Urinary Calcium Levels Research Articles

Estimation of Urinary Calcium as a Predictor of Pregnancy Induced Hypertension

Hypertensive diseases are still a leading cause of death among mothers all over the world. It’s complicated aetiology, which begins with aberrant placentation and ends with endothelial dysfunction, is yet unknown. The goal of this study is to learn about changes in serum and urine calcium levels in women who have Gestational Hypertension. 200 normotensive pregnant women between 24-28 weeks were included in the study based on inclusion and exclusion criteria. Urine calcium and creatinine and serum uric acid, total protein, albumin and serum sodium were estimated in corresponding samples collected from patients. The study showed a sensitivity of 80%, specificity of 71%, positive predictive value was 77%, negative predictive value 74%, and diagnostic accuracy as 74%. A single estimation of calcium to creatinine ratio in asymptomatic pregnant women between 24-28 week of gestation is a simple and cost-effective test.

Effect of Hydroalcholic Extract of Allium noeanum Reut. ex Regel on Ethylene Glycol- Induced Kidney Stone in Male Wistar Rats

We want to evaluate the effect of Allium noeanum Reut. ex Regel (Bonsor) known (traditional medicine agent) in calcium oxalate stones in kidney. 36 male rats were divided into 6 groups. I: healthy model + water, II: negative model + 1% ethylene glycol in water, III: 750 mg/kg of total extract +1% of ethylene glycol in water(Prevention), IV: 250 mg/kg flavonoid extract +1% of ethylene glycol in water (Prevention), V: 1500 mg/kg of total extract from 15th day+ 1% of ethylene glycol in water (Treatment), VI: 500 mg/kg of flavonoid extract from 15th of the study + 1% of ethylene glycol in water (Treatment).24-hour urine and blood samples were collected in 30th day for analysis. Pathology of kidneys was checked. Serum urea, uric acid, creatinine and urine calcium and oxalate were significantly increased, urine citrate was decreased in group II Vs I. (P < .05). Extract administration significantly decreased serum creatinine, urea and uric acid. Urine calcium and oxalate significantly decreased in treated groups. Urine calcium levels were significantly decreased in treated rats, but urine citrate levels were increased Vs group II. (P < .05). No crystal accumulation and tubular cast were observed in prevention groups. Hydroalcholic extract of Allium noeanum was able to reduce urine oxalate.

Spontaneous Alteration of Blood pH By a Bicarbonate Buffer System During Experimental Hypercalcaemia in Cows.

IntroductionMaintaining mineral homeostasis as well as the secretion and metabolism of mineralotropic hormones is important for healthy of periparturient dairy cows. To increase the activity of mineralotropic hormones, blood pH can be adjusted. The purpose of this study was to investigate changes in blood pH and the mechanism of action of this change in induced hypercalcaemic cows.Material and MethodsSix non-lactating Holstein cows were used in a 2 × 2 crossover design. To induce hypercalcaemia, calcium borogluconate was administered subcutaneously to experimental cows and normal saline was administered subcutaneously to control cows. Blood and urine samples were collected serially after administration. Whole blood without any anticoagulant was processed with a portable blood gas analyser. Plasma concentration and urinary excretion of calcium were measured.ResultsIn hypercalcaemic cows, both blood and urine calcium levels were significantly increased at 8 h compared to those at 0 h (P < 0.05), and a spontaneous increase in blood pH was also observed. The calcium concentration in plasma was highest at 2 h after administration (3.02 ± 0.27 mmol/L). The change in pH correlated with that in bicarbonate (r = 0.781, P < 0.001) rather than that in partial pressure of CO2 (r = 0.085, P = 0.424).ConclusionHypercalcaemia induced a spontaneous change in blood pH through the bicarbonate buffer system and this system may be a maintainer of calcium homeostasis.

