Urinary calcium and bone mineral density in children with nephrotic syndrome treated with glucocorticoids

Background: Mainstay of therapy in the idiopathic nephrotic syndrome is glucocorticoids. Glucocorticoid induced osteoporosis is considered as most prevalent type of secondary osteoporosis. Only limited studies are conducted in tropical nations. Therefore our study is undertaken with objectives to evaluate Glucocorticoid therapy impact on bone health in Nephrotic Syndrome (NS) children by 2 different tools, namely urinary calcium and bone mineral density (BMD) by Quantitative ultrasound (QUS) and compare both the tools.Methods: Total 42 children with NS who completed minimum 12 weeks of Glucocorticoid therapy (6 weeks of daily regimen and minimum 6 weeks of alternate day regimen) were subjected to 24 hour Urinary calcium and Bone Mineral density by QUS at Tertiary health centre, Kalaburagi.Results: Out of 42 cases, 45.2 % had Osteopenia and 2.4% had osteoporosis, so 47.6% of them had BMD measured by QUS. Hypercalciurea was seen in 10 out of 42 cases (23.8%). In normal BMD group only 0.5% had hypercalciurea, Osteopenia group had 47.4% of cases and all osteoporosis group had hypercalciurea.Conclusions: Present study data concludes that children with NS treated with Glucocorticoids are at risk of Negative impact on bone health. Though both the tools detect impact of Glucocorticoids on bone health, BMD by QUS has better rate then urinary calcium in detecting negative effect of Glucocorticoid on bone health. As BMD by QUS decreases, Urinary calcium increases reflecting inverse relation between them.

Reference range of random urinary calcium creatinine ratio in North Indian children and adolescents

PURPOSE: Urinary calcium creatinine ratio (UCaCrR) is a reliable indicator for monitoring hypercalciuria following vitamin D supplementation. However, the reference range varies from region to region. Previous studies did not take vitamin D and parathyroid hormone status into account while evaluating UCaCrR. Hence, we undertook this study to establish the 95th percentile of UCaCrR as an indicator of hypercalciuria in North Indian children and adolescents. METHODS: Four hundred seventy-three participants (boys 62.2%, girls 37.8%) with adequate dietary calcium intake, normal serum levels of 25-hydroxy-vitamin D (>20 ng/mL), and without secondary hyperparathyroidism following supplementation were selected for evaluation of UCaCrR. RESULTS: The mean age and body mass index of subjects were 11.2±2.6 years and 18.0±3.6 kg/m2, respectively. The 95th percentile of UCaCrR in the study population was 0.126. The mean, median, and 95th percentile of UCaCrR was significantly higher in prepubertal children (age ≤10 years) (0.0586±0.0374, median=0.0548, 95th percentile=0.136) compared to those >10 years old (0.0503±0.0363, median=0.0407, 95th percentile=0.123, P=0.02). No significant difference in UCaCrR was observed between genders and different weight categories. CONCLUSIONS: UCaCrR of 0.13 defines the cutoff value for hypercalciuria in North Indian children and adolescents with adequate dietary intake of calcium and sufficient serum vitamin D levels.

Effect of calcium sources in the diets of adult cats on urinary parameters and acid-base balance / Efeitos das fontes de cálcio na dieta de gatos adultos sobre parâmetros urinários e equilíbrio ácido-básico

Calcium is a macroelement that is part of the mineral composition of the diet of companion animals, and is considered a cation of strong alkalizing power, increasing urinary pH. Calcium salts have different solubilities and depending on the anion to which calcium is associated with, it can be more or less absorbed, modifying the pH of the urine. The aim of this study was to evaluate the efficiency of calcium sources on alkalinization of urinary pH, as well as excretion of urinary electrolytes and acid-base balance of adult cats. An extruded diet for cats was selected, and had 160mEq/kg of calcium from the sources of either calcium carbonate (CaCO3) or calcium gluconate (C12H22CaO14) added. In the control treatment there was no addition of calcium sources, resulting in three treatments. Nine adult cats were used, mixed breed, in two experimental periods, with six replicates per treatment. Animal average age was 4±1.3 years old and average weight was 3.96±0.71kg. The cats remained in metabolic cages for an adaptation period of seven days, followed by six days of urine total collection, with volume, density, pH and calcium concentration (g/d) measurements. The acid-base balance was studied by blood gas analysis of venous blood. The two sources of calcium alkalinized the urine (P<0.001). However, calcium gluconate had less alkalinization power compared to the calcium carbonate (P<0.05). Urinary calcium was not affected by treatments, and represented less than 0.5% of calcium intake. The experiment showed that calcium, although an alkaline cation and considered strong influencer of the EB of the diet, cannot be evaluated individually, because depending on its associated anion it may have greater or lesser influence on cats urine pH.(AU)

