Effect of Tamsulosin on Osteopontin Gene Expression in Preventing Ethylene Glycol-Induced Kidney Stone in Male Wistar Rats

Objective With multi-center investigation, to assess the life quality of patients with maintained hemodialysis (MHD) in Liaoning Province and to explore the relationship among the mineral metabolism, the life quality of the patients with MHD, and the repeated hospitalization within the latest three years. Methods 1192 patients with hemodialysis (at least 3 months) from January to March in 2015 at ten blood purification centers in Liaoning Province were selected for the cross-sectional survey. The Kidney Health-related Quality of Life (HRQOL) version 1.3 was used to evaluate the MHD patients' life quality. The total length of hospitalization was divided into four groups: 0 days, 3 to 15 days, 16 to 30 days and above 30 days. Results When serum calcium value ranged from 2.1 to 2.5 mmol/L, kidney-disease component summary (KDCS), mental component summary (MCS), physical component summary (PCS) and SF-36+KDCS corresponded to a higher value (P<0.05). When serum phosphorus value ranged from 1.13 to 1.78 mmol/L, KDCS and SF-36+KDCS corresponded to a higher value (P<0.05). When the calcium phosphorus product value ranged from 40.68 to 49.94, MCS corresponded to a higher value (P<0.05). KDCS showed a linear correlation with age (P<0.001), dialysis age, serum calcium (less than or equal to 2.5 mmol/L) (P<0.05); PCS showed a linear correlation with age (P<0.001) and dialysis age (P<0.05); SF-36+KDCS showed a linear correlation with age (P<0.001), and serum calcium (less than or equal to 2.5 mmol/L) (P<0.05), while age and dialysis age were negatively correlated. The hospitalization days showed a linear correlation with age, dialysis age (P<0.001) and serum phosphorus, calcium phosphorus product value (P<0.05), while dialysis age and calcium phosphorus product value were negatively correlated. Among different groups of total hospitalization days in three years, age, hemodialysis age, serum calcium, serum phosphorus, calcium-phosphorus product value and quality of life values were all statistically significant (P<0.05). Conclusions The life quality of patients with MHD were correlated with serum calcium, phosphorus, calcium and phosphorus product value, iPTH, dialysis age and age, while age and dialysis age were of negative correlation. The total number of hospitalization days in 3 years was closely linearly correlated with age and dialysis age, significantly correlated with serum phosphorus, calcium and phosphorus product value, while dialysis age, calcium and phosphorus product value were in a negative correlation. The total number of hospitalization in 3 years was correlated with the patients' age, dialysis age, serum calcium, serum phosphorus, calcium and phosphorus product value and quality of life. Key words: Renal dialysis; Quality of life; Mineral metabolism; Repeated hospitalizations

Biochemical and Stone-Risk Profiles With Topiramate Treatment

To establish the PTH dosage that maintains normal mineral homeostasis in the PTX rat, a series of doses of rat 1-34 PTH were infused via a subcutaneously implanted miniosmotic pump. The doses were 0, 0.011, 0.022, 0.044, and 0.11 microg/100 g/hour. After 48 hours, serum calcium ranged from 5.56 +/- 0.02 to 16.29 +/- 0.25 mg/dl, ANOVA P < 0.001, and serum phosphorus from 12.49 +/- 0.03 to 5.33 +/- 0.34 mg/dl, ANOVA P < 0.001. By post hoc test, the serum calcium level was different (P < 0.05) at every PTH dose; the serum phosphorus level was different (P < 0.05) at every PTH dose except between the two highest doses. The PTH dosage that produced a normal serum calcium (10.09 +/- 0.10 mg/dl) and phosphorus (6.90 +/- 0.18 mg/dl) was 0.022 microg/100 g/hour. The relationship between increasing doses of PTH and both serum calcium and phosphorus was curvilinear and the calcium-phosphorus product was remarkably constant from a serum calcium of 7-13 mg/dl. The increase in serum calcium and the decrease in serum phosphorus were more rapid at lower than at higher PTH doses so that for both, an asymptote was reached. At the highest serum calcium values, the calcium-phosphorus product increased and in individual rats, an increase in serum phosphorus was associated with a decrease in serum calcium. In summary, this study shows that (1) for rat 1-34 PTH, the normal replacement dose in the PTX rat with normal renal function on a normal diet is 0.022 microg/100 g/hour; (2) the relationship between PTH and both serum calcium and phosphorus is curvilinear, and an asymptote is reached for both; and (3) the calcium-phosphorus product is remarkably constant as the serum calcium increases from 7 to 13 mg/dl and only increased during marked hypercalcemia when serum phosphorus did not decrease further or even tended to increase.