SARCOIDOSIS AND HYPERCALCIURIA: A STONE COLD INDICATION FOR TREATMENT

TOPIC: Diffuse Lung Disease TYPE: Fellow Case Reports INTRODUCTION: Sarcoidosis may cause renal disease by several different mechanisms. Symptomatic nephrolithiasis is a rare occurrence as the initial manifestation of sarcoidosis. Hypercalciuria may occur commonly in sarcoidosis and warrants treatment. There is lack of data supporting screening for hypercalciuria. Herein we present a patient with asymptomatic sarcoidosis until she developed nephrolithiasis with a normal serum calcium but an elevated urine calcium. CASE PRESENTATION: 62 year old woman with a history of diabetes mellitus II and obesity was followed in the pulmonology clinic for abnormal chest imaging. She had previously presented to the emergency department for chest pain that lead to a chest radiograph and Chest CT scan. CT scan showed mediastinal adenopathy and pulmonary nodules. Bronchoscopy was performed with biopsies which revealed non necrotizing granulomas consistent with sarcoidosis. Patient had a normal spirogram, and no other extrapulmonary manifestations that would warrant treatment for sarcoidosis. Serum calcium and albumin were normal. 25 hydroxy vitamin D levels were 23 ng/ml. She did take over the counter Vitamin D supplements. Later she developed nephrolithiasis. Analysis of the stone revealed 65% calcium oxalate monohydrate and 15% calcium oxalate dihydrate. A 24 hour urine calcium showed 328 mg of calcium per volume of urine. Patient had a history of diabetes mellitus so treatment with steroids was avoided and she was started on 10 mg of methotrexate. Follow up urine calcium levels are pending. DISCUSSION: While there are guideline recommendations to screen for hypercalcemia with a serum calcium level and for measuring vitamin D levels for replacement, there is scant literature on screening for hypercalciuria in the setting of normal calcium levels, despite hyercalciuria being the most common renal manifestation of renal sarcoidosis. The incidence of renal disease in sarcoidosis varies from 1.1% to 9.7% with hypercalciuria occurring in up to 50% while hypercalcemia may occur in only 10-20% of cases, making hypercalciuria the most common renal manifestation of sarcoidosis. Hypercalciuria is the result of increasing calcium load filtered at glomerulus as a result of decreased PTH secretion secondary to elevated circulating calcitriol levels leading to a diminished tubular reabsorption of calcium. Hypercalciuria predisposes to calcium oxalate nephrolithiasis. Approximately 10 % of patients with sarcoidosis have 1 symptomatic stone. For 1 % of these patients it may be the initial presentation. Approximately 2.7% of sarcoidosis patients have asymptomatic stones. CONCLUSIONS: Hyercalciuria is the most common renal manifestation of sarcoidosis, yet it is not commonly screened for in asymptomatic sarcoidosis patients. Timely treatment may attenuate renal impairment secondary to sarcoidosis. It is suggested that hypercalciuria in the setting of sarcoidosis always be treated. REFERENCE #1: Adam R. Berliner, Mark Haas, Michael J. Choi, Sarcoidosis: The Nephrologist's Perspective, American Journal of Kidney Diseases, Volume 48, Issue 5,2006, Pages 856-870, ISSN 0272-6386, https://doi.org/10.1053/j.ajkd.2006.07.022. REFERENCE #2: Thomas KW, Hunninghake GW. Sarcoidosis. JAMA. 2003 Jun 25;289(24):3300-3. doi: 10.1001/jama.289.24.3300. PMID: 12824213 DISCLOSURES: No relevant relationships by Jonathan gwizdala, source=Web Response Grant for research relationship with Sanofi Please note: January 2021 Added 04/20/2021 by Daniel Ouellette, source=Web Response, value=Grant/Research No relevant relationships by Rajaninder Sharma, source=Web Response

Hyperparathyroidism in patients with overt and mild primary aldosteronism.

Increased prevalence of hyperparathyroidism (HP) has been observed in primary aldosteronism (PA) patients. However, HP prevalence in milder forms of PA has not to date been evaluated. The objectives of this study were to assess the prevalence of primary and secondary HP in overt and milder misdiagnosed cases of PA and to investigate the effect of treatment on parathormone (PTH) secretion. Seventy PA patients with normal renal function were included prospectively. Specifically, patients with biochemically overt PA (increased basal aldosterone/renin ratio (ARR) and a positive diagnostic suppression test (DCVT)) and patients with mild PA (normal basal ARR and a positive DCVT) were analyzed. Mean blood pressure and mineral metabolism were evaluated at diagnosis and after treatment. Primary and secondary HP were found in 4.3% (3/70) and 51.4% (36/70) of patients, respectively, and biochemically overt and mild PA in 47.1% (33/70) and 52.9% (37/70) of patients, respectively. Sixty-three PA patients were followed up after treatment without receiving calcium or vitamin D. There was a decrease of mean blood pressure (p < 0.001), PTH (p < 0.001), and 24-h urinary calcium (p < 0.001), and an increase of serum potassium (p < 0.001) and calcium (p = 0.018) levels in secondary HP patients. There was no significant difference between biochemically overt and mild PA patients as concerned serum PTH, calcium, and 25-hydroxyvitamin-D levels either before or after treatment. Aldosterone levels before treatment were positively correlated with serum PTH levels. HP prevalence was high in both overt and mild PA patients, whereas the effect of treatment on serum and urinary calcium and PTH levels was similar in both groups.

