), which were followed with dietary control (800 mg of calcium, around 1 g of animal proteins and < 100 mEq sodium a day). The appearance of stones, or the recurrence of stones, was not considered, nor was bone involvement. After an average of 17 months, everyone had their calciuria controlled and there were even 16 (13%) who, after 42 months of follow-up, continued to be normocalciuric only on a diet. We conclude that the division of the hypercalciurias is fundamental, according to their response to a restricted diet, in order to avoid or postpone the use of diuretics and its adverse effects, with an adequate management of the diet.

La hipercalciuria idiopática se define como la excreción de calcio superior a 220 y 300 mg/día en mujeres y hombres respectivamente o bien mayor a 4 mg/kg peso. En mujeres con osteoporosis se observa en el 19% de los casos, mientras que en litiasis renal varía entre el 50 y 70%. Seleccionamos 206 pacientes hipercalciúricos, de nuestra base de datos, con y sin litiasis renal, a los que se les había indicado una dieta restringida. Luego los dividimos, de acuerdo a la respuesta, en dieta dependiente y dieta independiente. De estos solo consideramos 122 pacientes con diagnósticos de hipercalciuria dieta-dependiente (105 mujeres y 17 hombres), que fueron seguidos con control dietario (800 mg de calcio, alrededor de 1 g de proteínas animales y < 100 mEq de sodio diarios). No se consideró la aparición de cálculos, o la recurrencia de los mismos, como tampoco el compromiso óseo. Luego de una media de 17 meses todos tenían controlada la calciuria e incluso hubo 16 (13%) que luego de 42 meses de seguimiento persistían normocalciúricos solo con dieta. Concluimos que es fundamental la división de las hipercalciurias, según su respuesta a una dieta restringida, con el fin de evitar o postergar el uso de diuréticos y sus efectos adversos, con una administración adecuada de la dieta.

Hipercalciuria idiopática ¿se pueden evitar los diuróticos? / Idiopathic hypercalciuria: can the diuretics be avoided?

La hipercalciuria idiopática se define como la excreció;n de calcio superior a 220 y 300 mg/día en mujeres y hombres respectivamente o bien mayor a 4 mg/kg peso. En mujeres con osteoporosis se observa en el 19% de los casos, mientras que en litiasis renal varía entre el 50 y 70%. Seleccionamos 206 pacientes hipercalció;ºricos, de nuestra base de datos, con y sin litiasis renal, a los que se les había indicado una dieta restringida. Luego los dividimos, de acuerdo a la respuesta, en dieta dependiente y dieta independiente. De estos solo consideramos 122 pacientes con diagnó;sticos de hipercalciuria dieta-dependiente (105 mujeres y 17 hombres), que fueron seguidos con control dietario (800 mg de calcio, alrededor de 1 g de proteínas animales y < 100 mEq de sodio diarios). No se consideró; la aparició;n de cálculos, o la recurrencia de los mismos, como tampoco el compromiso ó;seo. Luego de una media de 17 meses todos tenían controlada la calciuria e incluso hubo 16 (13%) que luego de 42 meses de seguimiento persistían normocalció;ºricos solo con dieta. Concluimos que es fundamental la divisió;n de las hipercalciurias, segó;ºn su respuesta a una dieta restringida, con el fin de evitar o postergar el uso de diuró;©ticos y sus efectos adversos, con una administració;n adecuada de la dieta.

Idiopathic hypercalciuria is defined as calcium excretion greater than 220 and 300 mg / day in women and men respectively, or greater than 4 mg / kg body weight. In women with osteoporosis it is observed in 19% of cases, while in kidney stones cases varies between 50 and 70%. We selected 206 hypercalciuric patients from our database, with and without renal lithiasis, to whom a restricted diet had been indicated. We divided them, according to the response, into a dependent diet and an independent diet. We considered 122 patients with diagnosis of hypercalciuria diet dependent (105 women and 17 men), which were followed with dietary control (800 mg of calcium, around 1 g of animal proteins and < 100 mEq sodium a day). The appearance of stones, or the recurrence of stones, was not considered, nor was bone involvement. After an average of 17 months, everyone had their calciuria controlled and there were even 16 (13%) who, after 42 months of follow-up, continued to be normocalciuric only on a diet. We conclude that the division of the hypercalciurias is fundamental, according to their response to a restricted diet, in order to avoid or postpone the use of diuretics and its adverse effects, with an adequate management of the diet.