O cálcio (Ca) é um macroelemento que faz parte da composição mineral da dieta de animais de companhia. Este macroelemento é considerado um cátion de forte capacidade alcalinizante e, de acordo com a fonte e quantidade inclusa, pode aumentar o pH urinário. Os sais de cálcio têm diferentes solubilidades e dependendo do ânion ao qual o cálcio está associado, pode ser mais ou menos absorvido e assim, alterar o pH da urina. O objetivo deste estudo foi avaliar os efeitos de duas fontes de cálcio na alcalinização do pH urinário, bem como a excreção de eletrólitos urinários e o equilíbrio ácido-básico de felinos. Foi selecionada uma dieta extrusada para gatos e adicionados 160mEq/kg de cálcio das fontes carbonato de cálcio (CaCO3) ou gluconato de cálcio (C12H22CaO14). No tratamento controle, não houve adição de fontes de cálcio. Foram utilizados nove gatos adultos, de raças mistas, em dois períodos experimentais, com seis repetições por tratamento. Os animais apresentavam idade média de 4,0±1,3 anos e peso corporal médio de 3,96±0,71kg. Estes permaneceram em gaiolas metabólicas em período de adaptação durante sete dias, seguido de coleta total de urina durante seis dias. Nestas amostras foram aferidos o volume, densidade, pH e concentração de cálcio (g/d). O equilíbrio ácido-básico foi avaliado por hemogasometria em amostras de sangue venoso. As duas fontes de cálcio alcalinizaram a urina (P<0,001). No entanto, o gluconato de cálcio apresentou menor potencial de alcalinização em comparação ao carbonato de cálcio (P<0,05). O cálcio urinário não foi afetado pelos tratamentos e representou menos de 0,5% da ingestão de Ca. O experimento demonstrou que o cálcio, apesar de ser um cátion alcalinizante e influenciador do EB da dieta, não pode ser avaliado individualmente, porque dependendo do ânion associado, pode apresentar maior ou menor influência no pH da urina de gatos.(AU)

A Comparative Study of High Sensitive C-Reactive Protein (hs-CRP) and Urinary Calcium/Creatinine Ratio in Normal Pregnancy and Pregnancy Induced Hypertension in Gujarat, India

Background:Pregnancy-induced hypertension (PIH) is a condition characterized by high blood pressure during pregnancy.It is the most common leading cause of maternal and perinatalmorbidity and mortality in females. Serum high sensitive C-reactive protein (hs-CRP) is one of the suitablemarkers for low grade inflammation evaluation.Urinary calcium-creatinine ratio (UCa/Cr) is a valuable marker for prediction of PIH Aim:To measure & correlate serum hs-CRP and urinary calcium-creatinine ratio in between pregnancy-induced hypertension and normal pregnancy.Material & Methods:In present study total 150 subjects attending Department of Obstetrics & Gynecology at Sir Takhtsinhji Hospital, Bhavnagar, Gujarat, were included which were categorized in two groups. Group A: 75 patients of pregnancy-induced hypertension; Group B: 75 normal pregnant women as a control group. They were primarily diagnosed based on measurement of bloodpressure, clinical examination followed by biochemical investigations like hs-CRP, urinary calcium & creatinine, RBS, urea, creatinine, uric acid, CK-MB. Written informed consent was obtained from all participants before enrolling in the study.Results:No significant change in the levels of biological parameters like RBS, urea, creatinine and CK-MB was observed in both the study groups (p>0.05) except serum uric acid shows a significant difference (p<0.001). The levels of hs-CRP were found to be significantly higher in patients of pregnancy-induced hypertension (7.81±3.681)as compared to the normal pregnant women (3.11±1.972)(p<0.0001) .UCa/Cr ratio had more sensitivity and specificity than hs-CRP for prediction of pregnancy-induced hypertension compared to normal pregnancy.Conclusion:UCa/Cr ratio can be used as a more sensitive and specific test to detect pregnancy induced hypertension

High Dietary Sodium Intake Assessed by 24-hour Urine Specimen Increase Urinary Calcium Excretion and Bone Resorption Marker