Clinical guidelines recommend vitamin D compounds to suppress serum parathyroid hormone (PTH) in chronic kidney disease (CKD), however treatment may be associated with increased serum phosphorus and calcium, which are associated with increased mortality in observational studies. Observational data also indicate vitamin D therapy may be independently associated with reduced mortality in CKD. We assessed the effects of vitamin D compounds on clinical, biochemical, and bone outcomes in people with CKD and receiving dialysis. We searched The Cochrane Renal Group's specialised register, Cochrane's Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and reference lists of retrieved articles. Randomised controlled trials (RCTs) in subjects with CKD and requiring dialysis that assessed treatment with vitamin D compounds. Data was extracted by two authors. Results are summarised as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). Sixty studies (2773 patients) were included. No formulation, route, or schedule of administration was associated with altered risks of death, bone pain, or parathyroidectomy. Marked heterogeneity in reporting of outcomes resulted in few data available for formal meta-analysis. Compared with placebo, vitamin D compounds lowered serum PTH at the expense of increasing serum phosphorus. Trends toward increased hypercalcaemia and serum calcium did not reach statistical significance but may be clinically relevant. Newer vitamin D compounds (paricalcitol, maxacalcitol, doxercalciferol) lowered PTH compared with placebo, with increased risks of hypercalcaemia, although inadequate data were available for serum phosphorus. Intravenous vitamin D may lower PTH compared with oral treatment, and be associated with lower serum phosphorus and calcium levels, although limitations in the available studies precludes a conclusive statement of treatment efficacy. Few studies were available for intermittent versus daily and intraperitoneal versus oral administration or directly comparative studies of newer versus established vitamin D compounds. We confirm that vitamin D compounds suppress PTH in people with CKD and requiring dialysis although treatment is associated with clinical elevations in serum phosphorus and calcium. All studies were inadequately powered to assess the effect of vitamin D on clinical outcomes and until such studies are conducted the relative importance of changes in serum PTH, phosphorus and calcium resulting from vitamin D therapy remain unknown. Observational data showing vitamin D compounds may be associated with improved survival in CKD need to be confirmed or refuted in specifically designed RCTs.

Objective To investigate the factors relevant to the vascular calcification in uiemic patients.Methods Eighty-five uiemic patients were enrolled in this study.The levels of fetuin-A,serum calcium,serum phosphorus,C-reactive protein and other parameters related to calcification were examined.B-ultrasound was used to detect carotid plaques.Results The Fetuin-A levels in patients with vascular calcification were significantly lower than those with non-vascular calcification[(2.34±0.95) μg/L vs (3.79±1.19) μg/L,t=5.94,P＜0.01],but serum calcium,serum phosphorus and C-reactive protein were higher than those non-vascular calcification [serum phosphorus (1.97±0.23) mmol/L vs (1.80±0.33) mmol/L,t=2.05,P＜0.05;calcium and phosphorus product (50.04±6.61) mg~2/dl~2 vs (44.84±9.75) mg~2/dl~2,t=2.05,P＜0.05;C-reactive protein (33.45±25.11)mmol/L vs (20.65±13.43) mmol/L,t=2.03,P＜0.05].Linear correlation analysis indicated that low fetuin-A level was correlated with C-reactive protein (r=-0.43,P＜0.01),calcium-phosphorus product (r=-0.32,P＜0.01),serum albumin concentration (r=0.37,P＜0.05) and phosphorus level (r=-0.36,P＜0.05).Conclusions The risk factors relevant to the vascular calcification are high serum phosphorus,calcium and phosphorus product and the micro-inflammatory status in uiemic patients.Vascular calcification is also correlated with low fetuinA level,adding exogenous Fetuin-A may become an effective means in preventing vascular calcification. Key words: Uremia; Vascular calcification; Serum phosphorus; Serum calcium; C-reactive protein

