ABSTRACT
Background: Serum phosphate level correlate with atherosclerosis in both animal models and humans with advanced chronic kidney disease and coronary calcification is a known impact of higher serum phosphate, but whether this relationship exists among individuals with Non-CKD is unknown. we conducted this study to observe role of higher serum phosphate level in cardiovascular comorbidities like MI and CHF in Non-CKD patients.Methods: In this observational study, 300 patients were enrolled, half of the patients having Clinical features or positive biochemical markers (Troponin-I for MI and serum BNP for CHF) suggestive of myocardial infarction and heart failure were taken as case group and half of the subjects were taken as control group with similar baseline characteristics. All participants in this study were consenting and more than 18 years of age.Results: The mean value of serum phosphate level in case group was 4.41±1.40 while in control group was 3.19±1.07 showing statistically significant difference (p-value <0.001). In case group 65% patients were having MI with higher serum phosphate level (4.22±1.40).Conclusion: Higher serum phosphate level is related to increased cardiovascular morbidities even in non-CKD patients.
ABSTRACT
Background: Globally, chronic kidney disease (CKD) is a major public health problem. Fibroblast growth factor (FGF)-23 is a newly recognized phosphatonin secreted by the osteocytes which acts as a key regulator of serum phosphate levels in CKD. In the present study, we aimed to estimate the levels of serum FGF-23 in patients with CKD and to compare them with healthy controls. Also, we aimed to compare the levels of FGF-23 levels with creatinine clearance and kidney size in various stages of CKD.Methods: A cross sectional comparative study was conducted at Thiruvarur Government Medical College hospital in Tamil Nadu. Patients aged between 20 and 65 years with an established diagnosis of CKD and healthy controls were included in the study. Enzyme Immuno-Assay method was followed for the estimation of FGF-23. Spot Urine sample was collected to determine the presence of albumin. Serum levels of glucose, Urea, Creatinine, Electrolytes (Sodium, Potassium), Albumin, Calcium, Phosphorus and Alkaline Phosphatase were measured. Information on kidney size, cortical echogenicity, parenchymal thickness and cortico-medullary differentiation were assessed based on ultrasound abdomen.Results: A total of 45 CKD cases and 45 healthy controls were studied. Mean (SD) age of CKD cases was 54(11) years and that of controls was 46(9.6) years. The mean value of FGF23 in cases was 730.7±492.7 pg/ml and this was higher than that of the control group whose mean value was 39.49±12.47 pg/ml (P<0.05). Mean GFR levels in cases and controls were 23.8 and 113.8 and this difference was statistically significant (P value<0.0001). Among cases, Pearson correlation between serum FGF-23 levels and eGFR, serum albumin was statistically significant and had a negative inverse correlation.Conclusions: The present study demonstrated that serum FGF23 levels were significantly increased in patients with CKD. This increase in serum FGF23 levels were progressive from the early stages to the late stages of CKD.
ABSTRACT
Background: Higher cardiovascular morbidity found to be more in early stages of chronic kidney disease patients. Present study was done to study the prevalence of cardiac valvular calcification correlated with serum phosphate levels in chronic kidney disease.Methods: A total of 153 (78 chronic kidney disease patients, 75 controls with age and sex matched) coming to ESIC Hospital, Chennai were utilized to conduct the present study. Patients of stages 3 to 5 with matched controls of age and sex were considered for this study. Cases were classified in to different stages of chronic kidney disease based on estimated Glomerular Filtration Rate which was calculated using Cockcroft-Gault equation using age, body weight, and serum creatinine. The blood samples of patients belonging to both the groups were tested for serum creatinine and serum phosphate. The Echocardiogram was done for the patient with chronic kidney disease to assess cardiac valvular calcification.Results: 51% of the subjects in the study group were detected as having chronic kidney disease in ultrasonogram. 20% of the patients in the study group were having coronary artery disease compared to 4% in the control group. Mean serum phosphate levels between subjects with Valvular calcification in chronic kidney disease and without calcification was statistically significant among the study group was noted in the present study.Conclusions: Elevated levels of serum phosphate correlated with cardiac valvular calcification showed significant role in chronic kidney disease.
