Blood Phosphorus Concentrations Research Articles

High plasma magnesium and phosphorus levels and their correlation with struvite urolithiasis in buffaloes

BackgroundUrolithiasis is a common urinary tract disease in buffaloes, almost exclusively affects young males, and has significant economic and production impacts. We have investigated hemato-biochemical and urinary changes in an attempt to deduce their correlation with struvite urolithiasis in buffaloes. MethodsTen male buffalo calves with obstructive urolithiasis were used. Blood samples were used for hematology and elemental analysis. Urine samples were used for physico-chemical examination, microscopy, and elemental analysis. Uroliths were subjected to chemical functional group determination using the FTIR spectroscopy. ResultsThe mean neutrophil, leukocyte, and neutrophil-to-lymphocyte ratio was significantly (p < 0.05) higher in urolithic buffaloes than in healthy controls. The mean blood calcium and magnesium concentrations were significantly (p < 0.05) lower and higher in urolithic buffaloes than in healthy controls, respectively. Mean blood phosphorus concentration and calcium-phosphorus ratio were found to be non-significantly (p > 0.05) higher and lower in urolithic buffaloes than in healthy controls, respectively. The urine pH was highly alkaline. Multiple prismatic lid-shaped crystals, along with erythrocytes, leukocytes, and epithelial cells, were found in urine. The mean urinary magnesium and phosphorus concentrations were non-significantly (p < 0.05) higher in urolithic buffaloes than in healthy controls. A positive correlation of magnesium (r = 0.864, p = 0.001) and phosphorus (r = 0.849, p = 0.002) concentrations between the blood and urine was observed in urolithic buffaloes. The FTIR spectra of uroliths were similar to those of magnesium ammonium phosphate hexahydrate, MgNH4PO4·6H2O or struvite. ConclusionThe findings suggest that high plasma magnesium and phosphorus concentrations have a positive correlation with struvite urolithiasis in buffaloes.

Blood fibroblast growth factor 23 concentration in cats with and without chronic kidney disease: a scoping review.

This study undertook a scoping review of research on blood fibroblast growth factor 23 (FGF-23) concentrations in healthy non-azotemic cats and cats with chronic kidney disease (CKD) to describe the volume and nature of existing literature, to determine whether published studies provide adequate evidence to support the use of FGF-23 as a biomarker in clinical practice and to identify any existing gaps in knowledge. PRISMA Extension for Scoping Reviews guidelines were used to design and perform the scoping review. Online databases were used to identify observational and clinical studies of blood FGF-23 concentrations in healthy cats and cats with CKD published before December 2022. Study and population characteristics and descriptive data on FGF-23 concentrations were extracted. A total of 205 publications were reviewed; 17 were retained for inclusion. Most studies were retrospective. Most studies included cats with International Renal Interest Society stage 2-4 CKD, with some variation. Key concepts explored in the literature include FGF-23 concentrations by CKD stage, effect of dietary phosphate restriction on FGF-23 concentrations, relationship between FGF-23 concentrations and blood phosphorus, calcium and magnesium concentrations, and FGF-23 concentrations in cats with progressive CKD. FGF-23 concentrations tended to be higher in cats with CKD compared with healthy cats, with an overlap between healthy and CKD populations, and there was significant variation within stages of CKD. FGF-23 is a biomarker of interest for the management and monitoring of phosphate overload in cats. Studies support several potential clinical applications for measuring FGF-23 concentration in practice; however, evidence is limited. Research on FGF-23 in cats with CKD would benefit from longitudinal, prospective studies that standardize CKD diagnosis and categorize cats by stage using current guidelines. Studies should include cats with early-stage, non-azotemic CKD and use commercially available assays so such results are comparable across studies.

Effect of a plant protein-rich diet on postprandial phosphate metabolism in healthy adult men: a randomised controlled trial.