Introduction: Patient adherence is important for long-term outcomes of peritoneal dialysis (PD). Artificial intelligence is a good tool to manage patients. However, there are limited data regarding its impact on the patient adherence and the effect of patient adherence on serum phosphate, calcium, and intact parathyroid hormone (iPTH) control in PD patients. Methods: This was a single-center, prospective cohort study including PD patients in Guangdong Provincial People’s Hospital. Adult patients (age ≥18 years) who were included in the smart PD care program from September 1, 2020, to April 31, 2023, were enrolled. Patient adherence was assessed using the patient-reported daily PD prescription data and calculated as the total days with PD ultrafiltration reported divided by the total days of follow-up. Good adherence was defined as the reporting rate ≥80%. The primary outcome was serum phosphate, calcium, and iPTH values achieved the treatment targets at 12-month follow-up. Unadjusted and adjusted generalized estimating equations were used to evaluate the association of patient adherence with the serum phosphorus, serum calcium, and iPTH control. Results: A total of 267 patients were included in this study. The mean age of the whole cohort was 43.3 ± 12.8 years, 130 (48.7%) were females, and 52 (19.5%) had diabetes. Patient adherence improved after being included in the smart PD care program and the overall patient adherence during 12-month follow-up was 77.1% ± 26.4%, 93.0% ± 7.4%, and 50.9% ± 25.6% for the entire cohort, patients with good adherence, and those with poor adherence, respectively. Compared to patients with poor adherence, those with good adherence were associated with a better serum calcium (adjusted OR: 3.76; 95% CI: 2.67–5.30; p < 0.001) and iPTH control (adjusted OR: 2.20; 95% CI: 1.56–3.11; p < 0.001) but not for serum phosphorus control (adjusted OR: 1.31; 95% CI: 0.89–1.91; p = 0.17) after being adjusted for potential confounders. Results were similar when assessing the relationship between patient adherence and the longitudinal changes of serum calcium, iPTH, and phosphorus during follow-up. Conclusions: Smart PD care program was effective in improving patient adherence. Good patient adherence was associated with better serum calcium and iPTH control but not for phosphorus control in PD patients. Further studies should be done to evaluate the effect of the smart PD care program on long-term patient outcomes.

Lack of evaluations of the dietary phosphorus and dialysis phosphorus removal in daily clinical practice are common obstacles to assessing phosphorus balance and controlling phosphorus in hemodialysis patients. We aimed to investigate whether individualized therapy using a phosphorus balance calculator improves phosphorus control. A randomized, open-label, multicenter, 4-week clinical trial was conducted. A total of 119 maintenance hemodialysis patients aged 18-85years old and with serum phosphorus level >1.45mmol/L from three university teaching hospitals in Shanghai were enrolled. Patients were randomized in a 1:1 ratio to individualized therapy (n=60) or conventional therapy (n=59). The primary outcome was the serum phosphorus concentration after 4-week treatment. Secondary outcomes included the serum calcium and parathyroid hormone (PTH) concentrations, changes in serum phosphorus, calcium and PTH concentrations, and the proportion of patients achieving target ranges of serum phosphorus, calcium and PTH after 4-week treatment. Among 119 randomized participants [mean age 62years; 68 male (57%)], 116 completed the trial. Using the phosphorus balance calculator, the individualized group achieved a better phosphorus balance state and significantly reduced serum phosphorus (1.62±0.45mmol/L versus 1.85±0.45mmol/L, P=.006), increased the proportions of patients achieving target serum phosphorus range (41% versus 18%, P=.006) and had greater adjusted mean difference in change in serum phosphorus over the 4weeks (-0.47 versus -0.23mmol/L, P=.010) when compared with conventional therapy. No significant changes were observed in serum calcium and PTH levels, the proportion of patients achieving target serum calcium or PTH levels, or the adjusted mean difference of serum calcium and PTH levels over the treatment period. Phosphorus balance calculator was proved to improve serum phosphorus control in patients undergoing maintenance hemodialysis, offering a new tool for managing hyperphosphatemia.

