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1.
Article | IMSEAR | ID: sea-226836

ABSTRACT

Introduction: As kidney function declines towards the more severe stages of chronic kidney disease (CKD), the interactions between kidney, intestine and bone become increasingly unstable. CKD with mineral and bone disorders and secondary hyperparathyroidism would be developing. The aim of this study was to determine the phosphocalcic profile of CKD patients in Libreville.Materials and Methods: This was a cross sectional study with 89 CKD patients recruited. A blood sample was taken to measure PTH, vitamin D, FGF-23 by ELISA method; calcium, magnesium, fasting blood glucose, phosphate and creatinine by spectrophotometer.Results: Mean phosphorus levels were 1.3 � 0.5 mmol/L and hormone levels 81.8 � 26.2 pg/mL and 27.5 � 5.0 ng/mL for PTH and vitamin D respectively. Significant hyperphosphatemia was found among 43 (48.3%; p=0.0135) patients. There were 59 (66.3%) subjects with hypovitaminosis D p=0.0000. Less than 50% of patients had normal blood glucose levels (p=0.0034). PTH was 99.4 � 16.4 pg/mL in dialysis patients and 61.7 � 20.3 pg/mL in non-dialysis patients, with a p=0.0000. Vitamin D levels were significantly higher in patients without calcium supplementation (29.5 � 5.0 ng/mL) than in those with supplementation (25.1 � 4.0 ng/mL, p= 0.0000).Conclusion: Phosphate levels remained high in our study population. Vitamin D deficiency was found in the majority of our patients. It would be advisable to readjust the management of these patients in order to minimize the effects of hyperphosphatemia and improve life quality.

2.
Clinics ; Clinics;79: 100329, 2024. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1534245

ABSTRACT

Abstract Objectives To compare the efficacy and safety of larotrectinib with those of infigratinib in adult glioma patients with tyrosine kinase alterations. Methods Patients received oral infigratinib 125 mg (IN cohort, n = 125) or oral larotrectinib (LB cohort, n = 105) until unacceptable toxicity or disease progression. Results Duration of treatment was longer in the LB cohort than in the IN cohort (8 [9.5-6.25] months vs. 5.5 [6-5.25] months, p < 0.0001). Patients with partial responses (p = 0.0424) and overall survival (p = 0.03) were higher in the IN cohort than those in the LB cohort. The number of patients with disease progression was higher in the LB cohort (p = 0.0015). All the patients reported diarrhea, fatigue, vomiting, constipation, and decreased appetite. Patients in the IN cohort reported hyperphosphatemia, hyperlipasemia, stomatitis, dry skin, alopecia, dyspepsia, onycholysis, palmar-plantar erythrodysesthesia, nail disorders, and dry eyes. Patients in the LB cohort reported upper respiratory tract infections, pyrexia, cough, anemia, bacterial/viral infections, conjunctivitis, urinary tract infections, headaches, ataxia, dizziness, and muscle tremors. A total of 30 (24 %) and 40 (38 %) patients from the IN and the LB cohorts died at the follow-up of 18 months (p = 0.03). Patients who received bevacizumab initial therapy had higher overall survival (p = 0.048). Conclusions Infigratinib has higher efficacy and overall survival than larotrectinib but has higher adverse effects in the management of both glioma and tyrosine kinase alterations after failure of initial therapies. Initial bevacizumab therapy is associated with a higher overall survival.

3.
Article | IMSEAR | ID: sea-221396

ABSTRACT

Introduction: Chronic kidney disease (CKD) has been recognized as a leading public health problem worldwide. The global estimated prevalence of CKD is 13.4%. Kidney plays a critical role in regulating serum levels of Calcium, Magnesium and Phosphate. Calcium, phosphorus and magnesium homeostasis is altered in chronic kidney disease(CKD). Objective Objective: of the study is to establish the correlation of increase in serum creatinine levels with Calcium, Magnesium and Phosphate levels in patients. Design & Methods: This observational retrospective study included patients attending nephrology department in tertiary care centre for a period of two months. In total, 229 patients' data was accessed from the medical records. Patients were grouped in 5 groups based on serum Results: creatinine levels. Group I with serum creatinine levels of 0.5mg/dl to 0.8mg/dl, group II with serum creatinine levels of 0.8 to 1.1mg/dl, group III with serum creatinine levels of 1.1 to 3mg/dl, group IV with serum creatinine levels of 3 to 6mg/dl, group V with serum creatinine levels above 6mg/dl. Overall from group I to Group V , Serum Calcium showed negative and significant correlation, Serum phosphorus levels showed positive and significant correlation, Serum magnesium showed negative and insignificant correlation with serum creatinine. As Conclusions: serum creatinine increases, more patients show decline in serum calcium levels and serum magnesium levels and increase in serum inorganic phosphorus levels. Hypocalcemia, hypomagnesemia and hyperphosphatemia have been associated with increased risk of cardiovascular morbidity and mortality in cases of CKD. Hypomagnesemia has possible association with rapid decline in kidney function. Therefore, regular analysis of these parameters is important for predicting the prognosis of CKD and cardiovascular risk in cases of CKD.