This study examined the effects of animal protein- and plant protein-rich diets on postprandial phosphorus metabolism in healthy male subjects. The study was conducted by randomised parallel-group comparison of healthy men aged 21-24 years. In Study 1, participants were divided into two groups and consumed either a 70% animal protein diet (AD, n = 6) or a 70% plant protein diet (PD, n = 6). In Study 2, participants were divided into three groups and consumed either AD (n = 10), PD (n = 10) or AD + DF, a 70% animal protein diet loaded with the same amount of fibre as PD (n = 9). The phosphorus contents of the diets used in this study were nearly equivalent (AD, 710.1 mg; PD, 709.7 mg; AD + DF, 708.9 mg). Blood and urine samples were collected before, and 2 and 4 h after the meal to measure phosphorus and calcium levels. In Study 1, PD consumption resulted in lower blood and urinary phosphorus concentrations 2 h postprandially compared with AD (p < 0.05). In Study 2, blood phosphorus levels in AD + DF after the diet remained lower, but not significantly so compared with AD, and urinary phosphorus levels were significantly lower 2 h postprandially (p < 0.05). A plant protein-rich diet reduced rapid postprandial increases in blood and urinary phosphorus concentrations compared with the animal protein-rich diets, suggesting that dietary fibre may play a partial role in the postprandial decreases in blood and urinary phosphorus concentrations.

The contribution of a novel PHEX gene mutation to X-linked hypophosphatemic rickets: a case report and an analysis of the gene mutation dosage effect in a rat model.

A Chinese family was identified to have two patients with rickets, an adult female and a male child (proband), both exhibiting signs related to X-linked hypophosphatemic rickets (XLH). Gene sequencing analysis revealed a deletion of adenine at position 1985 (c.1985delA) in the PHEX-encoding gene. To investigate the relationship between this mutation and the pathogenicity of XLH, as well as analyze the effects of different dosages of PHEX gene mutations on clinical phenotypes, we developed a rat model carrying the PHEX deletion mutation. The CRISPR/Cas9 gene editing technology was employed to construct the rat model with the PHEX gene mutation (c.1985delA). Through reproductive procedures, five genotypes of rats were obtained: female wild type (X/X), female heterozygous (-/X), female homozygous wild type (-/-), male wild type (X/Y), and male hemizygous (-/Y). The rats with different genotypes underwent analysis of growth, serum biochemical parameters, and bone microstructure. The results demonstrated the successful generation of a stable rat model inheriting the PHEX gene mutation. Compared to the wild-type rats, the mutant rats displayed delayed growth, shorter femurs, and significantly reduced bone mass. Among the female rats, the homozygous individuals exhibited the smallest body size, decreased bone mass, shortest femur length, and severe deformities. Moreover, the mutant rats showed significantly lower blood phosphorus concentration, elevated levels of FGF23 and alkaline phosphatase, and increased expression of phosphorus regulators. In conclusion, the XLH rat model with the PHEX gene mutation dosage demonstrated its impact on growth and development, serum biochemical parameters, and femoral morphology.

ДИНАМИКА СОДЕРЖАНИЯ ФОСФОРА СЫВОРОТКИ КРОВИ У ПАЦИЕНТОВ ПРИ КАРДИОХИРУРГИЧЕСКИХ ОПЕРАЦИЯХ

Perioperative phosphorus monitoring should be used to prevent the complications after cardiac surgery and, as a result, to reduce the length of intensive care and hospital stay. The purpose of the study was to describe the change in blood phosphorus concentrations in open heart cardiopulmonary bypass surgery patients over time. Material and methods. A prospective non-randomized cohort study was performed. The change in phosphorus concentrations was assessed in 45 adult patients admitted to the Cardiac Surgery Department for an open heart cardiopulmonary bypass surgery. All patients gave venous blood samples at the following sampling time points: 1 – before the surgery; 2 – at 24 hours after the start of the surgery, 3 and 4 – at 48 hours and 72 hours, respectively. Phosphorus concentrations were assayed by photometry at the clinical biochemistry laboratory. Results. A phase change in phosphorus concentrations was observed during the postoperative period vs. preoperative period. Blood phosphorus levels showed statistically significant increase vs. baseline by 0,193, 0,2 and 0,34 mmol/L at 24-, 48- and 72-hours post-surgery, respectively. In 33.3% of patients, hypophosphataemia of less than 0,8 mmol/L was seen at 48 hours. The change in phosphorus concentrations over time in patients with and without creatine phosphate administration was studied. Intraoperative creatine phosphate therapy did not affect the postoperative phosphorus levels. Conclusions. In the postoperative period of cardiosurgical interventions using cardiopulmonary bypass, it is necessary to control the content of phosphorus in the blood serum and, if hypophosphatemia develops, to perform the introduction of phosphates.

