Mean Serum Alkaline Phosphatase Levels Research Articles

Management of hypercalcemic hyperparathyroidism after renal transplantation.

To determine the optimal management of posttransplant hypercalcemia, a chart analysis of 100 stable renal allograft recipients (longer than one year) was accomplished. The incidence of hypercalcemia ranged from 12% to 20% up to 30 months after transplantation. The mean serum alkaline phosphatase level, phosphate level, and duration of dialysis in hypercalcemic patients did not differ significantly from normocalcemic patients; however, serum creatinine levels were significantly lower at 12 and 24 months in patients with hypercalcemia. In patients with hypercalcemia at three and six months, greater than 50% underwent spontaneous resolution, whereas this occurred in 25% of the patients with hypercalcemia at 12 months. Seven patients underwent parathyroidectomy with prompt resolution of their hypercalcemia and ten patients with persistent hypercalcemia have been followed up from 14 to 66 months without sequelae of hyperparathyroidism. In conclusion, hypercalcemic hyperparathyroidism is a frequent occurrence after renal transplantation. Sequelae of this condition are rare, however, and parathyroidectomy should be reserved for progressive clinical and/or roentgenographic findings.

Clinical characteristics of patients younger than 60 years with mitral anular calcium: Comparison with age- and sex-matched control subjects

The clinical characteristics of 107 patients younger than 60 years with mitral anular calcium (MAC) were compared with those of 107 age- and sex-matched control subjects. The patients with MAC included 55 men and 52 women, mean age 51 years. The control group included 55 men and 52 women, mean age 51 years. Patients with MAC had a higher prevalence of cardiomegaly on chest x-ray (p less than 0.0001), left atrial and left ventricular enlargement by echocardiography (p less than 0.0001), precordial murmurs (p less than 0.0001), diabetes mellitus (p less than 0.0001), systemic hypertension (p less than 0.025) and total conduction defects on surface electrocardiograms (p less than 0.0001) compared with the age- and sex-matched control subjects. The mean serum phosphorus and product of serum calcium and phosphorus were higher in patients with MAC (p less than 0.0025) than in the control subjects. The prevalence of coronary heart disease, aortic stenosis and hypertrophic cardiomyopathy and the mean serum cholesterol, triglyceride, total protein, albumin, creatinine, alkaline phosphatase and calcium levels were not significantly different between patients with MAC and the control subjects.

Erosive azotemic osteoarthropathy.

Fifty-nine patients with end-stage renal disease undergoing long-term dialysis were studied prospectively for joint disease. Radiographic assessment allowed division of patients into 3 groups: group 1 included 12 patients with renal osteodystrophy and erosions of the metacarpophalangeal, proximal interphalangeal, distal interphalangeal, shoulder, wrist, and knee joints; group 2 had 11 patients with renal osteodystrophy without articular erosions; group 3 included 36 patients without osteodystrophy or erosions. Clinical manifestations were frequent in patients of group 1 and included episodes of arthralgias of the metacarpophalangeal, wrist, proximal interphalangeal, and knee joints. Patients of groups 1 and 2, particularly those of group 1, had a longer mean duration of dialysis and a higher mean serum alkaline phosphatase level compared with group 3 patients. The study indicates that there is a relatively high incidence (20%) of erosive arthropathy in dialysis patients. Renal osteodystrophy, more specifically, secondary hyperparathyroidism, and duration of dialysis are important factors in the development of this articular disorder.

Effects of systemic hyperthermia and intrahepatic infusion with 5-fluorouracil.

Potential hepatotoxicity from systemic hyperthermia (43 degrees C) +/- simultaneous hepatic artery infusion with 5-FU was evaluated in an animal model. Twenty-two dogs had aorta-vena caval shunts (8 mm Dacron grafts) placed, and 10 of these dogs had silastic catheters inserted in their hepatic arteries. Two weeks later, Group I (n = 8) was heated to 43 degrees C for one hour (distal esophageal + intrahepatic temperature) using the shunts and blood-heat exchangers; Group II (n = 6) was heated to 43 degrees C for one hour with simultaneous intrahepatic infusion of 5-FU (10 mg/kg); Group III (n = 8) was shamheated (37 degrees C) and underwent a one hour intrahepatic infusion with 5-FU (10 mg/kg). Serum alkaline phosphatase, SGOT, SPGT (IU/ml) and bilirubin were measured, and liver biopsies were obtained at 0 and 1 hour, at one and seven days. Mean SGOT levels increased significantly (P less than 0.05) in Group II from 19 +/- 2 to 31 +/- 6 and 63 +/- 18 at one hour and one day; these levels rose slightly in Group I from 31 +/- 5 to 40 +/- 8 and 47 +/- 8 at one hour and one day. Hepatocellular enzyme levels returned to normal at seven days in both groups. Mean SGOT and SGPT levels remained similar in Group III at all time periods. No significant differences in mean serum alkaline phosphatase or bilirubin levels were noted. There was no histologic evidence of hepatocellular necrosis at any time period. Survival was 6/8, 5/6 and 8/8 dogs in Groups I, II, and III, respectively. Systemic hyperthermia to 43 degrees C for one hour in dogs does not adversely affect serum hepatic enzymes or cell structure; reversible serum hepatic enzyme changes occurred when hyperthermia was combined with hepatic artery infusion with 5-FU.

