Hipercalciuria idiopática ¿se pueden evitar los diuróticos? / Idiopathic hypercalciuria: can the diuretics be avoided?

La hipercalciuria idiopática se define como la excreció;n de calcio superior a 220 y 300 mg/día en mujeres y hombres respectivamente o bien mayor a 4 mg/kg peso. En mujeres con osteoporosis se observa en el 19% de los casos, mientras que en litiasis renal varía entre el 50 y 70%. Seleccionamos 206 pacientes hipercalció;ºricos, de nuestra base de datos, con y sin litiasis renal, a los que se les había indicado una dieta restringida. Luego los dividimos, de acuerdo a la respuesta, en dieta dependiente y dieta independiente. De estos solo consideramos 122 pacientes con diagnó;sticos de hipercalciuria dieta-dependiente (105 mujeres y 17 hombres), que fueron seguidos con control dietario (800 mg de calcio, alrededor de 1 g de proteínas animales y < 100 mEq de sodio diarios). No se consideró; la aparició;n de cálculos, o la recurrencia de los mismos, como tampoco el compromiso ó;seo. Luego de una media de 17 meses todos tenían controlada la calciuria e incluso hubo 16 (13%) que luego de 42 meses de seguimiento persistían normocalció;ºricos solo con dieta. Concluimos que es fundamental la divisió;n de las hipercalciurias, segó;ºn su respuesta a una dieta restringida, con el fin de evitar o postergar el uso de diuró;©ticos y sus efectos adversos, con una administració;n adecuada de la dieta.

Idiopathic hypercalciuria is defined as calcium excretion greater than 220 and 300 mg / day in women and men respectively, or greater than 4 mg / kg body weight. In women with osteoporosis it is observed in 19% of cases, while in kidney stones cases varies between 50 and 70%. We selected 206 hypercalciuric patients from our database, with and without renal lithiasis, to whom a restricted diet had been indicated. We divided them, according to the response, into a dependent diet and an independent diet. We considered 122 patients with diagnosis of hypercalciuria diet dependent (105 women and 17 men), which were followed with dietary control (800 mg of calcium, around 1 g of animal proteins and < 100 mEq sodium a day). The appearance of stones, or the recurrence of stones, was not considered, nor was bone involvement. After an average of 17 months, everyone had their calciuria controlled and there were even 16 (13%) who, after 42 months of follow-up, continued to be normocalciuric only on a diet. We conclude that the division of the hypercalciurias is fundamental, according to their response to a restricted diet, in order to avoid or postpone the use of diuretics and its adverse effects, with an adequate management of the diet.

Obstructive urolithiasis in growing-finishing pigs / Urolitíase obstrutiva em suínos de crescimento e terminação

Obstructive urolithiasis is a disease characterized by the presence of uroliths in the urinary tract, with consequent obstruction of excretion pathways. This paper described the epidemiological and clinical-pathological findings of 22 outbreaks of urolithiasis in growing-finishing pigs in Southern Brazil. All affected pigs were male and clinical presentation consisted of lethargy, dysuria, rectal prolapse, abdominal distention, peripheral cyanosis and reluctance to move. Clinical progression course ranged from 12 hours to one week, and the lethality rate was 100%. Gross changes were characterized by urinary bladder rupture associated with marked amount of yellowish liquid with ammoniacal odor (urine) in the abdominal cavity (uroperitoneum), as well as mild fibrin deposition on the surface of abdominal organs and hydronephrosis. Urinary uroliths ranging from 0.3 to 1cm in diameter were often observed obstructing the lumen of the penile urethra and sometimes those were free in the abdominal cavity. Histopathological findings included diffuse and marked urinary bladder edema and hemorrhage associated with inflammatory infiltrate of lymphocytes, plasma cells, and macrophages. Diffuse and marked necrosis of the mucosal epithelium was observed in the penile urethra. Intense fibrin deposition and inflammatory infiltrate of neutrophils were noted in the peritoneum, as well as in the serosa of the organs in the abdominal cavity. Uroliths were submitted to the method of qualitative determination of the mineral components, and were compatible with calcium carbonate and magnesium ammonium phosphate. Growing pigs ration analysis revealed low levels of calcium in relation to phosphorus, resulting in a Ca:P ratio of approximately 0.35:1. Histological findings and mineral analysis suggest that outbreaks of urolithiasis were related to a nutritional imbalance in the proportions of dietary calcium and phosphorus. The main cause of mortality was related to dehydration and uroperitoneum.(AU)