Arginine, symmetric and asymmetric dimethylarginine levels in canine leishmaniasis

The study aimed to investigate the levels of arginine, symmetric dimethylarginine (SDMA), and asymmetric dimethylarginine (ADMA) in dogs with canine leishmaniasis (CanL) and their relationship with some renal and cardiovascular parameters. A total of 60 dogs were enrolled, including 40 with CanL and 20 healthy controls. The CanL group was divided into four stages based on clinical and laboratory findings. The levels of plasma arginine, SDMA, and ADMA were determined by high performance liquid chromatography (HPLC). The data from the healthy group were compared with those from the CanL group, and according to the stages. In dogs with CanL, systolic and diastolic blood pressure, plasma creatinine, cystatin-C, phosphorus, potassium, and low-density lipoprotein concentrations, the urine protein/creatinine ratio, the amount of nitric oxide, and creatine kinase-MB activity were higher, while the high-density lipoprotein concentration was lower compared to healthy controls. The concentration of arginine was low (p < 0.05) and the levels of ADMA (p < 0.001) and SDMA (p < 0.05) were high in dogs with CanL. There were no statistically significant differences in arginine concentration among the different stages of CanL. However, the concentration of plasma ADMA was higher in all stages of CanL compared to the healthy group, and the concentration of plasma SDMA was higher in Stage IV compared to the healthy group and Stage III. The present study demonstrates for the first time a decrease in arginine concentration and an increase in ADMA concentration in dogs with CanL. The increase in SDMA concentration in dogs with CanL was consistent with previous studies. However, compared to other renal parameters, SDMA exhibited limited performance distinguishing between clinical stages of CanL. These findings could be a source for future diagnostic and therapeutic studies to explain the renal and cardiovascular pathophysiology of CanL. Additional clinical studies that include treatment and patient follow-up with an assessment of the acute phase response are needed to provide a more detailed understanding of the changes observed in dogs with CanL.

Serum Concentrations and Dietary Intake of Vitamin B12 in Children and Adolescents on Metformin: A Case–Control Study

The International Society of Pediatric and Adolescent Diabetes (ISPAD) recommends metformin (MET) use for metabolic disturbances and hyperglycemia, either in combination with insulin therapy or alone. A caveat of MET therapy has been suggested to be biochemical vitamin B12 deficiency, as seen mainly in studies conducted in adults. In the present case-control study, children and adolescents of different weight status tiers on MET therapy for a median of 17 months formed the cases group (n = 23) and were compared with their peers not taking MET (n = 46). Anthropometry, dietary intake, and blood assays were recorded for both groups. MET group members were older, heavier, and taller compared with the controls, although BMI z-scores did not differ. In parallel, blood phosphorus and alkaline phosphatase (ALP) concentrations were lower in the MET group, whereas MCV, Δ4-androstenedione, and DHEA-S were higher. No differences were observed in the HOMA-IR, SHBG, hemoglobin, HbA1c, vitamin B12, or serum 25(OH)D3 concentrations between groups. Among those on MET, 17.4% exhibited vitamin B12 deficiency, whereas none of the controls had low vitamin B12 concentrations. Participants on MET therapy consumed less energy concerning their requirements, less vitamin B12, more carbohydrates (as a percentage of the energy intake), and fewer fats (including saturated and trans fats) compared with their peers not on MET. None of the children received oral nutrient supplements with vitamin B12. The results suggest that, in children and adolescents on MET therapy, the dietary intake of vitamin B12 is suboptimal, with the median coverage reaching 54% of the age- and sex-specific recommended daily allowance. This low dietary intake, paired with MET, may act synergistically in reducing the circulating vitamin B12 concentrations. Thus, caution is required when prescribing MET in children and adolescents, and replacement is warranted.

Effects of new antiseizure medication on bone metabolism and bone mineral density in children: A meta-analysis.

To explore the effect of new antiseizure medication on bone metabolism and bone mineral density in children. The Chinese and English databases (PubMed, EMBASE, Cochrane Library, CNKI, Wanfang and VIP) were systematically searched for observational studies evaluating the effects of new antiseizure medication on bone metabolism and bone mineral density in children with epilepsy. The effects of new antiseizure medication on serum calcium, phosphorus, alkaline phosphatase, bone alkaline phosphatase, parathyroid hormone, 25-hydroxyvitamin D and bone mineral density in children were systematically evaluated. After systematic retrieval and screening, 12 studies with high literature quality (including 629 epileptic children and 627 control subjects) were included in the systematic evaluation. Meta-analysis showed that new antiseizure medication decreased bone mineral density (MD: -0.05, 95%CI, -0.09, -0.02; P = 0.004). From different kinds of antiseizure medication, levetiracetam can reduce blood phosphorus concentration in children (MD: -0.04; 95%CI, -0.07, -0.01). Oxcarbazepine increased serum alkaline phosphatase in children (MD:17.98; 95%CI, 10.43,25.53; P < 0.00001), and the increase intensity was significantly higher than that of levetiracetam (MD: 7.66; 95%CI, 0.29, 15.02; P = 0.04). In addition, oxcarbazepine can cause a significant increase in parathyroid hormone in children (MD: 7.52; 95%CI, 3.37,11.66; P = 0.0004), and 25 - hydroxyvitamin D was reduced, and the difference was statistically significant (MD:-2.18; 95%CI, -3.23, -1.13; P = 0.00006). However, the effects of new antiseizure medication on serum calcium and bone alkaline phosphatase in children were not statistically significant. New antiseizure medication have different effects on bone metabolism and bone mineral density in children with epilepsy, and the effects of different types of new antiseizure medication are different.