Obstructive urolithiasis in growing-finishing pigs / Urolitíase obstrutiva em suínos de crescimento e terminação

Obstructive urolithiasis is a disease characterized by the presence of uroliths in the urinary tract, with consequent obstruction of excretion pathways. This paper described the epidemiological and clinical-pathological findings of 22 outbreaks of urolithiasis in growing-finishing pigs in Southern Brazil. All affected pigs were male and clinical presentation consisted of lethargy, dysuria, rectal prolapse, abdominal distention, peripheral cyanosis and reluctance to move. Clinical progression course ranged from 12 hours to one week, and the lethality rate was 100%. Gross changes were characterized by urinary bladder rupture associated with marked amount of yellowish liquid with ammoniacal odor (urine) in the abdominal cavity (uroperitoneum), as well as mild fibrin deposition on the surface of abdominal organs and hydronephrosis. Urinary uroliths ranging from 0.3 to 1cm in diameter were often observed obstructing the lumen of the penile urethra and sometimes those were free in the abdominal cavity. Histopathological findings included diffuse and marked urinary bladder edema and hemorrhage associated with inflammatory infiltrate of lymphocytes, plasma cells, and macrophages. Diffuse and marked necrosis of the mucosal epithelium was observed in the penile urethra. Intense fibrin deposition and inflammatory infiltrate of neutrophils were noted in the peritoneum, as well as in the serosa of the organs in the abdominal cavity. Uroliths were submitted to the method of qualitative determination of the mineral components, and were compatible with calcium carbonate and magnesium ammonium phosphate. Growing pigs ration analysis revealed low levels of calcium in relation to phosphorus, resulting in a Ca:P ratio of approximately 0.35:1. Histological findings and mineral analysis suggest that outbreaks of urolithiasis were related to a nutritional imbalance in the proportions of dietary calcium and phosphorus. The main cause of mortality was related to dehydration and uroperitoneum.(AU)

Urolitíase obstrutiva é uma enfermidade caracterizada pela presença de urólitos no trato urinário, com consequente obstrução das vias de excreção. Este artigo descreve os achados epidemiológicos e clínico-patológicos de 22 surtos de urolitíase em suínos de crescimento e terminação no Sul do Brasil. Os suínos afetados eram machos e clinicamente apresentavam letargia, disúria, prolapso retal, abaulamento do abdômen, extremidades cianóticas e relutância em movimentar-se. A duração dos sinais clínicos variou de 12 horas a uma semana, e a letalidade foi de 100%. As alterações macroscópicas caracterizaram-se por ruptura da bexiga com acentuada quantidade de líquido de coloração amarelada e odor amoniacal (urina) livre na cavidade abdominal (uroperitônio), além de discreta deposição de fibrina sobre os órgãos e hidronefrose. Frequentemente obstruindo o lúmen da uretra peniana e por vezes livre na cavidade abdominal, era possível observar urólitos urinários que variavam de 0,3 a 1cm de diâmetro. Os achados histopatológicos incluíram edema e hemorragia difusos e acentuados na bexiga, associado a infiltrado inflamatório predominante de linfócitos, plasmócitos e macrófagos. Na uretra peniana havia necrose difusa e acentuada do epitélio da mucosa. No peritônio e nas serosas dos órgãos da cavidade abdominal havia intensa deposição de fibrina e infiltrado neutrofílico. Os urólitos foram submetidos ao método de determinação qualitativa dos componentes minerais, os quais foram compatíveis com carbonato de cálcio e fosfato de amônio magnesiano. A análise da ração de crescimento revelou baixos níveis de cálcio, em relação ao fósforo, perfazendo uma relação Ca:P de aproximadamente 0,35:1. Os achados histológicos e as dosagens minerais sugerem que os surtos de urolitíase foram relacionados a um desequilíbrio nutricional nas proporções de cálcio e fósforo dietético. A principal causa da morte dos suínos foi relacionada à desidratação e ao uroperitônio.(AU)

Obstructive urolithiasis in growing-finishing pigs / Urolitíase obstrutiva em suínos de crescimento e terminação

Obstructive urolithiasis is a disease characterized by the presence of uroliths in the urinary tract, with consequent obstruction of excretion pathways. This paper described the epidemiological and clinical-pathological findings of 22 outbreaks of urolithiasis in growing-finishing pigs in Southern Brazil. All affected pigs were male and clinical presentation consisted of lethargy, dysuria, rectal prolapse, abdominal distention, peripheral cyanosis and reluctance to move. Clinical progression course ranged from 12 hours to one week, and the lethality rate was 100%. Gross changes were characterized by urinary bladder rupture associated with marked amount of yellowish liquid with ammoniacal odor (urine) in the abdominal cavity (uroperitoneum), as well as mild fibrin deposition on the surface of abdominal organs and hydronephrosis. Urinary uroliths ranging from 0.3 to 1cm in diameter were often observed obstructing the lumen of the penile urethra and sometimes those were free in the abdominal cavity. Histopathological findings included diffuse and marked urinary bladder edema and hemorrhage associated with inflammatory infiltrate of lymphocytes, plasma cells, and macrophages. Diffuse and marked necrosis of the mucosal epithelium was observed in the penile urethra. Intense fibrin deposition and inflammatory infiltrate of neutrophils were noted in the peritoneum, as well as in the serosa of the organs in the abdominal cavity. Uroliths were submitted to the method of qualitative determination of the mineral components, and were compatible with calcium carbonate and magnesium ammonium phosphate. Growing pigs ration analysis revealed low levels of calcium in relation to phosphorus, resulting in a Ca:P ratio of approximately 0.35:1. Histological findings and mineral analysis suggest that outbreaks of urolithiasis were related to a nutritional imbalance in the proportions of dietary calcium and phosphorus. The main cause of mortality was related to dehydration and uroperitoneum.(AU)