4.
Article | IMSEAR | ID: sea-233083

ABSTRACT

Background: Sepsis is a life-threatening organ dysfunction resulting from dysregulated host responses to infection. Serum phosphorus level was closely related to the occurrence and prognosis of kidney disease and cardiovascular disease. It is of vital importance to re-evaluate the association between serum Phosphorus level and mortality in patients with sepsis and different septic subgroups. This study aims to examine the association of serum phosphorous levels with clinical outcomes among patients with sepsis. Methods: This study included 100 cases and was conducted at KIMS hospital Bangalore. Patients were included in the study as per inclusion criteria. SOFA scoring and APACHE-II scoring was done on first day of admission and serum phosphorus levels were sent. Patients were categorised according to phosphorous levels normal range (2.5-4.5mg/dl). Patients were followed up till primary and secondary outcome. Results: Of the 100 patients in this study 53 patients had normophosphatemia, 17 patients had hypophosphatemia, 30 patients had hyperphosphatemia. Comparison of mean APACHE-II scores, mean length of ICU stay (in days), mean length of hospital stay (in days), serum creatinine levels, between 3 groups was statistically significant. Conclusions: Hyperphosphatemia on first ICU admission day indicates poor clinical outcome among patients with sepsis or septic shock. Therefore, when patients are on ICU admission and under treatment, clinicians should pay more attention to the change of serum phosphate.

5.
Rev. nefrol. diál. traspl ; Rev. nefrol. diál. traspl. (En línea);43(1): 8-8, mar. 2023.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1515453

ABSTRACT

RESUMEN El manejo de la hiperfosfatemia de los pacientes con insuficiencia renal crónica en diálisis permanece como un desafío. A pesar de utilizar un enfoque multifacético que incluye la restricción dietética, la remoción de fósforo por la diálisis y el uso de quelantes de fósforo, esta estrategia múltiple no logra reducir los niveles de fósforo en más de 2 mg/dl. El control de fósforo de los pacientes en diálisis es fundamental en razón de la relación monotónica entre los niveles séricos de fosfato y el incremento del riesgo cardiovascular. Por lo tanto, hay una necesidad de explorar nuevas estrategias para reducir los niveles séricos de fosfato a niveles normales. Recientes avances en nuestra compresión de los mecanismos que subyacen a la homeostasis del fósforo sugieren que el transporte gastrointestinal del fósforo podría ser un objetivo. Recientemente se han desarrollado inhibidores de los cotransportadores sodio fosfato del intestino y se ha revalorizado el uso de la nicotinamida, en su formulación de liberación prolongada, que también actuaria por ese mecanismo. También se han drogas como el tenapanor, que inhibiendo el intercambiador sodio/hidrogeno isoforma 3 del enterocito, disminuyen la absorción paracelular de fósforo.


ABSTRACT Management of hyperphosphatemia in patients with chronic renal failure on dialysis remains challenging. Despite using a multifaceted approach that includes dietary restriction, phosphorus removal by dialysis, and phosphate binders, these multiple strategies fail to reduce phosphorus levels by more than 2 mg/dL. Phosphorus control in dialysis patients is essential due to the monotonic relationship between serum phosphate levels and increased cardiovascular risk. Therefore, there is a need to explore new strategies to reduce serum phosphate levels to normal levels. Recent advances in understanding the mechanisms underlying phosphorus homeostasis suggest that the gastrointestinal transport of phosphorus could be a target. Inhibitors of intestinal sodium phosphate cotransporters recently developed, and using of nicotinamide, in its prolonged release formulation, which would also act by this mechanism, has been revalued. There have also been drugs such as tenapanor, which, by inhibiting the isoform three sodium/hydrogen exchanger of the enterocyte, decreases the paracellular absorption of phosphorus.