Urolitíase obstrutiva é uma enfermidade caracterizada pela presença de urólitos no trato urinário, com consequente obstrução das vias de excreção. Este artigo descreve os achados epidemiológicos e clínico-patológicos de 22 surtos de urolitíase em suínos de crescimento e terminação no Sul do Brasil. Os suínos afetados eram machos e clinicamente apresentavam letargia, disúria, prolapso retal, abaulamento do abdômen, extremidades cianóticas e relutância em movimentar-se. A duração dos sinais clínicos variou de 12 horas a uma semana, e a letalidade foi de 100%. As alterações macroscópicas caracterizaram-se por ruptura da bexiga com acentuada quantidade de líquido de coloração amarelada e odor amoniacal (urina) livre na cavidade abdominal (uroperitônio), além de discreta deposição de fibrina sobre os órgãos e hidronefrose. Frequentemente obstruindo o lúmen da uretra peniana e por vezes livre na cavidade abdominal, era possível observar urólitos urinários que variavam de 0,3 a 1cm de diâmetro. Os achados histopatológicos incluíram edema e hemorragia difusos e acentuados na bexiga, associado a infiltrado inflamatório predominante de linfócitos, plasmócitos e macrófagos. Na uretra peniana havia necrose difusa e acentuada do epitélio da mucosa. No peritônio e nas serosas dos órgãos da cavidade abdominal havia intensa deposição de fibrina e infiltrado neutrofílico. Os urólitos foram submetidos ao método de determinação qualitativa dos componentes minerais, os quais foram compatíveis com carbonato de cálcio e fosfato de amônio magnesiano. A análise da ração de crescimento revelou baixos níveis de cálcio, em relação ao fósforo, perfazendo uma relação Ca:P de aproximadamente 0,35:1. Os achados histológicos e as dosagens minerais sugerem que os surtos de urolitíase foram relacionados a um desequilíbrio nutricional nas proporções de cálcio e fósforo dietético. A principal causa da morte dos suínos foi relacionada à desidratação e ao uroperitônio.(AU)

Perfil de riesgo litogénico en pacientes con urolitiasis en Paraguay / Lithogenic risk in patients from Paraguay with urolithiasis

The lithogenic risk profile is a graphical representation of metabolic factors and urinary saturation involved in the stone formation with their respective critical values. Aim: To determine the lithogenic risk profile in patients with urolithiasis. Material and Methods: Personal data such as anthropometric, history of diseases and family history of urolithiasis were recorded. Different compounds acting as promoters or inhibitors of crystallization were measured in serum and urine samples, and the data obtained were used to calculate urinary saturation using Equil software. Results: We included 30 men and 43 women with a median age of 45 (34-54) years. Overweight and family history of urolithiasis was reported in 63 and 32% respectively. Crystallization risk was detected in 74% of participants. The most common urinary abnormalities were hypocitraturia in 48% and hypercalciuria in 40%. Conclusions: The lithogenic profile revealed urinary saturation compatible with crystallization risk in 74% of the studied patients.

Estudio comparativo de la excreción urinaria de boro, calcio, magnesio y fósforo en mujeres posmenopáusicas con y sin osteoporosis / Comparative study of the urinary excretion of boron, calcium, magnesium and phosphorus in postmenopausal women with and without osteoporosis

Con el propósito de comparar la posible relación entre las concentraciones urinarias de boro y las concentraciones de calcio, de magnesio y de fósforo en suero y orina de mujeres posmenopáusicas con y sin osteoporosis, seleccionamos 45 mujeres posmenopáusicas con más de 47 años de edad, divididas en dos subgrupos: grupo I mujeres posmenopáusicas clínicamente sanas y grupo II mujeres posmenopáusicas con osteoporosis, sin enfermedades renales, hepáticas o diabetes mellitus. Se determinó el boro (B), el fósforo (P), el calcio total (Ca) y el magnesio total (Mg) en la orina de dos horas por espectroscopia de emisión atómica con plasma acoplado por inducción (ICPA-ES), el calcio y el magnesio total en suero por espectroscopia de absorción atómica en llama (FAAS) y el fósforo inorgánico en suero y la creatinina en suero y orina por espectroscopia de absorción molecular. Los resultados obtenidos sugieren preliminarmente una diferencia significativa (p<0,05) en las concentraciones de boro y de fósforo en la orina de dos horas entre los grupos estudiados. El análisis de regresión lineal aplicado, sugiere relación entre el índice boro/creatinina y los índices calcio/creatinina, magnesio/creatinina y fósforo/creatinina en la orina de las mujeres posmenopáusicas con osteoporosis.