Urolitíase obstrutiva é uma enfermidade caracterizada pela presença de urólitos no trato urinário, com consequente obstrução das vias de excreção. Este artigo descreve os achados epidemiológicos e clínico-patológicos de 22 surtos de urolitíase em suínos de crescimento e terminação no Sul do Brasil. Os suínos afetados eram machos e clinicamente apresentavam letargia, disúria, prolapso retal, abaulamento do abdômen, extremidades cianóticas e relutância em movimentar-se. A duração dos sinais clínicos variou de 12 horas a uma semana, e a letalidade foi de 100%. As alterações macroscópicas caracterizaram-se por ruptura da bexiga com acentuada quantidade de líquido de coloração amarelada e odor amoniacal (urina) livre na cavidade abdominal (uroperitônio), além de discreta deposição de fibrina sobre os órgãos e hidronefrose. Frequentemente obstruindo o lúmen da uretra peniana e por vezes livre na cavidade abdominal, era possível observar urólitos urinários que variavam de 0,3 a 1cm de diâmetro. Os achados histopatológicos incluíram edema e hemorragia difusos e acentuados na bexiga, associado a infiltrado inflamatório predominante de linfócitos, plasmócitos e macrófagos. Na uretra peniana havia necrose difusa e acentuada do epitélio da mucosa. No peritônio e nas serosas dos órgãos da cavidade abdominal havia intensa deposição de fibrina e infiltrado neutrofílico. Os urólitos foram submetidos ao método de determinação qualitativa dos componentes minerais, os quais foram compatíveis com carbonato de cálcio e fosfato de amônio magnesiano. A análise da ração de crescimento revelou baixos níveis de cálcio, em relação ao fósforo, perfazendo uma relação Ca:P de aproximadamente 0,35:1. Os achados histológicos e as dosagens minerais sugerem que os surtos de urolitíase foram relacionados a um desequilíbrio nutricional nas proporções de cálcio e fósforo dietético. A principal causa da morte dos suínos foi relacionada à desidratação e ao uroperitônio.(AU)

Long-Term Parathyroid Hormone 1-34 Replacement Therapy in Children with Hypoparathyroidism.

OBJECTIVE: To determine whether multiple daily injections of parathyroid hormone (PTH) 1-34 are safe and effective as long-term therapy for children with hypoparathyroidism. STUDY DESIGN: Linear growth, bone accrual, renal function, and mineral homeostasis were studied in a long-term observational study of PTH 1-34 injection therapy in 14 children. METHODS: Subjects were 14 children with hypoparathyroidism attributable to autoimmune polyglandular syndrome type 1 (N = 5, ages 7-12 years) or calcium receptor mutation (N = 9, ages 7-16 years). Mean daily PTH 1-34 dose was 0.75 ± 0.15 µg/kg/day. Treatment duration was 6.9 ± 3.1 years (range 1.5-10 years). Patients were evaluated semiannually at the National Institutes of Health Clinical Center. RESULTS: Mean height velocity and lumbar spine, whole body, and femoral neck bone accretion velocities were normal throughout the study. In the first 2 years, distal one-third radius bone accrual velocity was reduced compared with normal children (P < .003). Serum alkaline phosphatase correlated with PTH 1-34 dose (P < .006) and remained normal (235.3 ± 104.8 [SD] U/L, N: 51-332 U/L). Mean serum and 24-hour urine calcium levels were 2.05 ± 0.11 mmol/L (N: 2.05-2.5 mmol/L) and 6.93 ± 1.3 mmol/24 hour (N: 1.25-7.5 mmol/24 hour), respectively-with fewer high urine calcium levels vs baseline during calcitriol and calcium treatment (P < .001). Nephrocalcinosis progressed in 5 of 12 subjects who had repeated renal imaging although renal function remained normal. CONCLUSIONS: Twice-daily or thrice-daily subcutaneous PTH 1-34 injections provided safe and effective replacement therapy for up to 10 years in children with hypoparathyroidism because of autoimmune polyglandular syndrome type 1 or calcium receptor mutation.

[Lithogenic risk in patients from Paraguay with urolithiasis]. / Perfil de riesgo litogénico en pacientes con urolitiasis en Paraguay.