Primary Hyperparathyroidism Superimposed on a Pre-existing Familial Hypocalciuric Hypercalcemia Diagnosis

Familial hypocalciuric hypercalcemia is a rare clinical condition of persistently elevated serum calcium and reduced urinary calcium levels with an autosomal dominance inheritance pattern to the three out of four large types of this condition known. This rare condition goes largely undiagnosed as patients are largely asymptomatic and where symptoms are present, other causes of hypercalcemia are considered first. Hyperparathyroidism, super-imposing on FHH, is an even rarer occurrence. We present the case of an adult male with an initial provisional assessment of FHH, which was later confirmed with a genetic study. He went on to develop hyperparathyroidism (with evident enlarged parathyroid glands on Sestamibi parathyroid scan done, and an eventual histologic diagnosis of parathyroid adenoma after surgery). It remains to be established if this is an incidental occurrence or if there is a causal relationship between FHH and an onward development of parathyroid hypertrophy or adenoma(ta).

PD21-09 SODIUM ABNORMALITY LINKED TO DIET (SALTD): IMPACT OF FOOD PREPARATION ON URINARY VALUES IN STONE PATIENTS

You have accessJournal of UrologyStone Disease: Medical & Dietary Therapy (PD21)1 Sep 2021PD21-09 SODIUM ABNORMALITY LINKED TO DIET (SALTD): IMPACT OF FOOD PREPARATION ON URINARY VALUES IN STONE PATIENTS Igor Inoyatov, Zhenyue Huang, James Rail, Spencer Mossack, Ariel Schulsinger, Scott Herfel, Yefim Sheynkin, and David Schulsinger Igor InoyatovIgor Inoyatov More articles by this author , Zhenyue HuangZhenyue Huang More articles by this author , James RailJames Rail More articles by this author , Spencer MossackSpencer Mossack More articles by this author , Ariel SchulsingerAriel Schulsinger More articles by this author , Scott HerfelScott Herfel More articles by this author , Yefim SheynkinYefim Sheynkin More articles by this author , and David SchulsingerDavid Schulsinger More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002010.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Hypernatriuria is a known risk factor for nephrolithiasis. However, there is a paucity of data regarding factors that predispose stone formers to hypernatriuria and the role of dietary habits on urinary sodium abnormalities. To better understand potential risks of hypernatriuria, we investigated the impact of stone patient’s dietary preferences on 24-hr urinary sodium levels. METHODS: We prospectively queried patients regarding patient’s dietary habits, demographics, stone analysis, 24-hr urine data and socioeconomic status (SES). Patients were divided into 4 groups based on their 24-hr urinary sodium concentration levels: normonatriuric (NN) patients (urinary sodium ≤150mEq) and hypernatriuric (HN) patients: low (L-HN, 151-187mEq); moderate (M-HN, 188-235mEq), and severe (S-HN, ≥236mEq). These groups were compared using one-way ANOVA, Pearson chi-square and Student t-tests. RESULTS: A total of 80 patients (M=46, F=34) were analyzed into 4 groups: 20 NN and 60 HN (L-HN (n=20), M-HN (n=20) and S-HN (n=20)). There were no significant differences between NN and HN patient’s baseline demographics in regard to age, race, SES, or BMI values. No significant differences were noted in patient’s 24-hr urine volume, water consumption, or stone types between the HN and NN groups. Patients with HN levels were found to have a significantly higher percentage of non-home cooked meals (p=0.001), more total meals/week (p=0.045), and higher ratio of meals out/week (p=0.004) as compared to NN patients. Patients with S-HN reported significantly higher consumption of deli meats as compared to the control group (N=16 vs. N=8, p=0.01). Results of the Pearson correlation indicated that there was a significant positive association between urinary sodium levels and the ratio of unprepared meals (r=0.347, N=80, p=0.002). While urinary calcium levels were significantly greater in HN compared the NN groups (p=0.001), the S-HN group had a significantly higher proportion of patients with elevated urinary calcium levels as compared to the M-HN group, (p=0.01) and the L-HN group (p=0.04). CONCLUSIONS: Despite the desire that many stone patients yearn to modify their diets and reduce salt-rich foods, the “black hole” of consuming non-prepared meals puts patients at risk for HN. Patients with HN levels tend to have a significantly higher percentage of non-prepared meals, higher ratio of meals out/week and are more likely to consume deli meats. Urologists should be aware of the dietary tendencies of patients with HN and counsel these patients accordingly to reduce their risk of nephrolithiasis. Source of Funding: NA © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e378-e378 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Igor Inoyatov More articles by this author Zhenyue Huang More articles by this author James Rail More articles by this author Spencer Mossack More articles by this author Ariel Schulsinger More articles by this author Scott Herfel More articles by this author Yefim Sheynkin More articles by this author David Schulsinger More articles by this author Expand All Advertisement Loading ...