6.
Chinese Journal of Neurology ; (12): 1119-1127, 2023.
Article in Chinese | WPRIM | ID: wpr-1029120

ABSTRACT

Objective:To explore the clinical characteristics of paroxysmal kinesigenic dyskinesia (PKD) secondary to pseudohypoparathyroidism (PHP), so as to improve the clinicians′ understanding of the disease.Methods:The clinical data of 2 cases of PKD secondary to PHP in Beijing Tiantan Hospital, Capital Medical University from June 2022 to October 2022 were summarized, and the related literature was reviewed to analyze the pathogenesis, clinical manifestations, laboratory examination and imaging characteristics of the disease, as well as its treatment and prognosis.Results:Ten cases of PKD secondary to PHP were previously reported. A total of 12 cases (including these 2 cases) were included in the study, of which 7 were males (7/12) and 5 were females (5/12). The onset age was 8-23 years. The clinical manifestations of the disease included paroxysmal limb torsion, limb stiffness, limb tremor, throwing movements, and dance like movements. There were 3 cases (3/12) who had seizure at the same time. Ten cases (10/12) were induced by exercise, while 2 cases (2/12) were not mentioned the inducing factor. Eleven cases (11/12) with paroxysmal symptoms lasting less than 2 minutes can be relieved automatically. Only 1 case had a family history. Laboratory examination of all patients showed low calcium, high phosphorus and significant elevation of parathyroid hormone. The head CT scans of 10 cases (10/12) showed multiple intracranial calcifications. There were 9 cases (9/12) alone received the supplementation of calcium and active vitamin D, while 3 cases (3/12) were additionally treated with antiepileptic drugs. All cases had good prognosis.Conclusions:PHP is a rare cause of secondary PKD. A small number of patients can have seizures at the same time. Most patients have a good prognosis after receiving calcium and active vitamin D supplementation.

7.
Chinese Journal of Nephrology ; (12): 867-871, 2023.
Article in Chinese | WPRIM | ID: wpr-1029250

ABSTRACT

Chronic kidney disease (CKD)-mineral and bone disorder (CKD-MBD) is a common complication of CKD, which seriously affects the prognosis of patients. It is a series of abnormal mineral and bone metabolism syndrome caused by chronic renal function decline. The clinical manifestations are mainly decreased or increased serum calcium, increased serum phosphorus, increased intact parathyroid hormone, osteoporosis, and vascular calcification, etc. The paper reviews the research progress in the diagnosis, treatment and management based on the basic and clinical studies of hyperphosphatemia, secondary hyperparathyroidism, renal osteodystrophy and vascular calcification, etc.

8.
Chinese Journal of Nephrology ; (12): 465-468, 2023.
Article in Chinese | WPRIM | ID: wpr-995001

ABSTRACT

The paper reported a patient under maintained hemodialysis for 11 years, with a large mass appeared in the right thigh after local injury. The mass was clinically considered as tumoral calcinosis combined with clinical, imaging and pathological findings. Several treatments such as enhancing dialysis adequacy, low calcium dialysate, calcimimetic agent, non-calcium- phosphorus binding agents, parathyroidectomy and intravenous infusion of sodium thiosulfate could not vanish the mass. Finally, the lump was surgically removed. The treatment of tumoral calcinosis in the hemodialysis patient can provide a instruction for similar situations in clinical practice.

9.
Chinese Pharmacological Bulletin ; (12): 2354-2360, 2023.
Article in Chinese | WPRIM | ID: wpr-1013665

ABSTRACT

Aim To investigate the therapeutic effect of lanthanum hydroxide on renal injury and vascular calcification in rats caused by chronic kidney disease (CKD) and the underlying mechanism. Methods A CKD model was constructed by adenine, and the rats were randomly divided into model group, lanthanum hydroxide low, medium and high dose groups, lanthanum carbonate group and calcium carbonate group. After eight weeks, serum phosphorus ( Pi ), calcium (Ca), serum creatinine ( Scr), blood urea nitrogen ( BUN ), parathyroid hormone ( PTH ), fibroblast growth factor 23 ( FGF23 ) and tartrate-resistant acid phosphatase 5b ( TARP-5b) levels were measured. Histopathological staining was used to assess the degree of calcification of blood vessels, and the expressions of smooth muscle protein 22α ( SM22α), Runt-related transcription factor 2 ( RUNX2 ), hypoxia inducible factor 1 ( HIF-1) pathway mRNA and protein expression in blood vessels were detected. Results Lanthanum hydroxide can significantly reduce the levels of Pi, Scr, BUN, PTH, FGF23 and TARP-5b in the serum of CKD rats, significantly reduce the calcium deposition of the thoracic aorta of CKD rats, the expression of BMP-2, VEGF in the cytoplasm, the expression of RUNX2, HIF-1α in the nucleus, and increase the mRNA and protein expression of SM22. Conclusion Lanthanum hydroxide can markedly improve hyperphosphatemia in CKD rats, and can improve vascular calcification in CKD rats by blocking HIF-1α signaling pathway.