Effects of prepartum diet grain type and postpartum starch level on milk production, milk composition, and plasma metabolites of primiparous and multiparous Holstein cows

The study investigated the carry-over effects of prepartum diet fermentability, on productivity and metabolic status of cows that received two levels of starch during early lactation. For this aim, 49 multiparous (body condition score [BSC] of 3.63 ± 0.06) and 36 primiparous (3.66 ± 0.05 BCS) Holstein cows were placed in four free stall barns from 20.6 ± 3 days before expected parturition. Immediately, the cows were fed one of the two diets: (1) a diet with high barley grain content (BARL; 20 primiparous and 26 multiparous) and (2) a diet with a high corn grain content (CRN; 16 primiparous and 23 multiparous). After parturition, all cows were randomly assigned in a 2 × 2 factorial design to each of the two post-partum diets differing in the level of starch: (1) high (HS) or/and (2) low starch (LS) diets. All cows received postpartum diets until 21 days in milk (DIM). Blood samples from each cow were taken at calving and 21 DIM. Colostrum samples were taken from all animals immediately after parturition, and milk yield and composition were determined and analyzed in a weekly basis. The interaction effect of parity and grain type at prepartum period was not significant for BCS of cows at calving as well as BW and serum IgG concentration in calves (at 24 h of life) in both primiparous and multiparous cows (P > 0.05). The interactions of grain type, starch level and parity were not significant for any variables of BCS, milk yield and composition except for milk fat (P = 0.05). Alkaline phosphatase activity in blood was greater at calving in CRN- cows than in BARL-fed cows (P = 0.04). Regardless of parity, blood phosphorus was the only variable for which a tendency was observed for dietary treatments effects, as cows fed BARL (P = 0.09; 5.43 vs. 5.02 ± 0.24) and LS diets (P = 0.08; 5.44 vs. 5.02 ± 0.24) had higher blood phosphorus concentration compared with CORN-HS diets respectively. Our data showed that the metabolic and productive performances of primi- and multiparous animals did not change considerably by diet grain type at prepartum, level of starch at postpartum or their interaction. We concluded that diet grain type or level of starch may not be an important factor for changing metabolic status or productive performance of periparturient cows when diets have similar net energy of lactation.

Hematologic and plasma biochemical prognostic indicators for stranded free-ranging phocids presented for rehabilitation

This retrospective study used data obtained from medical records of 530 stranded free-ranging harbor (Phoca vitulina), grey (Halichoerus grypus), harp (Pagophilus groenlandicus), and hooded seals (Cystophora cristata) presented to the Marine Mammal Stranding Center in Brigantine, New Jersey from January 1998 through December 2016. The objective was to identify hematological and plasma biochemical parameters of seals at time of presentation that were associated with successful rehabilitation and with duration of hospitalization using univariate and multivariate logistic regressions. At presentation, animals that subsequently survived rehabilitation had greater alkaline phosphatase activity and absolute lymphocyte and total calcium concentrations and lower blood urea nitrogen, sodium, chloride, phosphorus, and total bilirubin concentrations and lower aspartate aminotransferase and alanine aminotransferase activities than animals that eventually died or were euthanized while under care. Results suggest that young, actively growing animals are more likely to survive rehabilitation and that bloodwork consistent with dehydration, systemic disease, and exhaustion are negative prognostic indicators. These results provide prognostic indicators that may aid clinical decision-making for seals presented for rehabilitation.

Blood concentration of symmetric dimethylarginine correlates with kidney damage as assessed with a proposed histologic grading system for chronic kidney disease in tigers (Panthera tigris).

