Hypocitraturia is present when renal function is impaired in diverse nephropathies and is not related with serum bicarbonate levels.

BACKGROUND: In autosomal dominant polycystic kidney disease (ADPKD) it is frequently found a reduction in urinary citrate of unknown origin. It has been suggested that it could be a marker of acid retention in chronic kidney disease. Our aim was to compare urinary citrate in ADPKD with other nephropathies and to show its relation with serum bicarbonate. METHODS: We determined urinary citrate in patients with several nephropathies and varied renal function. We included 291 patients, 119 with glomerular diseases, 116 with ADPKD, 21 with other nephropathies, and 35 patients with normal renal function. RESULTS: Urinary citrate was higher in women and in patients with normal renal function. ADPKD patients showed similar values of urinary citrate to patients with glomerular diseases and with other nephropathies. We observed a progressive reduction in urinary citrate with renal impairment, in a comparable way among patients with ADPKD and glomerular diseases. We did not observe a relationship with serum bicarbonate. Serum uric acid levels were significantly higher in patients with glomerular diseases than in ADPKD patients, even after correction with the degree of renal function. CONCLUSIONS: Hypocitraturia is not specific of ADPKD but it is also present in all tested nephropathies and is related with renal impairment and not with serum bicarbonate. It could be interesting to study urinary citrate as a marker of renal function and as a prognostic factor.

Urinary citrate as a marker of renal function in patients with autosomal dominant polycystic kidney disease.

INTRODUCTION: Autosomal dominant polycystic kidney disease (ADPKD) is frequent to find low urinary citrate levels. Recently, it has been suggested that urinary citrate could be a marker of covert metabolic acidosis in chronic kidney disease. OBJECTIVE: Our aim was to analyze relationship between urinary citrate levels, renal function, and serum bicarbonate in ADPKD patients. METHODS: We determined citrate in 24-h collected urine from ADPKD patients and correlated with glomerular filtration rate (CKD-EPI equation) and serum bicarbonate concentration. RESULTS: We included 120 patients, 60% men, eGFR was 71 ± 32 mL/min/1.73 m2. Urinary citrate/creatinine ratio was 195 ± 152 mg/gCr (range 1.2-689) with levels significantly higher in females. Urinary citrate lower than 300 mg/gCr was present in 75% of patients and when considering chronic kidney stages (CKD), we observed reduced levels in 48.8% in CKD1 stage, in 79.4% in CKD2 stage, in 96.2% in CKD3 stage, and in 94.7% of patients in CKD4 stage. Urinary citrate was correlated with serum creatinine (r = - 0.61, p < 0.001) and eGFR (r = 0.55, p < 0.001) in both gender. We did not find any correlation with serum bicarbonate. Using a general linear modeling analysis, we found as predictors of urinary citrate/creatinine ratio to glomerular filtration rate, gender, and age. Lower levels of urinary citrate were accompanied by a decline in urinary osmolality and in renal excretion of calcium and uric acid. In a subgroup of patients, we measured total kidney volume and we found an inverse correlation with urinary citrate levels that disappeared when it was corrected with glomerular filtration rate. CONCLUSIONS: Urinary citrate is very frequently reduced in ADPKD patients being present from very early CKD stages. Their levels in urine are inversely correlated with glomerular filtration rate and it is not related with serum bicarbonate concentration. We think that it would be interesting to study urinary citrate as a marker of chronic kidney disease in ADPKD patients.

Iodine is associated to semen quality in men who undergo consultations for infertility.

The role that adequate iodine intake could have on the male reproductive function is not entirely known. The aim of this study is to determine whether there is a relation between male infertility and urinary and semen iodine levels in 96 couples who underwent consultation for infertility. The median of semen iodine was higher in men who consumed iodized salt than in those who consumed non-iodized salt (p=0.019). Men with a higher semen iodine level had more morphological alterations in spermatozoa (p=0.032). Men with a higher urinary iodine level had a lower motile sperm count according to the "direct swim-up" technique (p=0.044). Men >3years without successfully achieving pregnancy had a higher urinary iodine level than those with ≤ 3years (p=0.035). In conclusion, iodine may play a role in the quality of semen: an increase in semen iodine levels is associated with different variables related to male infertility.

Estudio sobre las concentraciones sèricas de vitamina B 12 y ácido fólico en el primer trimestrede embarazo en el Complejo Hospitalario de Jaén / Vitamin B 12 and folic acid levels in the first trimester of pregnancy in a hospital in Jaen (Spain)

Introducción. Durante el primer trimestre de embarazo es muy importante, para el correcto desarrollo del feto, unas concentraciones sèricas adecuados de vitamina B12 y ácido fólico. Un déficit de estas vitaminas produce, entre otros efectos, defectos del tubo neural del feto. Por tanto, durante el primer trimestre del embarazo, se suplementan porque aumentan las necesidades de estas vitaminas. Métodos. Según el Proceso Asistencial Integrado de embarazo, parto y puerperio del Servicio Andaluz de Salud se indica la quimioprofilaxis de 0,4 mg/día de ácido fólico hasta la semana 12 de gestación, para prevenir los defectos del tubo neural ¿Sería necesario aumentar los estudios para modificar esta dosis en la actualidad? ¿Influye la edad de la gestante en la dosis de ácido fólico a tomar? Por otro lado, el Complejo Hospitalario de Jaén determina, en la décima semana de gestación, el riesgo prenatal de síndrome de Down, entre otras cromosomopatías, mediante una analítica a todas las embarazadas de nuestro medio. ¿Conocemos cómo son las concentraciones sèricas de ácido fólico y vitamina B12 en las embarazadas recientes de nuestro medio? ¿Hay diferencias con respecto a la edad de las gestantes? Resultados. Según nuestros resultados, la mayoría de las gestantes de nuestro estudio tienen concentraciones sèricas de vitamina B12 y ácido fólico en sangre por debajo de lo recomendado, un 82 y un 70% respectivamente. Además no existen diferencias en cuanto a la edad de las gestantes (AU)

Introduction. Adequate levels of vitamin B12 and folic acid during the first trimester of pregnancy is very important for the proper development of the foetus. A deficiency of these vitamins causes neural tube defects in the foetus, as well as having other effects. Therefore, these vitamins are supplemented during the first trimester of pregnancy due to increasing needs. Methods. According to the Integrated Care Process of pregnancy and childbirth of Andalusian Health Service, chemoprophylaxis of 0.4 mg/day of folic acid is indicated until the 12th week of pregnancy to prevent neural tube defects. Are more studies needed to determine if this dose should now be modified? Does age of the mother have an effect on the dose of folate to take?. Furthermore, in the tenth week of pregnancy Jaen Hospital tests for the prenatal risk of Down's syndrome, including chromosomal abnormalities, on all pregnant women in its catchment area. Do we know how the levels of folate and B12 in early pregnancy in our area? Are there differences regarding the age of the pregnant woman?. Results. According to our results the majority of pregnant women in our study have vitamin B12 and folic acid levels in the blood below that recommended, 82 and 70%, respectively. There are no differences in the ages of the pregnant women (AU)