UNLABELLED: The lithogenic risk profile is a graphical representation of metabolic factors and urinary saturation involved in the stone formation with their respective critical values. AIM: To determine the lithogenic risk profile in patients with urolithiasis. MATERIAL AND METHODS: Personal data such as anthropometric, history of diseases and family history of urolithiasis were recorded. Different compounds acting as promoters or inhibitors of crystallization were measured in serum and urine samples, and the data obtained were used to calculate urinary saturation using Equil software. RESULTS: We included 30 men and 43 women with a median age of 45 (34-54) years. Overweight and family history of urolithiasis was reported in 63 and 32% respectively. Crystallization risk was detected in 74% of participants. The most common urinary abnormalities were hypocitraturia in 48% and hypercalciuria in 40%. CONCLUSIONS: The lithogenic profile revealed urinary saturation compatible with crystallization risk in 74% of the studied patients.

Perfil de riesgo litogénico en pacientes con urolitiasis en Paraguay / Lithogenic risk in patients from Paraguay with urolithiasis

The lithogenic risk profile is a graphical representation of metabolic factors and urinary saturation involved in the stone formation with their respective critical values. Aim: To determine the lithogenic risk profile in patients with urolithiasis. Material and Methods: Personal data such as anthropometric, history of diseases and family history of urolithiasis were recorded. Different compounds acting as promoters or inhibitors of crystallization were measured in serum and urine samples, and the data obtained were used to calculate urinary saturation using Equil software. Results: We included 30 men and 43 women with a median age of 45 (34-54) years. Overweight and family history of urolithiasis was reported in 63 and 32% respectively. Crystallization risk was detected in 74% of participants. The most common urinary abnormalities were hypocitraturia in 48% and hypercalciuria in 40%. Conclusions: The lithogenic profile revealed urinary saturation compatible with crystallization risk in 74% of the studied patients.

Evaluating Sucralfate as a Phosphate Binder in Normal Cats and Cats with Chronic Kidney Disease.

Control of hyperphosphatemia is an important part of the management of chronic kidney disease (CKD). The purpose of this study was to determine the efficacy of sucralfate as a phosphate binder in normal cats and normophosphatemic CKD cats. A 500 mg sucralfate slurry was administered orally q 8 hr for 2 wk, and serum phosphorus, urine fractional excretion of phosphorus, and fecal phosphorus concentrations were measured. In normal cats treated with sucralfate, significant changes in serum phosphorus concentration or urinary excretion of phosphorus were not detected, and vomiting occurred after 14.7% of administrations. Of the five normophosphatemic cats with CKD treated with sucralfate, three experienced clinical decompensation, including vomiting, anorexia, constipation, and increased azotemia. Administration of sucralfate did not result in significant changes in fecal phosphorus concentration in these cats. The effects of sucralfate administration on serum phosphorus concentration and urinary excretion of phosphorus in CKD cats was difficult to determine because of dehydration and worsening azotemia associated with decompensation. Due to side effects and the apparent lack of efficacy of the medication, the study was discontinued. This study was unable to confirm efficacy of this sucralfate formulation as a phosphate binder, and side effects were problematic during the study.

Nitrogenous and phosphorus excretions in juvenile silver catfish (Rhamdia quelen) exposed to different water hardness, humic acid, and pH levels.

This study examined ammonia, urea, creatinine, protein, nitrite, nitrate, and phosphorus (P) excretion at different water hardness, humic acid, or pH levels in silver catfish (Rhamdia quelen) juveniles. The fish were exposed to different levels of water hardness (4, 24, 50, or 100 mg L(-1) CaCO3), humic acid (0, 2.5, or 5.0 mg L(-1)), or pH (5.0, 6.0, 7.0, 8.0, or 9.0) for 10 days. The overall measured nitrogen excretions were 88.1% (244-423 µmol kg(-1 )h(-1)) for ammonia, 10.9% (30-52 µmol kg(-1 )h(-1)) for creatinine, 0.02% (0.05-0.08 µmol kg(-1 )h(-1)) for protein, 0.001 % (0.002-0.004 µmol kg(-1 )h(-1)) for urea, 0.5% (0.64-3.6 µmol kg(-1 )h(-1)) for nitrite, and 0.5% (0.0-6.9 µmol kg(-1 )h(-1)) for nitrate, and these proportions were not affected by water hardness or humic acid levels. The overall P excretion in R. quelen was 0.14-2.97 µmol kg(-1) h(-1). Ammonia excretion in R. quelen usually was significantly higher in the first 12 h after feeding, and no clear effect of water hardness, humic acid levels, and pH on this daily pattern of ammonia excretion could be observed. Water hardness only affected the ammonia and P excretion of R. quelen juveniles in the initial and fifth days after transfer, respectively. The exposure of this species to humic acid increased ammonia excretion after 10 days of exposure but did not affect P excretion. An increase in pH decreased ammonia and increased creatinine excretion but did not change P excretion in R. quelen. Therefore, when there is any change on humic acid levels or pH in the culture of this species, nitrogenous compounds must be monitored because their excretion rates are variable. On the other hand, P excretion rates determined in the present study are applicable to a wide range of fish culture conditions.