10.
Article in Chinese | WPRIM | ID: wpr-1014584

ABSTRACT

Tenapanor is a novel phosphorus-lowering drug, which mainly inhibits sodium/hydrogen exchange protein 3 (NHE3), and also reduces intestinal phosphorus absorption by down-regulating the expression of sodium phosphate co-transporter protein (NAPI). Tenapanor is mainly used for the treatment of hyperphosphatemia in patients with end-stage renal disease-hemodialysis (ESRD-HD). Diarrhea is the most common adverse reaction to this product. This article reviews Tenapanor by performing a literature search on its pharmacological effects, pharmacokinetic properties, clinical evaluation, safety, drug interactions and dosage.

11.
Article | IMSEAR | ID: sea-218769

ABSTRACT

Aim: To assess the impact of dietetic intervention on the nutritional status and calcium–phosphorus metabolism in maintenance hemodialysis (MHD) patients. Material and methods: Six-month longitudinal intervention study of 162 MHD patients selected from one dialysis unit in Romania. They were divided into 4 groups according to serum albumin (SA) level and the comorbid condition of chronic liver disease (CLD). Clinical and biochemical parameters were measured at baseline and 6 months after PNC (personalized nutritional counseling). Nutritional status was assessed by mSGA (modified Subjective Global Assessment) and dietary calorie and protein intake by diet history with the help of 72 h recall method. Nutritional counselling and personalized diets were recommended by the dietician bimonthly for a period of 6 months only to groups I and III (groups with hypoalbuminemia). Results: Comparison of data collected prior PNC (T0) and 6 months after (T6) showed: phosphorus (P) level decreased significantly in all 4 groups: group I- T0 vs. T6 p=0.005, group II: T0 vs. T6 p= 0.002; group III: T0 vs. T6 p=0.001, and group IV T0 vs. T6 p=0.042; serum Ca followed a similar trend; serum parathyroid hormone (PTH) remained stationary; SA level was significantly improved in both nutrition counseling groups (group I: T0 vs. T6 p= 0.001, group III: T0 vs. T6 p=0.001, respectively). Conclusions: Our study suggests that dietetic intervention focused on phosphate and albumin control in MHD patients with hyperphosphatemia and hypoalbuminemia contributes to an improvement in important nutritional parameters and to a positive calcium-phosphorus balance.

12.
Rev. cuba. estomatol ; 59(3)sept. 2022.
Article in Spanish | LILACS, CUMED | ID: biblio-1441574

ABSTRACT

Introducción: La osteodistrofia renal es una osteopatía metabólica difusa, relacionada con la insuficiencia renal crónica, que incluye diversas patologías en el sistema musculoesquelético. Se produce en respuesta a trastornos metabólicos generados por cambios electrolíticos, la inflamación crónica y la alteración hormonal. Estas variaciones modifican el proceso de remodelación ósea. Las manifestaciones clínicas incluyen alteración en el parénquima y estroma óseo, y van desde lesiones expansivas, produciendo deformidad, hasta fracturas patológicas del hueso. Objetivo: Relacionar las manifestaciones clínicas, imagenológicas e histológicas en el componente óseo cráneo facial para el diagnóstico de la osteodistrofia renal. Presentación de caso: Se presentan dos casos clínicos de pacientes con enfermedad renal crónica e hiperparatiroidismo secundario de base, con múltiples masas en maxilares que causan asimetría facial y alteración funcional. Las imágenes tomográficas revelan alteración en la morfología ósea cortical y trabecular. Ambos individuos evidenciaron alteraciones en niveles de hormona paratiroidea, fosfatasa alcalina, fósforo y calcio sérico. La histopatología comprobó tejido fibroóseo con hueso neoformado y gran vascularización, con células multinucleadas tipo osteoclastos sin presencia de hemosiderina. Pacientes manejados de forma interdisciplinaria entre medicina interna, endocrinología y cirugía maxilofacial. Conclusiones: Los pacientes con enfermedad renal crónica avanzada presentan alteración de la estructura y del metabolismo óseo y mineral. Tal situación puede comprometer el complejo óseo craneofacial. Los casos graves de osteodistrofia renal se caracterizan por una marcada expansión de los maxilares, que genera asimetría y rasgos de leontiasis. Las imágenes tomográficas asociadas a osteodistrofia renal presentan óseos trabeculares con expansión de cortical, que evidencia el recambio óseo inmaduro presente. La histopatología no es específica y puede ser similar a los casos de displasia ósea craneofacial. Ante lo anteriormente planteado es fundamental relacionar estos hallazgos con la clínica para definir un diagnóstico adecuado(AU)