Effect of calcium content of diet on crystal formation in urine of patients with calcium oxalate stones: a randomized crossover clinical trial

BackgroundPatients with idiopathic calcium oxalate stones are advised to consume a low-oxalate diet to prevent recurrence. In this study, on patients with calcium oxalate stones we have attempted to determine the effect of calcium content of diet on the formation of calcium oxalate crystals in urine by in vitro supersaturation study of fresh postprandial urine samples and observing the morphology of the crystals formed using polarized optical microscopy.MethodsThe trial was conducted as a prospective interventional randomised crossover clinical trial in a repeated measures design. Sixty patients with calcium oxalate stones and no metabolic abnormalities in urine treated by lithotripsy at a tertiary care centre during the period May 2016 to May 2019 were recruited. Following a 14 h overnight fasting, urine samples were collected after providing the patient with either a low- or high-calcium meal for breakfast followed four hours later, by high-oxalate meal for lunch. Urine was tested for multiple parameters including urine pH, specific gravity, calcium/creatinine ratio and supersaturation of urine with sodium oxalate followed by optical density measurement by spectrophotometry and microscopic analysis of crystals formed.ResultsOptical density values and calcium/creatinine ratio of urine samples obtained after high-calcium meal are significantly higher than in corresponding sample obtained after low-calcium meal (p < 0.001). These findings were reflected in the morphology of formed crystals in their size, shape and number. When urinary calcium levels were low, no crystals were formed during supersaturation study of postprandial urine samples following a high-oxalate diet.ConclusionsHigh calcium content in diet significantly contributes to kidney stone formation. There is a lower risk of kidney stone formation with a low-calcium meal even on consumption of a high-oxalate diet.

Cow milk and its dairy products ameliorate bone toxicity in the Coragen-induced rat model

Abstract Coragen is an insecticide that stimulates calcium release from intracellular stores of muscle cells causing death to sensitive species. The present study aimed to evaluate the bone toxic effect of Coragen and the potential therapeutic effect of cow milk, yogurt, and soft cheese in rats. Toxicity was induced by Coragen administration with different doses of 1/20 or 1/40 LD50 in rats. Groups of rats (n = 6) were treated with either 5 g milk, 5 g yogurt, or 1.5 g cheese. Coragen administration elevated alkaline and acid phosphatases activity and reduced the calcium and phosphorus level in urine and serum of rats administered with Coragen. Femur and tibia length, thickness, weight, and breaking force were decreased by Coragen administration and femur Ca and P contents as well. Bone mineral area (BMA), bone mineral content (BMC), bone mineral density (BMD), protein profile (total, albumin, and globulin), and antioxidant system (TAC, GSH, GPX, GST, and SOD) were decreased by Coragen. All these parameters were improved on the treatment with milk and milk products. The results showed that yogurt treatment was significantly superior to the other treatments in increasing BMD (27%), breaking force (9%), femur Ca (41%), serum Ca (14%), and serum P (16%) and in reducing acid phosphatases (14%) and urine Ca and P by 8 and 10%, respectively. It can be concluded that the treatment with milk and milk products may provide treatment against osteoporosis and toxicity caused by Coragen.