Effects of Oral Paricalcitol on Secondary Hyperparathyroidism and Proteinuria of Kidney Transplant Patients

Aluminum Toxicity Alters the Regulation of Calbindin-D28k Protein and mRNA Expression in Chick Intestine

Introduction: Both watermelon and Persian melon extracts have various pharmacological properties like anti-diabetic, anti-viral, anti-cancer, and anti-urolithiasis effects. Objectives: The present study was conducted to investigate the effects of hydroalcoholic extracts of watermelon and Persian melon rind on kidney stone prevention in male Wistar rats. Materials and Methods: Fifty-six Wister rats were randomly divided into seven groups and treated for 28 days. The first group (healthy control) and the second group (negative control) received drinking water and water containing 1% ethylene glycol, respectively. The third and fourth groups, received 100 mg/kg/d hydroalcoholic extract of watermelon rind and Persian melon rind, respectively in addition to 1% ethylene glycol. The fifth and sixth groups, received 400 mg/kg/d hydroalcoholic extract of watermelon rind and Persian melon rind, respectively in addition to 1% ethylene glycol. The seventh group received 0.5 mEq/kg/d potassium citrate in addition to 1% ethylene glycol for prevention and treatment of kidney stone. A 24-hour urine collection was conducted to determine the levels of sodium, calcium, uric acid, oxalate and citrate concentration. Histological study of calcium oxalate crystals was also performed. The serum levels of urea, creatinine, uric acid, calcium, phosphorus, magnesium, SGPT (serum glutamic-pyruvic transaminase), SGOT (serum glutamic-oxaloacetic transaminase), total antioxidant capacity, and malondialdehyde (MDA) of blood were determined accordingly. Results: In the present study, administration of high-dose extract of watermelon and Persian melon rind (400 mg/kg/d) and potassium citrate showed significant changes in variables of sodium, calcium, uric acid, citrate, urine volume (P&lt;0.01), blood creatinine, blood uric acid, blood calcium, and serum SGPT (P&lt;0.05). The histological study of calcium oxalate crystals showed a significant reduction in oxalate levels in all prevention groups. Conclusion: The extracts of watermelon and Persian melon rind are effective in preventing calcium oxalate stones by decreasing the levels of oxalate, sodium, and calcium and increasing citrate levels and urine volume and affecting the total antioxidant capacity. Persian melon rind extract was more effective than potassium citrate and watermelon rind extract in reducing urine sodium. High-dose watermelon rind extract showed similar effects as potassium citrate.