To determine the utility of blood symmetric dimethylarginine (SDMA) concentration measurement as a diagnostic tool for chronic kidney disease (CKD) in tigers (Panthera tigris) by comparing results for SDMA with those for traditional renal biomarkers and investigating correlations between these biomarkers and histopathologic kidney changes in tigers with CKD. Blood, urine, and kidney samples from 35 tigers with CKD from 2 sanctuaries. Blood (serum or plasma) and urine samples were collected antemortem. Necropsy, including gross and histologic assessment, was performed for tigers that died or were euthanized for quality-of-life reasons. Results for CKD biomarkers in blood (BUN, creatinine, phosphorus, and SDMA concentrations) and urine (protein concentration, urine protein-to-creatinine ratio, and urine specific gravity) were evaluated for correlation with histologic kidney damage scored with an objective grading scale defined by percentage of inflammation, fibrosis, and tubular atrophy. Symmetric dimethylarginine had the strongest significant correlation (ρ = 0.667) with histologic kidney damage score, followed by urine specific gravity (ρ = -0.639), blood creatinine concentration (ρ = 0.624), and BUN (ρ = 0.588). No significant correlation with kidney score was identified for blood phosphorus concentration, urine protein concentration, or the urine protein-to-creatinine ratio. We recommend SDMA be prioritized as a renal biomarker in tigers, with SDMA results considered in addition to those of other traditional renal biomarkers when assessing kidney function in tigers. Additionally, the grading scale we developed could be replicated across patients and pathologists for more consistent postmortem assessment of CKD in tigers.

Identification of risk factors for iatrogenic hypophosphatemia: A retrospective case-control study.

To investigate the iatrogenic risk factors for hypophosphatemia in intensive care unit (ICU) patients. A total of 120 patients were enrolled and further divided into 4 groups, namely normal, mild, moderate or severe, according to the degree of hypophosphatemia. A number of related factors were analyzed and compared among the 4 groups, including the treatment method and outcomes. Univariate and multivariate regression analyses were employed to identify and confirm the risk factors associated with the occurrence of hypophosphatemia. The results revealed that the acute physiology and chronic health evaluation II (APACHEII), Sequential Organ Failure Assessment (SOFA), modified NUTrition Risk in Critically ill (NUTRIC) scores as well as the length of patient stays in ICUs exhibited a gradually increasing trend of aggravation of hypophosphatemia. Univariate regression analysis identified the use of dehydrating drugs to be closely associated with the occurrence of hypophosphatemia, which was further confirmed by a multivariate regression analysis. The use of dehydrating drugs led to hypophosphatemia; therefore blood phosphorus concentrations should be closely monitored during treatment of ICU patients.

Changes in the nutritional status of nine vitamins in patients with esophageal cancer during chemotherapy.

BACKGROUNDMany studies have investigated the relationships between vitamins and esophageal cancer (EC). Most of these studies focused on the roles of vitamins in the prevention and treatment of EC, and few studies have examined the changes in vitamin nutritional status and their influencing factors before and after chemotherapy for EC. Chemotherapy may have a considerable effect on EC patients’ vitamin levels and hematological indicators.AIMTo research the nutritional status of multiple vitamins in EC patients during chemotherapy and to assess its clinical significance. METHODSEC patients admitted to our center from July 2017 to September 2020 were enrolled in this study. Serum concentrations of nine vitamins (A, D, E, B9, B12, B1, C, B2 and B6), hemoglobin, total protein, albumin, blood calcium, blood phosphorus concentrations and body mass index (BMI) were measured in all EC patients. The changes in nine vitamins, hematological indicators and BMI were compared before and after two cycles of chemotherapy. The possible influential factors were analyzed.RESULTSIn total, 203 EC patients receiving chemotherapy were enrolled in this study. Varying degrees of vitamin A, D, C and B2 deficiency and weight loss were found in these patients, and the proportions of vitamin B2 and vitamin C deficiencies increased significantly after chemotherapy (both P < 0.05). Serum concentrations of vitamins A, C, B2 and B6 and BMI before and after chemotherapy were statistically significant (all P < 0.05). Multivariate analysis showed that vitamin A levels significantly differed between male and female EC patients, whereas vitamin D concentration significantly differed in EC patients in different stages (all P < 0.05). Correlations were observed between the changes in serum concentrations of vitamin A and C before and after two cycles chemotherapy and the change in BMI (P < 0.05). Hemoglobin, total protein, serum albumin and blood calcium concentrations significantly decreased in EC patients after chemotherapy (all P < 0.05), while the blood phosphorus level significantly increased after chemotherapy (P < 0.05). Using the difference in vitamin concentrations as the independent variables and the difference in BMI as the dependent variable, logistic regression analysis revealed statistically significant differences for vitamin A, vitamin D and vitamin C (F = 5.082, P = 0.002). CONCLUSIONVitamin A, D, C and B2 were mainly deficient in patients with EC during chemotherapy. Multivitamin supplementation may help to improve the nutritional status, chemotherapy tolerance and efficacy.