Evaluation of Relationship between Vitamin D Supplementation Treatment and Hypercalciuria in Patients with Kidney Stones

Background: Vitamin D, especially calcitriol (its active metabolite), increases gastrointestinal calcium absorption. Because urinary calcium excretion is associated with calcium absorption in the gastrointestinal tract; vitamin D metabolites could theoretically cause hypercalciuria. The aim of this study was to investigate the relationship between treatment and vitamin D supplementation on the rate of hypercalciuria in patients. Method: In the present double-blind randomized clinical trial, 90 patients (male-female) with urinary stones and serum vitamin D levels less than 30 ng/mL were evaluated. Patients were randomLy divided into two groups of 45 patients. One group was given 50,000 units of oral vitamin D weekly for up to 8 weeks. For the other group, the drug was given as a placebo for up to 8 weeks. Sampling was performed one month after the end of treatment. The data garnered from hospital records were inserted into SPSS software for analysis.Results: In the present study, the mean age of the subjects was 39.78 years. Also, out of 90 patients, 52 were male and 38 were female. Blood PTH levels decreased significantly after treatment in vitamin D group (P <0.001). Also, serum levels of vitamin D in this group showed a significant increase (P <0.001). However, in this study urinary calcium levels after treatment did not show significant changes (P = 0.680).Conclusion: The present study showed that in people with a history of kidney stones, taking vitamin D supplement alone for people with lower than standard serum levels of vitamin D did not show any significant difference in calcification. As a result, the therapeutic dose of this drug is recommended in patients with kidney stones according to the condition.

Probiotics as a New Regulator for Bone Health: A Systematic Review and Meta-Analysis.

Despite the proposed role of the gut microbiota-bone axis, findings on the association between probiotic consumption and bone health are conflicting. This systematic review aimed to assess the effect of probiotic consumption on bone health parameters. A systematic literature search of relevant reports published in PubMed/Medline, Web of Science, SCOPUS, EMBASE, and Google scholar before December 2020 was conducted. All clinical trials or experimental studies, which examined the relationship between probiotic consumption and bone health parameters, were included. No limitation was applied during the search. After screening articles based on inclusion criteria, 44 studies remained. In clinical trials, probiotic consumption affects bone health parameters such as serum calcium levels (3.82; 95% CI: 1.05, 6.59 mmol/l), urinary calcium levels (4.85; 95% CI: 1.16, 8.53 mmol/l), and parathyroid hormone (PTH) levels (−5.53; 95% CI: −9.83, −0.86 ng/l). In most studies, Lactobacillus species such as L. helveticus, L. reuteri, and L. casei were consumed and women aged 50 years or older were assessed. Spinal and total hip bone mineral density (BMD) was not affected significantly by probiotic consumption. In 37 animal experiments, probiotic or symbiotic feeding mostly had effects on bone health parameters. Some strains of Bifidobacterium and Lactobacillus including L. reuteri, L. casei, L. paracasei, L. bulgaricus, and L. acidophilus have indicated beneficial effects on bone health parameters. In conclusion, this systematic review and meta-analysis indicate that probiotic supplementation might improve bone health. Further studies are needed to decide on the best probiotic species and appropriate dosages.

The role of urinary kidney injury molecule-1 in monitoring the child with idiopathic microscopic hematuria

Background/Aim: Idiopathic microscopic hematuria is common during childhood, and numerous factors play a role with varying degrees in its etiopathogenesis. We aimed to investigate whether urinary kidney injury molecule-1 level could be a new indicator to detect a possible renal injury that may cause idiopathic microscopic hematuria. Methods: This prospective case-control study included 38 children between 1-15 years of age who were followed up due to idiopathic microscopic hematuria without hypertension and/or edema and 39 healthy individuals with similar gender distribution. Kidney injury molecule-1, urine culture, microalbumin, calcium, magnesium, uric acid, and creatinine levels in spot urine were measured in both groups. A throat culture and abdominal ultrasound were performed on all those included. Results: No significant differences were found between the patient and control groups in terms of age, gender, weight, and height (P>0.05). Microalbumin, microalbumin to creatinine ratio in spot urine, urinary kidney injury molecule-1 levels, and kidney injury molecule-1 to creatinine ratio were higher among the patients than the controls (P=0.016, P=0.013, P=0.001, and P=0.001, respectively). Conclusion: Urinary microalbumin and kidney injury molecule-1 levels, as well as rates of these two markers to creatinine, may be higher in the children with idiopathic microscopic hematuria. Our findings show that children with microscopic hematuria should be monitored for renal tubular injury and the development of chronic renal disease.

Changes in Serum Calcium and Treatment of Hypoparathyroidism During Pregnancy and Lactation: A Single-center Case Series.