BACKGROUND: The average dietary sodium intake of Koreans is 2.6 times higher than the World Health Organization's recommended amount. The effect of a diet high in sodium on the skeletal system, especially osteoporosis, has not previously been examined in Korean postmenopausal women with low bone mass. We assessed the daily sodium intake, and determined the impact of sodium intake on urinary calcium excretion and bone resorption marker. METHODS: A retrospective review of medical records was performed for 86 postmenopausal subjects who were initially diagnosed with osteopenia or osteoporosis at the health promotion center. They were subsequently referred to the Division of Endocrinology and Metabolism between 2010 and 2013. All subjects completed a modified food frequency questionnaire. Twenty-four hour urine collection for sodium, calcium and creatinine excretion, and serum C-terminal telopeptides of type I collagen (CTX-I) were also obtained. RESULTS: The average amount of daily sodium and calcium intake were 3,466 mg and 813 mg, respectively. Average dietary sodium intake and 24-hour urinary sodium excretion showed significant positive linear correlation (r=0.29, P=0.006). There was also a significant positive linear correlation between 24-hour urine sodium and calcium excretion (r=0.42, P<0.001); CTX-I and 24-hour urinary calcium excretion (r=0.29, P=0.007). CONCLUSIONS: Excessive sodium intake assessed by 24-hour urine specimen is associated with high calcium excretion in urine. High calcium excretion is also related to increasing bone resorption marker.

A Study on Dietary Mineral Intakes, Urinary Mineral Excretions, and Bone Mineral Density in Korean Postmenopausal Women / 대한지역사회영양학회지

The purpose of this study was to determine the urinary Ca, P, Mg, Zn, Cu, and Mn levels and bone mineral density (BMD) in sixty-two postmenopausal women. The study was conducted through anthropometric checkup, 24-hour recall, 24-hour urine and bone mineral density using DEXA. Average age, height, weight and body fat of the subjects were respectively 65.39 years, 150.19 cm, 58.03 kg and 37.22%. The average spine and femoral neck BMD of subjects were -2.19, -3.13. The mean intakes of Ca, P and Mg were 524.7 mg, 993.10 mg, and 254.6 mg and those of Zn, Cu and Mn were 8.6 mg, 1.5 mg, and 3.5 mg. The average 24-hour urinary excretion of Ca (UCa), P (UP) and Mg (UMg) were 161.07 mg, 673.68 mg, and 99.87 mg. The average 24-hour urinary excretion of Zn (UZn), Cu (UCu) and Mn (UMn) were 366.50 microg, 22.57 microg, and 1.55 microg. Ca intake showed significantly positive correlations with urinary UCa (p < 0.05), UMg (p < 0.01) and spine BMD (p < 0.05). P intake showed significantly positive correlations with UCa (p < 0.05), UMg (p < 0.05) and UZn (p < 0.05). Mg intake showed significantly positive correlations with UZn (p < 0.05) and Mn intake showed significantly positive correlations with UCa (p < 0.05). Multiple regression analysis indicates that Ca intake and UMg is the most important factor to increase spine BMD. On the other hand, UCa is the most important factor to decrease spine BMD. Higher femoral neck BMD was related to UP, while lower femoral neck BMD was related to UCa. In conclusion, Dietary intake of Ca showed positive effect of spine BMD, while excessive P intake showed negative effect on BMD due to increases in UCa, UMg and UZn. Further studies are required to investigate the relationship between bone metabolism and mineral excretion.

A Study on the Calcium and Sodium Intakes and Urinary Calcium Excretion of Adults in Busan / 대한지역사회영양학회지

The purpose of this study was to assess calcium and sodium intakes and urinary excretion of adults in Busan and to evaluate the relationship between urinary calcium excretion (UCa) and the status of anthropometric, blood pressure, urine analysis, and nutrient intake of subjects. Nutrient intake by 24 hr recall, 24 hr urinary calcium and sodium excretion (UNa) were measured with 87 adults aged 20-59 yrs (42 men and 45 women). The mean calcium intake was 88.0% for men and 103.0% for women of Recommended Intake. The mean sodium intake was 283.4% for men and 250.5% for women of Adequate Intake (AI). The mean 24hr UCa was 127.4 mg in men and 107.3 mg in women. The mean 24 hr UNa was 3650.6mg in men and 3276.4mg in women. The intake and urinary excretion of calcium and sodium were not significantly different by gender. UCa showed significantly positive correlations with sodium intake and UNa in men (p < 0.001, p < 0.05) and women (p < 0.001, p < 0.001) and with age, systolic blood pressure (SBP) and sodium density in women (p < 0.05, p < 0.05, p < 0.01). The UCa/creatinine showed significantly positive correlations with age, sodium intake, sodium density, and UNa in women (p < 0.05, p < 0.01, p < 0.01, p < 0.01). When UCa was stratified into quartile (Q1-Q4), age, SBP, UCa, UNa, sodium intake, and AI percentage of sodium (p < 0.01, p < 0.05, p < 0.001, p < 0.001, p < 0.001, p < 0.001) were significantly higher in Q4. The mean intake and AI percentage of sodium in Q4 were 4768.8mg and 329.0. Based on the results, UCa was related to age, SBP, UNa, and sodium intake. Therefore, nutritional education of decreasing sodium intake for decreasing UCa is needed.