(AU)Introduction: Renal osteodystrophy is a diffuse metabolic osteopathy, related to chronic renal failure, which includes various pathologies in the musculoskeletal system. It occurs in response to metabolic disorders generated by electrolyte changes, chronic inflammation and hormonal alteration. These variations modify the process of bone remodeling. Clinical manifestations include alteration in the parenchyma and bone stroma, and range from expansive lesions, producing deformity, to pathological fractures of the bone. Objective: Relate the clinical, imaging and histological manifestations in the skull-facial bone component for the diagnosis of renal osteodystrophy. Case Presentation: Two clinical cases of patients with chronic kidney disease and secondary underlying hyperparathyroidism are presented, with multiple masses in the jaws that cause facial asymmetry and functional alteration. Tomographic images reveal alteration in cortical and trabecular bone morphology. Both individuals showed alterations in levels of parathyroid hormone, alkaline phosphatase, phosphorus and serum calcium. Histopathology verified fibro-bone tissue with neoformed bone and great vascularization, with multinucleated osteoclast-like cells without the presence of hemosiderin. Patients were attended in an interdisciplinary way between internal medicine, endocrinology and maxillofacial surgery. Conclusions: Patients with advanced chronic kidney disease present alteration of the structure and bone and mineral metabolism. Such a situation can compromise the craniofacial bone complex. Severe cases of renal osteodystrophy are characterized by a marked expansion of the jaws, which generates asymmetry and traits of leonthiasis. The tomographic images associated with renal osteodystrophy present trabecular bones with cortical expansion, which evidences the immature bone turnover present. Histopathology is not specific and may be similar to cases of craniofacial bone dysplasia. Given the above, it is essential to relate these findings to the clinic to define an adequate diagnosis(AU)


Subject(s)
Humans , Male , Female , Chronic Kidney Disease-Mineral and Bone Disorder/diagnosis
13.
Chinese Journal of Nephrology ; (12): 296-303, 2022.
Article in Chinese | WPRIM | ID: wpr-933860

ABSTRACT

Objective:To explore the effects of dietary phosphate restriction education on serum phosphorus level, dietary phosphate intake and the knowledge of hyperphosphatemia in maintenance hemodialysis (MHD) patients.Methods:This study was a retrospective cohort study. A total of 116 hemodialysis patients in Huashan Hospital, Huadong Hospital and Tongji Hospital from October 2019 to December 2020 were enrolled in this study. They were divided into short-term group (84 cases) and long-term group (32 cases). The short-term group did not receive education or received education≤60 minutes. Meanwhile, the long-term group received education>60 minutes. Serum phosphorus level, dietary phosphate intake and knowledge of hyperphosphatemia were compared between the two groups after 4 weeks.Results:At baseline, age [64(56, 69) years old vs 65(60, 73) years old, Z=-1.493, P=0.136], the proportion of males [58.3%(49/84) vs 56.3%(18/32), χ2=0.041, P=0.839], dialysis age [55(26, 130) months vs 53(20, 132) months, Z=-0.062, P=0.951], body mass index, diabetes history, single-pool Kt/V, proportion of calctriol used, blood calcium, blood phosphorus, intact parathyroid hormone and dietary protein, dietary phosphorus and dietary phosphorus protein ratio had no statistical significance between short-term group and long-term group (all P>0.05). Adequate dietary phosphate restriction education reduced dietary phosphate intake [777.98(653.81, 943.16) mg/d vs 896.56(801.51, 1 015.51) mg/d, Z=-2.903, P=0.004], phosphate/protein ratio [13.16(11.52, 14.21) mg/g vs 15.27(13.31, 17.48) mg/g, Z=-3.929, P<0.001] and serum phosphorus level [(1.42±0.37) mmol/L vs (1.85±0.44) mmol/L, t=4.984, P<0.001]. Meanwhile, such education significantly improved achievement rate of serum phosphorus (62.5% vs 41.7%, χ2=4.034, P=0.045). In addition, patients in long-term group answered more questions correctly (completely correct plus partially correct) about the causes (93.8% vs 72.6%, χ2=6.120, P=0.013), poor prognosis (78.1% vs 52.4%, χ2=6.372, P=0.012) of hyperphosphatemia as well as the types of food with high phosphate (65.6% vs 52.4%, χ2=1.650, P=0.199). Conclusion:Adequate dietary phosphate restriction education reduces serum phosphorus level and dietary phosphate intake, and improves the knowledge of hyperphosphatemia in MHD patients.