Renal calcium, phosphorus, magnesium and uric acid handling: comparison between stage III chronic kidney disease patients and healthy oldest old.

INTRODUCTION: It is known that chronic kidney disease (CKD) and senescence bring about a progressive reduction in glomerular filtration rate (GFR) and that in the former this is usually associated with an increase in the fractional excretion of calcium, phosphorus, magnesium, and uric acid. However, it has not yet been explained how these substances are excreted in the healthy oldest old. Thus, in the present study, we examined the renal handling of these substances in very aged people in comparison with CKD patients with similar GFR levels (stage III-CKD). MATERIALS AND METHODS: Twenty volunteers were studied; 10 of them were healthy very old (VO) (≥ 75 years old) individuals and 10 were stage III CKD patients. Exclusion criteria were as follows: presence of altered (abnormally high or low) plasma calcium, phosphorus, magnesium and uric acid, as well as previous diagnoses of diabetes mellitus and obstructive uropathy and use of drugs that could alter plasma levels of the studied substances. All volunteers were on a diet with the same content of these elements (3-day dietary register). We measured calcium, phosphorus, magnesium, uric acid, creatinine in serum plasma and morning urine, as well as serum parathyroid hormone level, in each volunteer. From these data, fractional excretion (FE) of these substances was obtained. A statistical analysis was carried out using the Wilcoxon test. RESULTS: Serum creatinine: 1.8 ± 0.4 mg/dl (CKD) versus 0.8 ± 0.2 mg/dl (VO), p = 0.0002; serum calcium: 9.1 ± 0.3 mg/dl (CKD) versus 8.7 ± 0.4 (VO), p = 0.022; serum magnesium: 2.3 ± 0.2 mg/dl (CKD) versus 2.0 ± 0.1 (VO), p = 0.05; serum phosphorus: 3.9 ± 0.5 mg/dl (CKD) versus 3.0 ± 0.4 mg/dl (VO), p = 0.002; serum uric acid: 6.6 ± 1.5 (CKD) versus 5.2 ± 1.4 mg/dl (VO), p = 0.04; FE of calcium: 2.5 ± 1 % (CKD) versus 0.8 ± 0.3 % (VO), p = 0.04; FE of magnesium: 7.2 ± 4.1 % (CKD) versus 2.9 ± 0.9 % (VO), p = 0.02; FE of phosphorus: 25 ± 9 % (CKD) versus 9.1 ± 5.7(VO), p = 0.001; FE of uric acid: 10 ± 3 % (CKD) versus 8 ± 5 % (VO), p = 0.05. CONCLUSION: Serum levels and FE of calcium, phosphorus, magnesium and uric acid were significantly higher in CKD patients compared to healthy very old people with similar GFR, except for serum magnesium and FE of uric acid, which were similar in both groups.

[Comparative study of the urinary excretion of boron, calcium, magnesium and phosphorus in postmenopausal women with and without osteoporosis]. / Estudio comparativo de la excreción urinaria de boro, calcio, magnesio y fósforo en mujeres posmenopáusicas con y sin osteoporosis.

In order to compare the possible relationship between urinary concentrations of boron, calcium, magnesium and phosphorus in serum and urine of postmenopausal women with and without osteoporosis, we selected 45 postmenopausal women over 47 years of age, divided into two groups: group I clinically healthy postmenopausal women and group II postmenopausal women with osteoporosis, without chronic kidney and hepatic diseases or diabetes mellitus. We determined the boron (B), phosphorus (P), total calcium (Ca) and total magnesium (Mg) in the urine of two hours, by atomic emission spectroscopy with induction-coupled plasma (ICPA-ES). Total calcium and total magnesium in serum were determined by atomic flame absorption spectroscopy (FAAS) and inorganic phosphorus in serum, and creatinine in serum and urine, by molecular absorption spectrometry. The preliminary results suggest the existence of a significant difference (p < 0.05) in boron and phosphorus concentrations in the urine of two hours between the groups. The model of linear regression analysis used showed a relationship between urinary concentrations of boron/creatinine index and calcium/ creatinine, magnesium/creatinine and phosphorus/creatinine indexes in the urine of postmenopausal women with osteoporosis.