Hypoparathyroidism (hypo-PT) is rare, and studies on hypo-PT, especially during pregnancy and lactation, are limited. This was a retrospective study on a relatively large case series in a single center from mainland China. A total of 19 patients with 25 pregnancies, diagnosed with hypo-PT before pregnancy, were enrolled. Data on clinical characteristics and treatment strategies at onset time and around pregnancy period were collected. During pregnancy, except for 2 patients with missing data, 5 patients with 6 pregnancies (6/23, 26.1%) experienced improved hypo-PT condition, defined as an increased serum calcium level; 4 patients with 4 pregnancies (4/23, 17.4%) experienced worsened hypo-PT condition, defined as a more than 0.2 mmol/L decline in the serum calcium level; and 3 patients with 3 pregnancies (3/23, 13.0%) remained in stable hypo-PT condition. The prevalence of adverse pregnancy outcomes was 30.4% (4/23 for preterm delivery; 3/23 for miscarriage). The serum calcium and 24-hour urine calcium levels significantly increased during lactation compared with pregnancy (2.57 ± 0.34 vs 1.99 ± 0.11 mmol/L, P < 0.001; 12.28 ± 5.41 vs 8.63 ± 3.22 mmol/L, P = 0.013), and 5 patients with 5 lactations (5/12, 41.7%) developed hypercalcemia in the first 2 months after delivery. Female patients with hypo-PT had different changes in calcium homeostasis and a high prevalence of adverse outcomes during pregnancy. Thus, they should be monitored closely to maintain the optimal serum calcium level. Decreasing drug dosage during the lactation period should be considered to avoid hypercalcemia.

Association of neonatal blood calcium levels with perinatal factors and neonatal urinary calcium levels measured by an intelligent urine test system

OBJECTIVE To study the association of neonatal blood calcium levels with perinatal factors and neonatal urinary calcium levels measured by an intelligent urine test system. METHODS The medical data of 96 full-term singleton neonates with mild diseases were collected by a cross-sectional survey, who were hospitalized in the Department of Neonatology, The First Affiliated Hospital of Xi'an Jiaotong University, from June to August 2018. Urinary calcium levels measured by an intelligent urine test system, total blood calcium levels, ionized calcium levels, and the mother's calcium and vitamin D supplementation during pregnancy were recorded. RESULTS Compared with the group without vitamin D supplementation for the mother (17 neonates), the group with vitamin D supplementation for the mother (79 neonates) had significantly higher levels of total blood calcium and ionized calcium (P 0.05). The hypothermia group (5 neonates) had a significantly lower level of total blood calcium than the normal body temperature group (91 neonates) (P < 0.05). There was a significantly positive correlation between the maternal blood total calcium level and the neonatal blood total calcium and ionized calcium levels (r=0.881 and 0.703 respectively; P < 0.05). The neonatal urinary calcium level measured by the intelligent urine test system was significantly correlated with the blood ionized calcium level (r=0.526, P=0.025). CONCLUSIONS Vitamin D supplementation during pregnancy can increase the blood levels of total calcium and ionized calcium in neonates, and calcium supplementation alone cannot increase the blood levels of total calcium or ionized calcium in neonates. Hypothermia in neonates might cause the reduction in blood calcium levels. The urinary calcium level measured by the intelligent urine test system is positively correlated with the blood level of ionized calcium.

Establishment of a male Wistar rat model of nanobacteriainduced kidney stones

Purpose: To establish a male Wistar rat model of nanobacteria (NB)-induced kidney stones.&#x0D; Methods: Sixty male Wistar rats were randomly divided into control group (NC group) given caudal vein injection of saline + saline gavage, and NB-induced stone group (NBS group) given caudal vein injection of NB + saline gavage.&#x0D; Results: Compared with NC, serum creatinine, blood uric acid, urea nitrogen and urinary calcium levels in NBS group increased between weeks 3 and 8 (p &lt; 0.05). Kidney index (kidney weight/body weight ratio) in the NBS group was higher than that in NC group from weeks 8-10. At week 8, urine pH and serum phosphorus in NBS group were higher than those in NC group (p &lt; 0.05). Between weeks 6 and 7, serum calcium in NBS group was higher than that in NC group (p &lt; 0.05). Calcium crystals in NBS rats were distributed mostly in the distal and proximal convoluted tubules. However, no such crystals were observed in NC rats. Similarly, no such pathological changes were seen in the renal tissue of NC group. Calculus analysis showed that stone formation was higher in NBS group than in NC group (p &lt; 0.05). There was no significant difference in micro-CT between the two groups (p ˃ 0.05).&#x0D; Conclusion: The successful establishment of the Wistar rat kidney stone model using NB cultured from urine of upper urinary tract stone patient is potentially useful for further etiological studies on kidney stone formation.