Gout is well known to be produced by increased uric acid level in blood. The objective of this paper is to assess the relationship between gout and calcium oxalate stone formation in the humans. 48 patients with combination of gout and calcium oxalate stone problem were included. The biochemical values of this group were compared with 38 randomly selected uric acid stone patients with gout, 43 stone patients with gout alone, 100 calcium oxalate stone patients without gout and 30 controls, making a total of 259 patients. Various biochemical parameters, namely serum calcium, phosphorus and uric acid and 24-h urine calcium, phosphorus, uric acid, oxalate, citrate and magnesium were analysed. ANOVA and Duncan's multiple-range tests were performed to assess statistical significance of the variations. The promoters of stone formation, namely serum calcium (P < 0.05), phosphorus (P < 0.05) and uric acid (P < 0.05) and urine calcium (P < 0.05), uric acid (P < 0.05) and oxalate (P < 0.05) were significantly variable in the different groups. The inhibitor citrate (P < 0.05) was also significantly variable. Multiple-range test showed that the promoters, namely serum calcium (P < 0.05) and urine uric acid (P < 0.05) were in a significantly higher range in the gouty patients, gouty uric acid stone patients and gouty calcium oxalate stone patients compared to the non-gouty patients and controls. Urine oxalate (P < 0.0001) was in the highest range in the gouty calcium oxalate or gouty uric acid stones patients. The inhibitor urine citrate (P < 0.001) was significantly lower in the gouty, gouty uric acid and gouty calcium oxalate patients. Serum uric acid was highest in the non-stone gouty patients, followed by the gouty uric acid stone formers and gouty calcium oxalate stone patients. The high values of promoters, namely uric acid and calcium in the gouty stone patients indicate the tendency for urinary stone formation in the gouty stone patients. There is probably a correlation between gout and calcium oxalate urinary stone. We presume this mechanism is achieved through the uric acid metabolism. The findings point to the summation effect of metabolic changes in development of stone disease.

Uric acid (UA) might be linked to bone health, but it is unclear whether its effects on bone are limited to certain population subgroups. This study is aimed at investigating the correlation between serum uric acid levels and bone mineral density (BMD) in Iranian adolescents. This cross-sectional study was conducted on 413 (221 girls and 192 boys) Iranian adolescents aged 9-19years. An analysis of anthropometric, biochemical parameters and bone density was performed on the participants. Measurements included serum uric acid, calcium, phosphorus, alkaline phosphatase, albumin, and vitamin D. They were divided according to their serum UA into the low UA group who had UA ≤ 6mg/dL and the high UA group with UA > 6mg/dL. BMD and bone mineral content (BMC) were measured in the total body, lumbar spine, and left femoral neck, using dual energy X-ray absorptiometry (DXA), and bone mineral apparent density (BMAD) was calculated. A Pearson correlation analysis revealed a significant correlation between UA and bone parameters. In multiple regression analyses adjusted for potential confounders, serum UA was proven to be associated with BMD and BMC at all sites. There was no association between UA, serum calcium, and vitamin D concentrations. Our study, as the first research on adolescents, demonstrated a higher bone density in those who had higher UA levels.

To investigate the serum calcium level in 86 patients with newly diagnosed multiple myeloma (MM) and its correlation with clinical features. The clinical data of 86 patients with newly diagnosed multiple myeloma in our hospital from 2009 to 2016 were retrospectively analyed. Clinical data of sex, age, hemoglobin, albumin, globulin, creatinine, uric acid, serum phosphorus, β2-microglobulin, immunophenotyping and disease staging were collected. After the serum calcium level was corrected, the patients were grouped into low serum calcium (<2.20 mmol/L), normal serum calcium (2.20-2.60 mmol/L) and high serum calcium (>2.60 mmol/L). The correlation between the clinical characteristics and the serum calcium level was analysed, the clinical characteristics between the low and non-low calcium group were compared. The number of cases in low, normal and high serum cnlcium groups before correction was 58 (67.4%), 18 (20.9%) and 10 (11.6%) respactively, while the number of cases in 3 group after correction was 34 (39.5%), 36 (41.9%) and 16 (18.6%) respectively. The age, globulin, creatinine, uric acid and serum phosphorus levels were positively correlated with serum calcium level in patients with multiple myeloma, while the sex, hemoglobin,albumin and β2-microglobulin levels did not correlated with serum calcium level. There was significant difference in the age, globulin, creatinine and serum phosphorus between low calcium and non-low calcium group (P<0.05). However the differences of sex, hemoglobin, albumin, uric acid, β2-microglobulin, immunophenotyping and clinical stage were not statistically significant (P>0.05). Multiple myeloma patients suffered from both hypercalcemia and hypocalcemia, and the incidence of hypocalcemia is not low. The levels of serum calcium in patients with multiple myeloma correlate with age, globulin, creatinine, uric acid, serum phosphorus level and other factors, thus it is necessary to correct the level of ionized calcium with physiological activity.