ABSTRACT
Hypophosphataemia is a metabolic disorder that is commonly encountered in critically ill patients.Phosphate has many roles in physiological functions, thus the depletion of serum phosphate could leadto impairment in multiple organ systems, which include the respiratory, cardiovascular, neurologicaland muscular systems and haematological and metabolic functions. Hypophosphataemia is defined asplasma phosphate level below 0.80 mmol per litre (mmol/L) and can be further divided into subgroupsof mild (plasma phosphate of 0.66 to 0.79 mmol/L), moderate (plasma phosphate of 0.32 to 0.65mmol/L) and severe (plasma phosphate of less than 0.32 mmol/L). The causes of hypophosphataemiainclude inadequate phosphate intake, decreased intestinal absorption, gastrointestinal or renal phosphateloss, and redistribution of phosphate into cells. Symptomatic hypophosphataemia associated withhaematological malignancies has been reported infrequently. We report here a case of asymptomaticsevere hypophosphataemia in a child with acute T-cell lymphoblastic leukaemia.A 14-year-old Chinese boy was diagnosed to have acute T cell lymphoblastic leukaemia (ALL).His serum biochemistry results were normal except inorganic phosphate and lactate dehydrogenaselevels. The serum inorganic phosphate level was 0.1mmol/L and the level was low on repeatedanalysis. The child had no symptoms related to low phosphate levels. The possible causes of lowphosphate were ruled out and urine Tmp/GFR was normal. Chemotherapy regime was started andthe serum phosphate levels started to increase. Hypophosphataemia in leukaemia was attributed toshift of phosphorus into leukemic cells and excessive cellular phosphate consumption by rapidlyproliferating cells. Several reports of symptomatic hypophosphataemia in myelogenous andlymphoblastic leukaemia in adults have been reported. To our knowledge this is the first case ofsevere asymptomatic hypophosphataemia in a child with ALL.
ABSTRACT
Objective To evaluate the effect of red light irradiation on serum phosphorus reduction in hemodialysis.Methods Sixty maintenance hemodialysis patients were divided into treatment group and control group.During the hemodialysis,the blood in the extracorporeal circulation tube of the patents in the treatment group was irradiated with red light by a MRX-1 red light therapy system.The irradiation was continued for 60 minutes each time,and one course of the treatment contained 10 times of irradiations.Patients in the control group were subjected to hemodialysis by conventional methods.The serum phosphate levels of all patients were measured before and after the treatment.Results The symptoms of dialysis disequilibrium of the patients in the treatment group were alleviated.There was no significant difference in serum phosphate levels between the treatment group and the control group before hemodialysis,while a statistically significant difference was found after the treatment (P＜0.05).Conclusions Hemodialysis combined with red light irradiation on external blood trails can contribute to the decrease of serum phosphate levels in maintenance hemodialysis patients.
ABSTRACT
PURPOSE: The purposes of this study were to evaluate the efficacy of deformity correction of the knee and leg lengthening by the Ilizarov method in patients with vitamin D resistant rickets (VDRR) . MATERIALS AND METHODS: There were 7 patients with average age of 13 years and 6 months. 5 patients had genu varum and 2, genu valgum. 3 patients underwent deformity correction alone in 4 femora, and the remaining 4 patients underwent concomitant deformity correction and lengthening in 5 femora, and 12 tibiae and fibulae. RESULTS: Angular correction averaged 22.6. and the amount of lengthening averaged 3.5 cm. The healing index (H.I) averaged 2.1 month/cm. But those who had serum phosphate level more than 2.5 mg/dL showed rapid regenerate bone healing (H.I: 1.6 month/cm) . There was a statistically negative correlation between H.I and the level of serum phosphate. CONCLUSION: Maintenance of appropriate serum phosphate level (> or = 2.5 mg/dL) is important for satisfactory regenerate bone healing in due time in patients with VDRR. The recurrence rate of deformity appears to be relatively higher in immature patients.