Bone turnover markers are associated with the PTH levels in different subtypes of pseudohypoparathyroidism type 1 patients.

Bone responsiveness to parathyroid hormone (PTH) in different subtypes of pseudohypoparathyroidism type 1 (PHP1) remains controversial. We aimed to investigate this phenomenon using bone turnover markers (BTMs) in a large cohort of PHP1 patients. Retrospective study. Sixty-three PHP1 patients diagnosed by molecular analysis were used as subjects, and 48 sex- and age-matched patients with nonsurgical hypoparathyroidism (NS-HP) were used for comparison. Bone turnover markers, alkaline phosphatase (ALP), C-terminal telopeptide of type I collagen (β-CTX) and related parameters in PHP1 were compared among different subtypes and with NS-HP. Among all the PHP1 patients (15 PHP1A, 14 familial 1B and 34 sporadic 1B), 23.8% had elevated baseline BTM levels. No significant difference was found in the β-CTX levels among different subtypes. The β-CTX level was positively correlated with the PTH level for all PHP1, PHP1B and PHP1A patients (B=0.001, 0.001 and 0.004, respectively; all p<.05). The BTM levels of PHP1 patients were significantly higher than those of NS-HP patients (β-CTX: 0.56ng/ml vs. 0.20ng/ml, p=.001; ALP: 105 U/L vs. 72 U/L, p=.001). The serum β-CTX levels in different PHP1 subtypes were all significantly higher than those in NS-HP patients in adults. Among the 22 followed up patients, changes in BTMs were associated with changes in PTH (β-CTX: r=.507, p=.023; ALP: r=.475, p=.034). Bone tissues respond to PTH in different PHP1 subtypes, and it is reasonable to monitor and normalize PTH and BTMs in addition to the serum and urinary calcium levels in the follow-up of PHP1 patients.

Serum and urinary calcium level in Latvian patients with sarcoidosis at the time of diagnosis – 2013–2018 data

Serum and urinary calcium level in Latvian patients with sarcoidosis at the time of diagnosis – 2013–2018 data

Antilithiatic activity of a non-pharmacopoeial Unani formulation in chemically induced urolithiasis in rats.

Parshioshan (Adiantum capillus-veneris L.), Duqu (Peucedanum grande C.B. Clarke), Kaknaj (Physalis alkekengi L.) and Kharekhasak (Tribulus terresteris L.) have been selected for this study as they have been associated with medicinal actions for litholytic activity. The experiment was carried out in Sprague Dawley rats divided into seven groups, serving as plain control, disease control, standard control, curative A and B and preventive A and B groups. Animals of plain control received distilled water. Remaining six groups received Ethylene glycol 0.75% and Ammonium chloride 1% by adding in the drinking water for the first three days followed by 0.75% Ethylene glycol for 18days. From 8th day till 21st day, standard control received Cystone in the dose of 750mg/kg. Preventive and curative test groups were treated with hydroalcoholic extract of the test drug in the dose of 132mg/kg and 264mg/kg from 1st to 21st day and 8th to 21st day of calculi induction. Test drug reduced the number of calcium oxalate crystals in the urine; the level of urinary calcium, creatinine, magnesium, phosphorus, sodium and chloride decreased significantly in standard and test groups. The urine volume increased significantly in all the test groups. The level of serum calcium, urea, phosphorus and creatinine were significantly reduced in all the test groups. These results indicated that the test drug reduced and prevented the growth of urinary stones. Moreover, the test drug also possessed significant antiurolithiatic activity. However, the protective effect was found more than its curative effect.

Variable Clinical Presentation of Children With Hereditary Hypophosphatemic Rickets With Hypercalciuria: A Case Series