Association of Serum Calcium and 24 Hours Urinary Excretion of Calcium in Patients of Preeclampsia.

Preeclampsia is a leading cause of fetal growth retardation, infant morbidity, mortality and maternal death. Several biochemical changes occur during the course of the disease, among them serum total calcium and 24 hr urinary calcium excretion rate have drawn remarkable attention. A case control study was designed to see the association of serum calcium and 24 hours urinary excretion of calcium in patients of pre- eclampsia. The study was done from July 2008 to June 2009 in the Department of Biochemistry, Dhaka Medical College, Dhaka. Total 60 subjects were selected as study population. Among them 30 were diagnosed case of preeclampsia and 30 were age- and sex-matched normal pregnant female healthy control. It was found that the mean measured serum calcium level in case group were 1.96 ±0.17 ( mean±SD ) mmol / l and that of control group were 2.34±0.12 (mean±SD) m mol/ l respectively. The mean 24 hr urinary calcium excretion level were 94.40 ±10.68mg/24 hr (mean±SD) in case group and that of control group were 154.35±66.68 (mean ±SD) mg / 24 hr respectively. The study suggests that low level of serum calcium and urinary excretion of calcium was associated with Pre-eclampsia.

Effects of Soy Isoflavones Supplementation and Exercise on Urinary Calcium, Magnecium, Copper and Zinc Excretion in Postmenopausal Women

This study assessed the effects of soy isoflavones supplementation with exercise on urinary mineral (calcium, magnesium, copper, zinc) excretion as an index of bone resorption rates in 67 postmenopausal women. A total subjects were assigned to Isoflavone (90 mg/day) or placebo groups. These groups were further divided into groups that undergone a regular exercise or a rather sedentary state performing daily activity only. We conducted study eight week period. Result showed urinary zinc excretion was more significantly decreased in the isoflavone-sedentary group (-180.76 +/- 171.30 ug/day) than in the placebo-sedentary group (-31.23 +/- 146.60 ug/day), placebo-exercise group (40.93 +/- 193.44 ug/day) and isoflavione-exercise group (-1.21 +/- 160.61 ug/day) (p < 0.05), but no significant changes in the differences between the values of the pre and post study values in urinary calcium, magnesium and copper excretion. These results suggest that Isoflavone supplementation decrease urinary zinc excretion rate in postmenopausal subjects.

Urinary Calcium, Prostaglandin E2 and C-AMP in Urolithiasis / 대한비뇨기과학회지

Hypercalcluria is well recognized as an important factory in the cause of idiopathic calcium stone disease. Absorptive hypercalciuria and renal hypercalciuria constitutes two major forms of idiopathic hypercalciuria. It is now suggested that renal prostaglandins influence internal hemodynamics and tubular electrolyte excretion, so determine the renal handling of calcium. It is generally believed that urinary c-AMP which comes from renal tubular cells in response to parathyroid hormone stimulation may have an effect calcium reabsorption in distal convoluted tubules. We performed the study to evaluate the significance of urinary calcium, PGE2 and c-AMP in stone formation. Urinary sodium, calcium, PGE2 and c-AMP were measured in 23 in-patients with urolithiasis under the usual diet. The results obtained were summarized as follows: l. 24-hour urinary Na was 120.6+/-49.7mEq/day(mean S.D), 24-hour Ca 202.8+/-68.3 mg/day, Urinary PGE2 625.6+-h 386.9pq/ml and Urinary c-AMP l2.9+/-10.2 nmol/mg creatinine. 2. There was high correlation between urinary. PGE2 level and urinary Na level(r =0.95, <0.005 by paired t-test). 3. There was high correlation between urinary PGE2 level and urinary Ca level(r=0.87, p< 0.005). 4. Urinary Ca level has no significant correlation with urinary c-AMF level(r=0.63, p<0.05).