Estudio comparativo de la excreción urinaria de boro, calcio, magnesio y fósforo en mujeres posmenopáusicas con y sin osteoporosis / Comparative study of the urinary excretion of boron, calcium, magnesium and phosphorus in postmenopausal women with and without osteoporosis

Con el propósito de comparar la posible relación entre las concentraciones urinarias de boro y las concentraciones de calcio, de magnesio y de fósforo en suero y orina de mujeres posmenopáusicas con y sin osteoporosis, seleccionamos 45 mujeres posmenopáusicas con más de 47 años de edad, divididas en dos subgrupos: grupo I mujeres posmenopáusicas clínicamente sanas y grupo II mujeres posmenopáusicas con osteoporosis, sin enfermedades renales, hepáticas o diabetes mellitus. Se determinó el boro (B), el fósforo (P), el calcio total (Ca) y el magnesio total (Mg) en la orina de dos horas por espectroscopia de emisión atómica con plasma acoplado por inducción (ICPA-ES), el calcio y el magnesio total en suero por espectroscopia de absorción atómica en llama (FAAS) y el fósforo inorgánico en suero y la creatinina en suero y orina por espectroscopia de absorción molecular. Los resultados obtenidos sugieren preliminarmente una diferencia significativa (p<0,05) en las concentraciones de boro y de fósforo en la orina de dos horas entre los grupos estudiados. El análisis de regresión lineal aplicado, sugiere relación entre el índice boro/creatinina y los índices calcio/creatinina, magnesio/creatinina y fósforo/creatinina en la orina de las mujeres posmenopáusicas con osteoporosis.

In order to compare the possible relationship between urinary concentrations of boron, calcium, magnesium and phosphorus in serum and urine of postmenopausal women with and without osteoporosis, we selected 45 postmenopausal women over 47 years of age, divided into two groups: group I clinically healthy postmenopausal women and group II postmenopausal women with osteoporosis, without chronic kidney and hepatic diseases or diabetes mellitus. We determined the boron (B), phosphorus (P), total calcium (Ca) and total magnesium (Mg) in the urine of two hours, by atomic emission spectroscopy with induction-coupled plasma (ICPA-ES). Total calcium and total magnesium in serum were determined by atomic flame absorption spectroscopy (FAAS) and inorganic phosphorus in serum, and creatinine in serum and urine, by molecular absorption spectrometry. The preliminary results suggest the existence of a significant difference (p <0.05) in boron and phosphorus concentrations in the urine of two hours between the groups. The model of linear regression analysis used showed a relationship between urinary concentrations of boron/creatinine index and calcium/ creatinine, magnesium/creatinine and phosphorus/creatinine indexes in the urine of postmenopausal women with osteoporosis.

Persistence of hypercalciuria after successful surgical treatment for primary hyperparathyroidism.

UNLABELLED: Primary hyperparathyroidism (PHPT) causes hypercalciuria and stone disease in a subset of patients. Hypercalciuria typically normalizes after surgery, although the risk of stone formation may persist up to 10 years. There are few reports in the literature that show persistent hypercalciuria despite normalization of serum calcium after parathyroid surgery. We retrospectively analyzed 111 patients with PHPT from the osteoporosis, and stone clinics seen between 1999 and 2006. We selected only patients who had a complete metabolic profile that included 24-hour collections before and at least 3 months after parathyroidectomy. We excluded patients who had creatinine clearance <60 ml/min/1.73 m(2). Fifty-four patients were selected for further analysis, 46 with baseline hypercalciuria and 8 with normocalciuria. Changes in filtered load of calcium and fractional excretion of calcium were evaluated before and after parathyroid surgery. Total and ionized calcium and phosphorus normalized in all patients after surgery (24 ± 19 months); fractional excretion of calcium decreased, but did not normalize. Hypercalciuria persisted after surgery in 30.7% (n = 12/39) of the women and 50% (n = 4/8) of men. Of the patients in whom calciuria normalized after parathyroidectomy, 43.3% (n = 13/30) had kidney stones before surgery, whereas kidney stones were present in 87.5% (n = 14/16) in those in whom hypercalciuria persisted postsurgery. In hypercalciuric men and women before surgery in whom hypercalciuria persisted after surgery, fractional excretion of calcium was significantly higher than that in patients with normocalciuria. CONCLUSIONS: Persistently increased fractional excretion of calcium could explain the sustained increased risk of stone disease in patients with PHPT for many years after successful parathyroidectomy.

Role of overweight and obesity on the urinary excretion of promoters and inhibitors of stone formation in stone formers.