14.
Acta méd. peru ; 38(2): 117-122, abr.-jun 2021. tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1339021

ABSTRACT

RESUMEN Los niños con deficiencia de vitamina D pueden tener fósforo normal o alto a pesar de tener una prueba de hormona paratiroidea (PTH) elevada. El pseudohipoparatiroidismo (PHP) se caracteriza por cursar con hiperfosfatemia. La similitud que puede ocurrir entre la deficiencia de vitamina D asociada a hiperfosfatemia y el PHP hace importante revisar reportes de casos de deficiencia de vitamina D asociada a hiperfosfatemia para entender por qué puede ocurrir esta asociación y cuál es la relevancia de estudiar el nivel de vitamina D en niños con sospecha de PHP. El objetivo de esta revisión fue identificar reportes de niños con deficiencia de vitamina D asociada a hiperfosfatemia y discutir los mecanismos de esta asociación. Se identificaron reportes de 7 casos en niños. La deficiencia de vitamina D reduciría la respuesta fosfatúrica ante una PTH elevada. Se concluye que es importante descartar deficiencia de vitamina D en todo niño con sospecha de PHP.


ABSTRACT Children with vitamin D deficiency can have normal or high phosphorus despite having a high parathyroid hormone test (PTH). Pseudohypoparathyroidism (PHP) is characterized by hyperphosphatemia. The similarity that can occur between vitamin D deficiency associated with hyperphosphatemia and PHP makes it important to review case reports of vitamin D deficiency associated with hyperphosphatemia to understand why this association may occur and what is the relevance of studying the vitamin D level in children with suspected PHP. The aim of this review was to identify reports of children with vitamin D deficiency associated with hyperphosphatemia and to discuss the mechanisms of this association. Reports of 7 children cases were identified. Vitamin D deficiency could reduce the phosphaturic response to elevated PTH. It is concluded that it is important to rule out vitamin D deficiency in all children with suspected PHP.

15.
Article in Chinese | WPRIM | ID: wpr-908384

ABSTRACT

Objective:To analyze the relationship between hyperphosphatemia and steroid-sensitive nephrotic syndrome(SSNS)in children.Methods:A retrospective study was carried out in 61 children with SSNS at Department of Paediatric Nephrology and Rheumatism and Immunology, Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2017 to December 2018.The changes of serum phosphorus levels during the active and remission stages were observed, and the correlation between serum phosphorus level and serum albumin, blood lipid, renal function, blood calcium, blood phosphorus, urine protein and other indicators were analyzed.Results:Serum phosphorus level of 61 children with SSNS was 1.79(1.65-1.91)mmol/L in the active phase of the disease, of which 33 patients(54.1%)had hyperphosphatemia, while serum phosphorus level was 1.64(1.46-1.79)mmol/L after the complete remission, and 15(24.6%)patients had hyperphosphatemia.Serum phosphorus level was positively correlated with ratio of urine protein/creatinine, serum lipoprotein A and calcium-phosphorus product( r=0.239, P<0.05; r=0.188, P<0.05; r=0.623, P<0.05), and negatively correlated with levels of serum albumin and serum calcium( r=-0.201, P<0.05; r=-0.195, P<0.05). Conclusion:The morbidity of hyperphosphatemia in children with SSNS is quite high during the active stage of the disease.The disorder of blood phosphorus significantly improve with remission of the disease.