Incidence, clinical patterns, and risk factors of postpartum uterine diseases in dairy cows from high-altitude tropical herds

The cow's uterus sustains bacterial contamination and active inflammation after calving as part of the normal physiological process of uterine involution. Although the definition, incidence, and risk factors for postpartum uterine diseases (PUD) have been documented in annual calving systems with high-producing cows on total mixed ration, the literature contains little information for other production systems. The objective of this study was to quantify the incidence risk and factors associated with metritis, clinical endometritis, and cytological endometritis in high-altitude tropical dairy herds in a pasture-based system. A total of 248 cows from 5 commercial dairy herds in northern Antioquia, Colombia, were enrolled in this prospective observational longitudinal cohort study. Data collection and PUD diagnosis were performed at d 0, 3, 10, 17, 24, 31, 38, 45, and 52 (±1) after parturition. Between 60 and 70 d, cows were systematically enrolled in a synchronization protocol, and herds were visited monthly for pregnancy diagnosis until 180 ±15 d. The multivariable logistic regression model of variables associated with PUD occurrence included (a) parity, season of calving, transition diet, and body condition score at calving; (b) blood calcium, phosphorus, and magnesium concentrations, and milk urea nitrogen, β-hydroxybutyrate and fat-to-protein ratio; and (c) dystocia, retained placenta, and delayed uterine involution. The incidences of puerperal metritis, clinical metritis (MET), clinical endometritis (CE), and cytological endometritis (CYTO) were 2.8, 25, 29, and 26%, respectively. Retained placenta and dystocia were associated with MET, and MET was associated with CE. Low blood calcium concentration at calving was associated with CYTO. Overall, 51.2% of the cows suffered at least 1 category of PUD during the first 60 d postpartum (DPP). However, cows also suffered from different consecutive clinical events of PUD (MET, CE, and CYTO) during the follow-up period (0 to 180 ±15 DPP). These events could be grouped into 4 types (which were referred to as "clinical patterns") based on interactions between MET, CE, and CYTO.

Novel sliding hybrid microchip detection system for determination of whole blood phosphorus concentration

A novel detection system consisting of a three-dimensional (3-D) sliding hybrid microchip (SHM) and a smart analysis device is presented to determine the phosphorus concentration in whole blood samples. The novelty of the SHM detection system includes filtering whole blood directly into serum, reacting different reagents in stages, performing a closed-type reaction to prevent evaporation of the test sample and uniform heating. The SHM is fabricated on PET and PMMA substrates and incorporates a sample injection zone, a filter paper-strip, two paper-chip reagent zones (reagent A and reagent B), and a detection zone. In the proposed detection method, 6 μL of whole blood sample is injected into the sample chamber and is filtered / separated by the paper-strip as it diffuses toward reagent zone A under the effects of capillary action. After 1 min, the sliding mechanism of the SHM is activated such that reagent zone B is positioned over reagent zone A in the detection/reaction zone. The SHM is then inserted into the smart analysis device and heated at 35°C for 4 min to prompt a modified molybdenum blue reaction. Finally, the blood phosphorus concentration is measured through a colorimetric method performed by a self-developed color analysis app installed on a smartphone. The feasibility of the current SHM detection system is demonstrated by the known control serum phosphorus concentrations ranging from 0.1–9 mg/dL. It is shown that the total R + B + G color intensity of the reaction complex image (Y) is linearly related to the serum phosphorus concentration (X) as Y = -31.502X + 600.740. The coefficient of determination (R2) and detection limit are 0.9936 and 0.06 mg/dL, respectively. The phosphorus concentration detection results obtained using the current SHM system for the whole blood samples of 100 real-world chronic kidney disease (CKD) patients are shown to be in excellent consistent with the detection results acquired through a macroscopic technique. Overall, the current SHM detection system provides a rapid and reliable method to detect the phosphorus concentration in whole blood samples.