In recent decades there has been an increasing prevalence of urolitithiasis in many western countries and at the same time there has been an increasing progression of obesity that has reached epidemic proportions. The aim of the present study was to assess the influence of overweight/obesity on the metabolic risk factors for renal stone formation. We studied 799 renal stone formers (462 men and 337 women) who came to the clinic for metabolic risk factors evaluation. They were all studied with a standard protocol (two 24-h urine collections and serum parameters). They were divided according to their BMI in normal (BMI < 25) overweight (BMI 25-29.9) and obese (BMI > 30). Low-weight individuals were excluded. Overall, 487 of 799 (60.9%) patients had a BMI > 25, including 40.6% overweight and 20.3% obese. Among women 55.2% had normal weight, 25.5 were overweight, and 19.3% were Obese; among men 27.3% had normal weight, 51.7 were overweight, and 21% were obese. Age increased significantly with increasing BMI both in men and women. In women there was a significant increase in the excretion of oxalate, uric acid, phosphorus, creatinine, and sodium with increasing BMI, but no change was observed in calcium, magnesium, citrate, and urine pH. In men there was a significant increase in the excretion of oxalate, uric acid, creatinine, phosphorus, sodium, magnesium, and citrate with increasing BMI, no change in urinary calcium and significant progressive decrease in urinary pH. In this population of stone formers there was a high prevalence of overweight/obesity (60.9%). Both in men and women we found a significant increase in the urinary excretion of two promoters of stone formation, oxalate, and uric acid but no change in urinary calcium. There was either no change or increase in magnesium and citrate, inhibitors of crystallization, and a significant decrease in urine pH only in men.

Effect of sodium fluoride administration to rats on bone phosphorous content and phosphatemia.

Fluoride (F) has a known mitogenic effect on bone cells. The daily administration of 40 micromol NaF per 100 g of body weight (bw) increases bone mass in rats. Nevertheless, the quality and composition of bone formed under F stimulus is still matter of study. The objective of this work was to investigate the effect of sodium fluoride (NaF, CAS 7681-49-4) administration on phosphate metabolism and its impact on bone. Experiments were carried out in female fasted 50-day-old rats. Unless otherwise stated, NaF dose was 40 micromol NaF/day . 100 g bw, administered by gastric tube. Four groups of 4 rats each were given the following daily NaF doses: Group A: 0, B: 20, C: 40 and D: 60 micromol NaF/day x 100 g bw. After 30 days rats were killed saving their femora and plasma. Bone phosphorous contents (BPC) and phosphatemia (mg/dl) were measured. BPC decreased significantly as a function of NaF dose. A: 93.3+/-14.1; B: 78.7+/-15.5; C: 61.1+/-14.7**; D: 59.6+/-8.6 **mg P/g dry bone (** significant difference to group A, p < 0.01). Phosphatemia (mg/dl) increased significantly with a peak at 90 min after NaF dose (basal: 5.34+/-0.06; 90 min: 8.15 +/-0.43, p < 0.001). Phosphaturia (microg/min) increased though differences were not significant (basal: 46.7+/-42.8; 4 h: 1275 +/-757, p > 0.05). In thyroparathyroidectomized rats, plasma phosphate increased continuously for at least 240 min. Renal plasmatic flow, glomerular filtration rate and renal blood flow were not affected by NaF treatment. In isolated perfused rat kidneys, urinary phosphate excretion remained unaffected after NaF administration. Phosphate concentration was measured in the plasma and erythrocytes of rats after one dose of NaF (n = 8). Phosphate content of erythrocyte was not affected by NaF, in spite of the concurrent increase in phosphatemia. It is concluded that the treatment with NaF causes a transitory increase in plasma phosphate levels. Neither renal hemodynamic factors nor the inhibitory effect on parathormone actions appear to be the causes of hyperphosphatemia. Efflux of phosphate from cells might not be the cause of the increase in phosphatemia. The loss of phosphorous from bone appears as the most probable determinant of hyperphosphatemia after fluoride administration.

Effects of aluminum on phosphate metabolism in rats: a possible interaction with vitamin D3 renal production.

The effect of chronic aluminum (Al) administration on the phosphorous (Pi) metabolism of different target tissues was studied. Male Wistar rats received aluminum lactate for 3 months (5.75 mg/kg bodyweight of Al, i.p., three times per week). The animals were studied at the end of the 1st, 2nd and 3rd month of treatment. They were housed individually in metabolic cages for 4 days to study Pi and calcium (Ca) balance. Daily food and water intakes were recorded for all animals and urine and feces were collected for Pi and calcium assays. After 3 months the Pi intestinal absorption and the Pi deposition in bone were studied using 32Pi. Another group of rats was treated daily for 7 days with calcitriol (0.08 microg/kg body weight in sesame oil, i.p.) and the Pi balance was studied for the last 4 days. The results indicated that chronic administration of Al affected simultaneously the Pi and calcium balance, with a significant diminution of calcium and increased Pi accretion in bones, together with a diminution in the intestinal absorption of Pi. The treatment of the rats with calcitriol promoted a normalized Pi balance in Al treated rats. These findings suggest that Al could modify the Pi metabolism acting directly on intestine, kidney and bone, or indirectly through possible changes in the levels of vitamin D3.