In order to compare the possible relationship between urinary concentrations of boron, calcium, magnesium and phosphorus in serum and urine of postmenopausal women with and without osteoporosis, we selected 45 postmenopausal women over 47 years of age, divided into two groups: group I clinically healthy postmenopausal women and group II postmenopausal women with osteoporosis, without chronic kidney and hepatic diseases or diabetes mellitus. We determined the boron (B), phosphorus (P), total calcium (Ca) and total magnesium (Mg) in the urine of two hours, by atomic emission spectroscopy with induction-coupled plasma (ICPA-ES). Total calcium and total magnesium in serum were determined by atomic flame absorption spectroscopy (FAAS) and inorganic phosphorus in serum, and creatinine in serum and urine, by molecular absorption spectrometry. The preliminary results suggest the existence of a significant difference (p <0.05) in boron and phosphorus concentrations in the urine of two hours between the groups. The model of linear regression analysis used showed a relationship between urinary concentrations of boron/creatinine index and calcium/ creatinine, magnesium/creatinine and phosphorus/creatinine indexes in the urine of postmenopausal women with osteoporosis.

Evaluation of different biochemical markers of bone turnover as a diagnostic tool for osteoporosis in postmenopausal women

Osteoporosis is a major global health problem affects mainly elderly and postmenopausal women with increased risk of bone fractures. The value of different biochemical markers of bone turnover as diagnostic tool for osteoporosis is still debated. The aim of this study is to assess the value of different biochemical markers of bone turnover as a diagnostic tool for osteoporosis in postmenopausal women. We measured fasting urinary calcium [Uca], total ALP, inorganic phosphorus [Pi], urinary deoxypyridino-line [DPD], carboxyterminal telopeptide of collagen type I [ICTP] and serum N-terminal telopeptide [NTX] in 40 postmenopausal females [diagnosed by DEXA as osteoporotic, | mean age, 60.2 years], 16 preimenopausal non-osteoporotic females [mean age, 39.1 years] and 24 healthy controls [mean; age, 29.2 years]. The postmenopausal osteoporotic group showed significantly higher levels of ALP, DPD, NTX and ICTP compared to controls [p<0.001] and only ALP was significantly higher in preimenopausal group compared to controls [p<0.001]. However, there was no significant difference of Uca and Pi among the three groups. On comparing peri and postmenopausal groups together, DPD, NTX and ICTP were the only markers that clearly discriminate the two groups being higher in the osteoporotic postmenopausal group. There were significant negative correlations between bone mineral density [BMD] and each of ALP, DPD, NTx, and ICTP. The clinical utility of DPD, NTx and ICTP in identifying patients with osteoporosis was assessed by ROC [receiver operating characteristic] curve analysis. This revealed that the best diagnostic cut-off level for DPD was 6.8nM DPD/mM creatinine. This gave a diagnostic sensitivity of 100% and specifity 100%, whereas NTx at a level 17.0 nM BCE had a diagnostic sensitivity of 100% and specifity of 98%. Regarding ICTP at cut-off level of 3.6 microg/L its sensitivity was 88% and specifity was 65% which considered the lesser better sensitivity and specifity among the three studied parameters

Hypocitraturia in metabolically active calcium nephrolithiasis

Hypocitraturia is presumed to contribute to calcium stone formation. In this study, 52 patients with active calcium urolithiasis have been subjected to infrared spectrophotometric urolith analysis an collection of a 24-hour urinary sample for measurement of citrate, pH, calcium phosphorus, magnesium uric acid and oxalate. A venous blood sample was also taken for the measurement of calcium, potassium, uric acid, sodium phosphorus, carbon dioxide and creatinine levels. 93.3% of these patients had definite hypocitraturia, either as an isolated anomaly in 11.5% of patients or in association with hyperoxaluria and hyperuricosuria. When hypocitraturia was diagnosed more than half of the patients suffered from the severe form. Hypocitraturia in Egyptian metabolically active stone formers exceeds any known universal levels

Modificaciones del contenido de fosforo hepatico y renal en cobayos tratados con dosis elevadas de vitamina A alcohol (retinol) / Alterations in the liver and kidney phosphorus in guinea pigs exposed to high doses of vitamin A (retinol)