Effect of Calcium Carbonate Level with or without Benzoic Acid on Weanling Pig Growth Performance, Fecal Dry Matter, and Blood Calcium and Phosphorus Concentrations

Effect of Calcium Carbonate Level with or without Benzoic Acid on Weanling Pig Growth Performance, Fecal Dry Matter, and Blood Calcium and Phosphorus Concentrations

Eight novel KCNJ1 variants and parathyroid hormone overaction or resistance in 5 probands with Bartter syndrome type 2

PurposeBartter syndrome type 2 (BS2) is an autosomal recessive renal tubular disorder, which is caused by the mutations in KCNJ1. This study was designed to analyze and describe the genotype and clinical features of five Chinese probands with BS2. MethodsIdentify KCNJ1 gene variants by the next generation sequencing and evaluate their mutation effects according to 2015 American College of Medical Genetics and Genomics (ACMG) standards and guidelines. ResultsTen variants including eight novel ones of KCNJ1 gene were found, the most common type was missense variant. The common symptoms and signs from high to low incidence were: polydipsia and polyuria (5/5), one of them (1/5) presented with diabetes insipidus; maternal polyhydramnios and premature delivery (4/5); growth retardation (3/5). Two patients presented with hypochloremic metabolic alkalosis and hypokalemia; whereas the acid-base disturbance was absent in the others. One patient had evident parathyroid hormone (PTH) resistance (hypocalcemia, hyperphosphatemia and markedly elevated PTH levels), three presented with PTH overacting (hypercalcemia, hypophosphatemia and mild elevated PTH levels), and one showed normal blood calcium and phosphorus concentrations with high-normal PTH levels. All patients had nephrocalcinosis and/or hypercalciuria, and one of them complicated with nephrolithiasis. Indomethacin has significant therapeutic effect on the growth retardation, polydipsia and polyuria and treatment was associated with a decrease in urine calcium excretion, normalization of electrolyte disturbance and PTH parameters. ConclusionsTen variants of KCNJ1 gene were identified in five Chinese probands. These patients had atypical BS phenotype lacking evident metabolic alkalosis and/or manifesting with PTH overaction/resistance, which reminds clinicians to carefully differentiate BS2 with other parathyroid disorders. This is the first report of BS2 from Chinese populations.

Investigation on urinary and serum alpha klotho in dogs with chronic kidney disease

BackgroundAs a co-receptor for fibroblast growth factor 23, klotho plays a pivotal role in phosphate metabolism. The kidney is known to be the main source of soluble alpha-klotho and the principal regulator of its concentration. Previous studies in human participants showed that the concentration of soluble alpha-klotho in serum and urine decreased in chronic kidney disease (CKD) patients. However, no previous study has assessed soluble alpha-klotho levels in dogs. This study aimed to measure serum and urinary alpha-klotho levels in CKD dogs and identify their associations with International Renal Interest Society (IRIS) CKD stages and other parameters known to be associated with CKD.ResultsSerum and urinary alpha klotho concentrations were measured by a commercially available canine-specific sandwich enzyme-linked immunosorbent assay kit and compared between groups by a nonparametric Kruskal–Wallis test. Spearman’s correlation coefficient was used to evaluate the relationships between variables. A stepwise multiple regression analysis was performed to estimate the effects of independent predictors on klotho concentrations. The urine klotho-to-creatinine ratio (UrKl/Cr) was significantly lower in stage 3 dogs than the control group and was significantly lower in dogs with stage 3 and 4 CKD than in those with stage 1 and 2 disease. UrKl/Cr was negatively correlated with serum symmetric dimethylarginine (sSDMA), blood urea nitrogen (BUN), creatinine, and phosphorus concentration. Serum alpha-klotho concentration in dogs with stages 2 and 3 CKD was significantly lower than those in the control group. There was no significant correlation between serum alpha-klotho and BUN, creatinine, and phosphorus concentrations. No statistically significant differences were observed in UrKl/Cr and serum alpha-klotho concentration between groups based on sex, age, urine protein-to-creatinine ratio (UPC), or blood pressure.ConclusionsUrKl/Cr decreased in dogs with advanced CKD, and it was negatively correlated with sSDMA, BUN, creatinine, and phosphorus concentrations. Thus, klotho is associated with CKD and its clinical consequences, including CKD-mineral bone disorder, in dogs. Although serum klotho concentration was negatively correlated with sSDMA levels, it was not apparently related to IRIS CKD stage or other parameters known to be associated with CKD.