16.
China Pharmacy ; (12): 1003-1008, 2021.
Article in Chinese | WPRIM | ID: wpr-876273

ABSTRACT

OBJECTIVE:To study influential factors for medication compliance of phosphate binder in patients with maintenance hemodialysis and the effects of pharmacist intervention ,and to improve medication compliance and the effects of disease control. METHODS :The patients with maintenance hemodialysis who were treated in the blood purification center of our hospital from Jun. to Dec. ,2019 were selected for questionnaire survey. The questionnaires involved general information , medication compliance of phosphate binder ,disease and medicine related knowledge ,social support ,self-efficacy. The t-test,χ2 test and multivariate Logistic regression analysis were used to analyze influential factors for medication compliance. The patients were randomly divided into pharmaceutical intervention group and non-intervention group. Intervention group were provided with pharmaceutical care for 3 months according to risk factors. Blood phosphorus level and medication compliance was compared between 2 groups. RESULTS :Totally 298 patients completed the survey (effective recovery rate of 96.1%). Among them ,163 patients(54.7%)had good adherence to phosphate binder ,while 135 patients(45.3%)had poor compliance. Results of single factor analysis showed that medication compliance of phosphate binder was closely associated with age ,dialysis duration , parathyroid hormone levels ,total daily dose ,daily dose of phosphate binder ,disease and medicine related knowledge scores , social support ,self-efficacy(P<0.05). Results of multivariate Logistic regression analysis showed that total daily dose ,daily dose of phosphate binder ,disease and medicine related knowledge scores ,social support and self-efficacy were the influential factors for medication compliance (P<0.05 or P<0.01). Medication compliance ,disease control status ,disease and medicine related knowledge score , social support and self-efficacy in pharmaceutical intervention group were significant improved , blood phosphorus level was significant lower ,compared with non-intervention group (P<0.05). CONCLUSIONS :Independent risk factors influencing medication compliance of phosphate binder include total daily dose ,daily dose of phosphate binder ,disease and medicine related knowledge scores ,social support and self-efficacy. The patients with maintenance hemodialysis have poor compliance to phosphate binder. Pharmacists should take individualized and targeted intervention measures for the above risk factors,which can effectively improve the medication compliance and disease prognosis of patients.

17.
Arch. endocrinol. metab. (Online) ; 64(4): 374-382, July-Aug. 2020. tab, graf
Article in English | LILACS | ID: biblio-1131115

ABSTRACT

ABSTRACT Objective The aim of the present study was to evaluate whether arterial stiffness is affected in the patients with hypoparathyroidism through pulse wave analysis (PWA). Subjects and methods Sixty-three patients diagnosed with hypoparathyroidism and sixty volunteers were evaluated for the study. When 21 patients were excluded in the hypoparathyroidism group due to exclusion criteria, the research continued with 42 patients and 60 volunteers who are similar to the patients in terms of age, gender and body mass index (BMI). Fasting plasma glucose after 10 hours of fasting, creatinine, thyroid stimulating hormone (TSH), free thyroxine (fT4), albumin, calcium, phosphorus, magnesium, 25-OH vitamin D, parathormone (PTH) and urine calcium results in 24-hour urine for the patients in the hypoparathyroidism group were recorded. Evaluation of arterial stiffness was performed by Mobil-O-Graph 24h PWA device. Results Systolic blood pressure (SBP) (p = 0.01), diastolic blood pressure (DBP) (p = 0.005), mean blood pressure (p = 0.009), central SBP (p = 0.004), central DBP (p = 0.01) and pulse wave velocity (PWV) (p = 0.02) were found higher in the hypoparathyroidism group. A positive correlation was detected between phosphorus level and SBP [(p = 0.03. r = 0.327)], central SBP [(p = 0.04, r = 0.324)] and PWV [(p = 0.003, r = 0.449)]. We detected that age and serum phosphorus levels were independent predictor variables for PWV (B = 0.014, p < 0.001 and B = 0.035, p < 0.001, respectively). Conclusion We detected that hypoparathyroidism causes an increase in blood pressure and arterial stiffness. The most significant determinant factors were detected as advanced age and hyperphosphatemia. The patients diagnosed with hypoparathyroidism should be closely monitored and treatment planning should include to prevent the patients from hyperphosphatemia.


Subject(s)
Humans , Vascular Stiffness , Hypoparathyroidism , Blood Pressure , Body Mass Index , Pulse Wave Analysis
18.
Arch. endocrinol. metab. (Online) ; 64(3): 282-289, May-June 2020. tab
Article in English | LILACS | ID: biblio-1131085