BackgroundDisorders of calcium and phosphorus metabolism have been reported to be associated with all-cause and cardiovascular mortality in patients requiring long-term dialysis therapy. However, its role in disease progression is not well established in patients without dialysis, especially in immunoglobulin A (IgA) nephropathy. We aim to evaluate the association of serum phosphorus and calcium and progression of IgA nephropathy.MethodsWe assessed 2567 patients with IgA nephropathy at the First Affiliated Hospital, College of Medicine, Zhejiang University. Serum phosphorus and calcium were collected at the time of kidney biopsy and at each visit. The associations of serum phosphorus and serum calcium with composite kidney disease progression events, defined as 50% estimated glomerular filtration rate (eGFR) decline and kidney failure, were examined using Cox models and restricted cubic splines.ResultsDuring a median follow-up of 31.9 months, 248 (10%) patients reached composite kidney disease progression events. A linear relationship was observed between serum phosphorus and composite kidney disease progression events. With higher levels of phosphorus, the risk of kidney disease progression events increased {hazard ratio [HR] 3.54 [95% confidence interval (CI) 1.37–9.12]; P = 0.009}. Compared with the first quartile group, the HR of kidney disease progression events was 1.66 (95% CI 0.91–301) for the second quartile, 1.67 (95% CI 0.91–3.08) for the third and 2.62 (95% CI 1.44–4.77) for the fourth (P for trend = 0.002). The association between serum phosphorus and kidney disease progression was detectable [HR 8.94 (95% CI 2.33–34.21); P = 0.001] within the subgroup with eGFR <60 mL/min/1.73 m2 but not among patients with eGFR ≥60 mL/min/1.73 m2 [HR 0.87 (95% CI 0.17–4.44); P = 0.87]. After adjustment for traditional risk factors, a higher level of serum calcium was not associated with kidney disease progression events [HR 0.33 (95% CI 0.10–1.09)].ConclusionsHigher serum phosphorus rather than serum calcium was independently associated with kidney disease progression in IgA nephropathy.

BAKCGROUND: Urinary stones disease is common pathology encountered in urological practice in Nepal. Supersaturated urine and its stagnation are well known facts for the development of urolithiasis. Metabolic disorders like hypercalciuria, hyperuricaemia, hypocitraturia are also responsible for formation of urolithiasis. The aim of this study was to identify the level of calcium, phosphorus, uric acid, and magnesium in the blood and urine of Nepalese patients with urinary stones. This study was conducted over a period of six months (From May to November 2010). It is a descriptive cross sectional study and quantitative method was used for analysis. Primary data were collected and utilized from 79 cases. The prevalence of urolithiasis in male patients was 65.8% and 34.2% in female patients (p less than 0.05). Serum calcium in stone former and non-stone former was 8.3+/-1.2 and 7.5+/-1.5 (p less than 0.01) respectively. Serum phosphorus and uric acid in both groups were statistically not significant (p value 0.269 and 0.597 respectively) though in 24 hours urine of stone formers value of phosphorus was 447.9+/-182.4 but in non-stone formers it was 186.5+/-118.7 (p less than 0.001). Magnesium level in urine was 48.1+/-69.7 and 131.4+/-86.9 (p less than 0.001) respectively. Higher level of calcium in serum was found in patients with urolithiasis in our population. Though phosphate level in blood serum was not different in the both groups but in urine phosphate and magnesium levels were significantly different.