P1230CHANGES IN CKD-MBD-REALTED MARKERS AND MIDDLE MOLECULAR WEIGHT SOLUTES (Β2MG, Α1MG)IN PATIENTS ON PD-HD COMBINATION THERAPY

Abstract Background and Aims According to a survey by the Japanese Society for Dialysis Therapy (as of December 31, 2017), among the 9,090 patients that underwent peritoneal dialysis (PD) in Japan, 1,765 patients were treated with PD in combination with once-weekly hemodialysis (HD) or hemodiafiltration (HDF) (PD-HD/HDF combination therapy); these patients accounted for 19.4% of the overall PD population. It has been confirmed that middle-molecular-weight solutes, such as β2MG, α1MG, that cannot be effectively removed by PD can be removed by HD/HDF in PD-HD/HDF combination therapy. In this study, we examined the changes in CKD-MBD-related markers (phosphorus, PTH, FGF-23 [molecular weight 32,000 Da], Fetuin-A [molecular weight 59,000 Da]) and middle-molecular-weight solutes (β2MG [molecular weight 11,800 Da] and α1MG [molecular weight 32,000 Da]) in nine patients on PD-HD combination therapy. Method We recruited nine patients (four men, five women) on PD-HD combination therapy with an underlying disease of chronic glomerulonephritis. The patients had a mean age of 66.2 years and a mean dialysis period of 49.1 months on PD alone and 32.1 months on PD combined with HD. The PD protocol included 2 L bag × 4/day (5 days, Monday–Friday; no therapy on Saturday and Sunday), and the HD protocol included 4 hours QB at 200 mL/min, QD at 500 mL/min, and Dialyzer Polysulfone (Asahi Medical Japan) every Saturday. Blood was collected before and after HD and before the next HD (1 week later) to measure CKD-MBD-related markers and middle-molecular-weight solutes. Kits to measure FGF-23 (Millipore, US) and Fetuin-A (Biovendor, Czech) were used. Results The levels of the different markers and solutes were as follows: phosphorus (mg/dL) (mean before HD: 5.31, mean after HD: 2.28 (P &amp;lt; 0.01), and mean before the next HD: 5.53); iPTH (pg/mL) (mean before HD: 131.9, mean after HD: 98.8, and mean before the next HD: 125.9); FGF-23 (pg/mL) (mean before HD: 785.3, mean after HD: 576.1 (P &amp;lt; 0.01), and mean before the next HD: 897); Fetuin-A (μg/mL) (mean before HD: 427.9, mean after HD: 423.1, and mean before the next HD: 428.75); β2MG (mg/L) (mean before HD: 36.31, mean after HD: 13.23 (P &amp;lt; 0.01), and mean before the next HD: 36.11); and α1MG (mg/L) (mean before HD: 141.9, mean after HD: 130.4, and mean before the next HD: 114.8). Conclusion β2MG and phosphorus levels were significantly decreased when PD was combined with HD, confirming that HD was able to eliminate them. Furthermore FGF-23 (molecular weight 32,000 Da) significantly decreased after HD but α1MG (molecular weight 30,000 Da) did not, suggesting that the decrease in FGF-23 was caused by the decrease in blood phosphorus concentration.

Positive correlation of serum fibroblast growth factor 23 with peripheral arterial stiffness in kidney transplantation patients

BackgroundFibroblast growth factor 23 (FGF-23) has a role in arterial stiffness (AS) apart from regulating mineral metabolism. We investigated the association between FGF-23 concentration and peripheral AS in renal transplantation (RT) recipients. MethodsThe fasting blood samples of RT recipients (n = 66) were collected and analyzed. ResultsA total of 29 (43.9%) RT recipients were classified under the peripheral AS group. The RT recipients in this group had a higher prevalence of diabetes (P < 0.001), hypertension (P = 0.001), and metabolic syndrome (P = 0.023); longer post-RT duration (P = 0.006); higher systolic blood pressure (P < 0.001) and diastolic blood pressure (P = 0.024); and higher fasting glucose (P = 0.002), total cholesterol (P = 0.049), blood urea nitrogen (P = 0.027), phosphorus (P = 0.047), and FGF-23 concentrations (P = 0.003) and FGF-23/α-klotho ratio (P < 0.001) but lower klotho concentrations (P = 0.025) than those in the control group. Moreover, FGF-23 concentration (adjusted odds ratio: 1.057, 95% confidence interval: 1.011–1.105, P = 0.015) was found to be an independent predictor of peripheral AS in RT recipients. ConclusionsSerum FGF-23 concentration was a significant predictor of peripheral AS in RT recipients.