ABSTRACT

ABSTRACT Objective Hypoparathyroidism is a rare condition, whose most common etiology is complications of neck surgery. The aim of the study was to identify the clinical and biochemical profile of the patients with diagnosis of hypoparathyroidism, including the frequency of symptoms, clinical signs, long-term complications and disease control. Additionally, the study sought to know what the medication profile was, and the doses required by the patients. Subjects and method A retrospective cohort study was conducted wherein all patients with ICD-10 codes associated with hypoparathyroidism between 2011 and 2018 at the Hospital Universitario San Vicente Fundación were included. We investigated the etiology of the disease; biochemical profile including lowest serum calcium, highest serum phosphorus, 25OHD levels, calciuria and calcium/phosphorus product; medication doses, disease control, and presence of complications, especially renal and neurologic complications were also evaluated. Results The cohort included 108 patients (99 women/9 men) with a mean age of 51.6 ± 15.6 years. The main etiology was postoperative (93.5%), the dose of elemental calcium received was relatively low (mean 1,164 mg/day), and in only 9.2% of cases more than 2,500 mg/day of elemental calcium was necessary. We were able to evaluate the follow-up in 89 patients, and found that only 57.3% met the criteria for controlled disease. Conclusion The clinical profile of patients with hypoparathyroidism in our cohort is similar to that described in other international studies, with predominantly postoperative etiology. With standard therapy, only adequate control is achieved in a little more than half of patients. Arch Endocrinol Metab. 2020;64(3):282-9


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Parathyroid Hormone/blood , Hypoparathyroidism/complications , Biomarkers/blood , Retrospective Studies , Colombia , Hypoparathyroidism/blood , Middle Aged
19.
Rev. nefrol. diál. traspl ; Rev. nefrol. diál. traspl. (En línea);40(1): 25-31, Mar. 2020. graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1377067

ABSTRACT

Resumen Introducción: Las calcificaciones vasculares forman parte del trastorno mineral óseo en la enfermedad renal crónica y constituye una de las principales causas de mortalidad. Existe plausibilidad y asociación experimental entre el trastorno bioquímico con la calcificación vascular, sin embargo, no existe evidencia suficiente de su asociación clínica. Objetivo: Determinar la asociación de las alteraciones bioquímicas del trastorno mineral óseo (calcio >10 mg/dl, fósforo >5 mg/dl, paratohormona >300 pg/ml) con las calcificaciones vasculares valoradas de acuerdo al score de Kauppila. Material y métodos: Estudio observacional, transversal y analítico. Se incluyeron 97 pacientes con ERC estadio V, en terapia de hemodiálisis, 69% prevalente (establecido en >6 meses) con un tiempo promedio de 5,3 años. Se estableció asociación estadística según test Chi2 de Pearson y regresión logística. Resultados: El 60,8% presentó algún grado de calcificación vascular con un score de Kauppila >1 y el 43,3% presentó un score ≥3, que fue predominante en la población prevalente en hemodiálisis (78,6%). Sin embargo, no se encontró asociación estadística con el trastorno bioquímico mineral óseo en el análisis bivariado por Chi2 ni por regresión logística. Conclusiones: Una valoración transversal de la alteración bioquímica del trastorno mineral óseo no permite establecer su asociación con las calcificaciones vasculares. Es necesario establecer previamente el balance positivo prospectivo de calcio y de fósforo para demostrar esta asociación.


Abstract Introduction: Vascular calcifications are part of the mineral bone disorder in chronic kidney disease and they are one of the main causes of mortality. There is plausibility and experimental association between metabolic disorder and vascular calcification; however, there is no enough evidence for their clinical connection. Objective: To determine the association of biochemical alterations of mineral bone disorder (calcium: >10 mg/dL; phosphorus: >5 mg/dL; paratohormone: >300 pg/mL) with vascular calcifications evaluated according to the Kauppila score. Methods: An observational, cross-sectional, analytical study was performed. 97 stage V CKD patients undergoing hemodialysis were included; 69% were prevalent cases (diagnosed within >6 months) with an average time of 5.3 years. A statistical association was established according to Pearson's Chi2 test and logistic regression. Results: A level of vascular calcification was found with a Kauppila score of >1 in 60.8% of patients and of ≥3 in 43.3% of them, being predominant in the prevalent dialysis population (78.6%). However, no statistical association was found with mineral bone disorder in the chi-squared bivariate analysis or the logistic regression. Conclusions: A cross-sectional test of the biochemical alteration in mineral bone disorder does not allow to find an association with vascular calcifications. It is necessary to establish a prospective calcium-phosphorus positive balance first to prove this association.

20.
Article | IMSEAR | ID: sea-194593

ABSTRACT

Tumoral calcinosis is a rare condition characterized by solitary or multiple, periarticular masses. Surgical excision of the tumoral calcinosis lesion is a well-documented treatment, but recurrences are not uncommon. A case of 42 year old male patient of tumoral calcinosis presented to us with history of repeated surgical excision twice in past 8 years for recurrent swellings. He was started on IV zoledronic acid and the patient has shown improvement after two years with no recurrence in follow up.

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