Background: Hereditary Hypophosphatemic Rickets with Hypercalciuria (HHRH) is a rare condition of phosphate wasting due to variants in the SLC34A3 gene, encoding the sodium-phosphate cotransporter 2c (NaPi2c) at the brush border of proximal renal tubular cells (1). While labs are characterized by low serum phosphorus, high 1,25 dihydroxyvitamin D and inappropriately high levels of urine phosphate and calcium, the presenting symptoms can vary widely. Little remains known about specific phenotype-genotype correlations, especially in children. Clinical Cases: We report three new cases of HHRH in an unrelated 12 year-old male, 9 year-old female and 14 year-old male. All three patients were found to have low serum phosphorus for age (2.9-3.2 mg/dL), normocalcemia (9.4-9.9 mg/dL), low to low-normal parathyroid hormone (7-15 pg/mL), elevated 1,25 dihydroxyvitamin D (91-178 pg/mL), and hypercalciuria (4.5-7.6 mg/kg/day). Urine phosphorus was inappropriately elevated given the degree of their hypophosphatemia. Despite having similar lab findings, however, their clinical presentations were varied. The 12 year-old male presented with lower extremity pain, which was previously ascribed to patellofemoral pain syndrome. He had no history of renal symptoms, though a renal ultrasound later identified stones bilaterally. Conversely, the 9 year-old female and 14 year-old male presented with recurrent urinary stones and no bone symptoms. Genetic analyses identified 4 novel SLC34A3 gene mutations. Of interest, the 12 year-old male and 9 year-old female each shared a variant (c.575C-T (p.Ser192Leu)) despite having disparate symptoms. All three patients were treated with phosphorus supplementation and were advised to discontinue Vitamin D, if this had previously been prescribed. Conclusion: These three cases highlight the variability of presenting signs and symptoms among individuals with HHRH. Obtaining an accurate diagnosis is critical, as the addition of Vitamin D can seriously worsen symptoms in HHRH though it is a commonly used treatment for other disorders of phosphate wasting and bone demineralization. To aid in clinical decision making, we present a stepwise approach to the diagnosis of hypophosphatemic diseases.

An Interesting Case of Isolated Bone Marrow Sarcoidosis

Introduction: About 30% cases of sarcoidosis have extrapulmonary manifestations but only 7% of patients present without any lung involvement. Among those 7%, most of the patients have manifestations on the skin but isolated bone marrow sarcoidosis has not been commonly reported. This case represents an unusual manifestation of isolated bone marrow sarcoidosis presenting with very high calcium levels. Case Presentation: A 58-year-old female presented to us with fatigue, poor appetite, and nausea. She did not report any weight changes. Her cancer screening was up to date. On examination, she appeared dehydrated. No neck swelling was appreciated. Cardiac, respiratory, abdominal, and neurological examinations were normal. Complete blood count showed hemoglobin of 10.6 mg/dL, white blood cell count of 3.8 k/dL, and platelet count of 87 x109/L. Metabolic panel revealed hypercalcemia with corrected calcium levels as high as 12.6 mg/dL. Ionized calcium was 8.1 mg/dL (normal 4.8 - 5.6). Her parathyroid hormone (PTH) level was elevated up to 64.6 mg/dL and then further increased to 134.3 mg/dL. A 24-hour urinary calcium level was normal. 1, 25-dihydroxy (1,25-OH) and 25-OH vitamin D levels were 97 mg/dL (normal 18–72) and 31.2 mg/dL, respectively. Serum protein electrophoresis and light chain analysis were normal. Hyperparathyroidism was suggested as a cause of hypercalcemia. Ultrasound of the neck and sestamibi scan showed a right lower pole parathyroid adenoma. Paraneoplastic hypercalcemia was also one of the differentials. Parathyroid hormone related peptide (PTHrP) was 9 pg/mL (normal 14 - 27). Colonoscopy was normal. Computerized tomography showed normal lungs, liver and spleen. No masses and lymphadenopathy was seen. A bone marrow biopsy was done for pancytopenia. Patient underwent parathyroid adenoma removal followed by a drop in serum calcium level (8.2 mg/dL). Patient was discharged on calcium carbonate and vitamin D tablets. Upon outpatient follow-up, calcium level started to rise again up to 9.8 mg/dL. Despite discontinuation of supplemental calcium and vitamin D, calcium continued to uptrend (11.5 mg/dL 4 weeks later). Angiotensin converting enzyme (ACE) level came back as high as 129 (normal level < 40 mcg/L). Meanwhile, the bone marrow biopsy results showed that 40% of bone marrow was occupied by non-caseating granulomas suggesting sarcoidosis. Patient was started on steroids for isolated bone marrow sarcoidosis, and eventually her serum calcium level normalized. Conclusion: An isolated bone marrow sarcoidosis is an extremely rare manifestation of extrapulmonary sarcoidosis. It can present with pancytopenia and should be sought in patients with persistent hypercalcemia. In addition, our case was challenging due to the presence of a concurrent hyperparathyroidism which was initially thought to be the only explanation of our patient’s hypercalcemia.