?-Glutamyl Transpeptidase Levels in Thyroid Disease

To evaluate the association between serum γ-glutamyl transpeptidase activity (GGT) and thyroid function, we measured the GGT, alkaline phosphatase, free thyroxine index (FT 4 I), free triiodothyronine index (FT 3 I), and thyrotropin (TSH) levels in patients with hyperthyroidism and hypothyroidism and in normal subjects. Ten of 16 hyperthyroid patients had elevations of GGT activity. There was no difference in mean FT 4 I or FT 3 I between the groups with high GGT and normal GGT levels. Six months after treatment with radioactive iodine, serum GGT levels decreased, while there was no significant change in mean serum alkaline phosphatase levels. Mean serum GGT levels were decreased in patients with hypothyroidism and correlated well with serum TSH levels. Replacement therapy with levothyroxine sodium caused an elevation in mean serum GGT levels in six hypothyroid patients. Thus, serum GGT activity is frequently increased in patients with hyperthyroidism and may be decreased in patients with hypothyroidism. Euthyroidism results in restoration of normal GGT levels. ( Arch Intern Med 1982;142:79-81)

Gamma-Glutamyl transpeptidase levels in thyroid disease

To evaluate the association between serum, gamma-glutamyl transpeptidase activity (GGT) and thyroid function, we measured the GGT, alkaline phosphatase, free thyroxine index (FT4I), free triiodothyronine index (FT3I), and thyrotropin (TSH) levels in patients with hyperthyroidism and hypothyroidism and in normal subjects. Ten of 16 hyperthyroid patients had elevations of GGT activity. There was no difference in mean FT4I or FT3I between the groups with high GGT and normal GGT levels. Six months after treatment with radioactive iodine, serum GGT levels decreased, while there was no significant change in mean serum alkaline phosphatase levels. Mean serum GGT levels were decreased in patients with hypothyroidism and correlated well with serum TSH levels. Replacement therapy with levothyroxine sodium caused an elevation in mean serum GGT levels in six hypothyroid patients. Thus, serum GGT activity is frequently increased in patients with hyperthyroidism and may be decreased in patients with hypothyroidism. Euthyroidism results in restoration of normal GGT levels.

Variations in total serum alkaline phosphatase activity with age and sex in adult and adolescent ghanaians

Variations in the mean serum alkaline phosphatase activity with age and sex in 500 healthy Ghanaians aged 16 to 80 years have been studied. The values are on the whole higher in males than females. The highest levels in both sexes are found in adolescence. After the age of 20 years in both sexes, there is a fall in the mean serum alkaline phosphatase level which tends to rise again after the age of 40 years in females and 50 years in males.

Symptomatic skeletal disease in non-terminal renal failure.

Sixteen patients suffering from stable non-terminal renal failure and complaining of skeletal symptoms were studied. Fifteen of the patients were female and all gave a history of analgesic abuse. All patients had radiological, bacteriological or histological evidence of pyelonephritis. All patients had histological osteomalacia and in fifteen this lesion was considered severe. Eight patients showed histological evidence of osteitis fibrosa; this lesion was severe in two patients. These patients had a significantly lower mean serum calcium level, a significantly lower mean serum bicarbonate level, a significantly higher mean serum alkaline phosphatase level and a significantly higher mean serum immunoreactive parathyroid hormone level than a group of uræmic patients not complaining of skeletal symptoms.

Alkaline phosphatase levels in thyroid disease

Serum alkaline phosphatase was estimated in eighty-one unselected patients with suspected thyroid dysfunction. Nineteen were found to be thyrotoxic, fifty-six euthyroid and six myxoedematous. In seven of the thyrotoxic patients the serum alkaline phosphatase level was higher than 10 KA units. There was a significant elevation of mean serum alkaline phosphatase levels in the thyrotoxic patients compared with the euthyroid controls. No significant difference in serum calcium or phosphorus levels was demonstrated between the thyrotoxic patients and the euthyroid controls. The possibility of thyrotoxicosis should be borne in mind in patients with a raised alkaline phosphatase level of otherwise obscure aetiology.

A search for sub-clinical rickets in Glasgow children.

Two random samples of Glasgow children aged 12 to 24 months were examined for clinical, biochemical and radiological evidence of subclinical rickets. No cases of florid rickets were discovered. One-third of the first sample studied (202 children) were estimated to be receiving less than 100 i.u. of vitamin D daily from all sources except sunshine. A poor dietary intake was most prevalent in the higher birth ranks and in social classes II and III (non-manual). The mean serum alkaline phosphatase level was 20 K.A. units per 100 ml. (S.D. 8 units) and 11 per cent had levels of 25 K.A. units per 100 ml. or above. No reason, either dietary or clinical, was found which would account for these high levels. Bone changes were observed in the wrist X-rays of about 9 per cent of children. They disappeared gradually with vitamin D therapy and there is some correlation with a raised alkaline phosphatase level and with tallness. They may be due to a relative insufficiency of vitamin D. Serum alkaline phosphatase estimations and wrist radiography do not appear to be useful methods for estimating the prevalence of hypovitaminosis D in the community or as screening procedures in the detection of individual cases of subclinical rickets.