Role of plasma and urinary calcium and phosphorus measurements in early detection of phosphorus deficiency in very low birthweight infants.

AIM: To analyse the role of serum and urinary calcium and phosphorus levels in early detection of mineral deficiency in very low birthweight (VLBW) infants born appropriate (AGA) and small for gestational age (SGA). METHODS: 64 VLBW infants were included in a cohort study and divided into two groups: AGA (n = 30) and SGA infants (n = 34). Then, they were divided according to the presence of radiological signs of metabolic bone disease (MBD): with MBD (n = 21) and without MBD (n = 34). Blood samples and 6 h urine collections were obtained for calcium, phosphorus, alkaline phosphatase activity and creatinine determinations between 3 and 5 wk of life. RESULTS: There were no biochemical differences between AGA and SGA. Higher values of urinary calcium (MBD = 31.9 +/- 20.2, without MBD = 19.8 +/- 15.4; p = 0.017), calciuria (MBD = 2.3 +/- 0.3, without MBD = 1.4 +/- 0.8; p = 0.037) and alkaline phosphatase activity (MBD = 369 +/- 114, without MBD = 310 +/- 93; p = 0.04) were found in infants who developed MBD. Both groups showed high tubular phosphorus reabsorption indicating mineral deficiency. CONCLUSION: Serum calcium and phosphorus levels are not good markers in early detection of mineral deficiency. However, the monitoring of calcium urinary levels may be helpful in early detection of mineral deficiency.

Oral and clinical characteristics of a group of patients with Turner syndrome.

OBJECTIVE: The loss of the X chromosome in girls with Turner syndrome (TS) affects the shape and the size of craniofacial structures. Few studies have been reported on female patients with TS in South America. Records of odontologic alterations of 23 Argentinian patients with TS were compared with those of 25 girls in a control group, and associations were made with medical indications. STUDY DESIGN: Oral clinical diagnoses were completed with periapical, occlusal, panoramic, and orthopantomograms; urine and blood determinations were performed by conventional methods. RESULTS: Blood phosphorus and calcium levels were altered, and osteoporosis was detected. In some patients, TS was associated with autoimmune thyroiditis. Control subjects had normal blood and urine values. The decayed, missing, and filled permanent surfaces index for temporary teeth was statistically higher for the control group. About 78% of the patients had hypoplasia, 65% had reduced root length and bifurcated roots, and 100% had high arch palate. Incisor asymmetry was also observed. CONCLUSIONS: Medical and laboratory indexes are essentially indicative of hormone alterations. TS patients have a particular oral anatomy that could be closely related to an alteration in calcium and phosphorus metabolism.

Cellular immunity aspects in elderly subjects with Paget's disease of bone.

The etiology and pathophysiology of Paget's disease of bone are not yet entirely defined. There is evidence suggesting the participation of the immune system in the pathophysiology of this disease. Hence, we examined T cell mitogenic proliferation, NK cell activity, T cell subsets, interleukin-1 (IL-1), and interleukin-6(IL-6) production by peripheral mononuclear cells and IL-6 levels in the peripheral blood sera of 17 Paget's patients aged (74.5 +/- 2.4 years) and of 17 elderly control subjects (74.7 +/- 2.2 years). Pagetic patients were found to have immunological parameters not significantly different from those of the elderly control group. Moreover, the results obtained from Paget's patients with the active form of the disease did not differ from those of patients with inactive disease. Therefore, at least on the basis of the parameters used in this study, it is possible to conclude that the cellular immunity of Paget's patients is not different from that of elderly control subjects and that the role of IL-1 and IL-6 in this disease should be reviewed.

[Changes in liver and kidney phosphorus in guinea pigs exposed to high doses of vitamin A (retinol)]. / Modificaciones del contenido de fósforo hepático y renal en cobayos tratados con dosis elevadas de vitamina A alcohol (Retinol).

In this study, the serum, urinary, hepatic and renal levels of total inorganic phosphorus (Pi) were determined in guinea pigs treated with 100,000 U.I. of vitamin A, dissolved in Tween Span, given each day by intramuscular injections during seven days (treated group), and compared with the levels in healthy guinea pigs which were given the same feed as the treated group, and received the same amount of Tween Span (control group). The activity of the enzymes alkaline phosphatase and acid phosphatase was simultaneously determined in liver and kidneys of both groups, and the phospholipid content in serum and tissue was also determined. The treated group did not show changes in serum and urinary phosphorus as compared with the control group. Liver and kidney of the treated group showed an increase in total Pi (p < 0.05). In this group a definite increase (p < 0.05) was also observed both in serum and tissue levels of phospholipids, as well as in the activity of the liver and kidney enzymes studied. These results suggest that phosphorus enters the blood stream in the form of lipid complexes (phospholipids) that are involved in certain characteristic functions.