In this study, the serum, urinary, hepatic and renal levels of total inorganic phosphorus (Pi) were determined in guinea pigs treated with 100,000 U.I. of vitamin A, dissolved in Tween Span, given each day by intramuscular injections during seven days (treated group), and compared with the levels in healthy guinea pigs which were given the same feed as the treated group, and received the same amount of Tween Span (control group). The activity of the enzymes alkaline phosphatase and acid phosphatase was simultaneously determined in liver and kidneys of both groups, and the phospholipid content in serum and tissue was also determined. The treated group did not show changes in serum and urinary phosphorus as compared with the control group. Liver and kidney of the treated group showed an increase in total Pi (p <0.05). In this group a definite increase (p < 0.05) was also observed both in serum and tissue levels of phospholipids, as well as in the activity of the liver and kidney enzymes studied. These results suggest that phosphorus enters the blood stream in the form of lipid complexes (phospholipids) that are involved in certain characteristic functions

Marcadores bioquímicos del remodelamiento óseo en mujeres pre y postmenopáusicas / Biochemical markers of bone turnover in pre and postmenopausal women

La disminución o cese de la producción de estrógenos en lamenopausia, ocasiona alteraciones del metabolismo óseo, caracterizadas por la resorción acelerada de tejido óseo. Esta condición es responsable, comúnmente, de la presentación de osteoporosis. Con el objeto de evaluar el estado del remodelamiento óseo, se estudiaron tres grupos de 46 mujeres cada uno: premenopáusicas (A), postmenopáusicas naturales (B) y con ooforectomía bilateral (C) de 41.30 ñ 9.72, 55.93 ñ 7.11 y 50.24 ñ 8.66 años ñ D.E., respectivamente. La concentración (U/L x ñ DE) de fosfatasa alcalina total (FAt), marcador de formación ósea fue 125.88 ñ 65.67, 149.26 ñ 51.48 y 131.18 ñ 57.3 para los grupos A, B y C, respectivamente. Como marcador de resorción ósea se determinó fosfatasa ácida tartrato resistente (FATR), obteniéndose (UI/LxñD.E.) para A: 7,99ñ2.78, B: 9.82ñ2.15 y C: 8.68ñ2.23. Las diferencias entre las medias de los tres grupos fueron significativas para FAt y FATR (p < .001), entre los tres grupos estudiados. Se concluye que la determinación de FAt y FATR, así como de Ca, P y Mg séricos y Ca y P urinarios, permiten evaluar el estado del remodelamiento óseo

Isquemia y necrosis intestinal: valor diagnóstico del fósforo sérico y urinario. Informe preliminar de un estudio prospectivo / Intestinal ischemia and necrosis: diagnostic value of serum and urinary phosphorus. Preliminary report of a prospective study

Entre enero de 1983 y enero de 1991 se llevo a cabo un estudio prospectivo de la enfermedad hemorroidal tratada quirurgicamente por Entre los años de 1989 y 1993 se llevo a cabo un estudio clinico prospectivo y controlado con base en 87 muestras sericas y urinarias de 18 pacientes controles sanos, 56 pacientes controles con patologias abdominales y extrabdominales diferentes a la isquemia y necrosis intestinal, y 17 muestras en 7 pacientes con confirmacion diagnostica operatoria o patologica de isquemia o necrosis intestinal. El objetivo fue determinar clinicamente el comportamiento de las diferentes determinaciones del fosforo inorganico y los indices de fosforo y fosfaturia/creatinuria que en estudios experimentales previos realizados en la decada de los 70's habian demostrado su importancia diagnostica temprana y sugerian su uso en la clinica. Se realizó un trabajo descriptivo y un análisis estadistico fundamentado en el programa IBM-PC MICROSTAT, en el que se encontraron valores que para el indice de fosforo 0.5 y el indice de fosfaturia/creatinuria > 0.9 mostraron diferencia significativa (p<0.001) en los Test de Chi cuadrado y prueba exacta de Fisher, con una sensibilidad de 69 y 92 por ciento y especifidad de 96 y 96 por ciento respectivamente, diagnostica para la necrosis intestinal. Se concluye que la utilidad clinica del Indice de fosfaturia/creatinuria como marcador urinario de la necrosis intestinal, alcanza dimensiones diagnosticas con una sensibilidad y especificidad confiables.

Effect of menopause on serum calcium phosphorus and alkaline phosphatase in relation to urinary calcium, phosphorus and hydroxyproline

Our study included thirty premenopausal and thirty postmenopausal women and their serum calcium, inorganic phosphate, alkaline phosphatase and urinary calcium, phosphates, creatinine and hydroxyproline were determined. Serum calcium and its urinary excretion was found to be significantly higher in postmenopausal group while urinary hydroxproline was also markedly raised in postmenopausal women. Serum phosphorous does not appear to be of importance although it was slightly higher. Alkaline phosphatase showed no significant changes. Our findings show that serum and urinary calcium and urinary hydroxyproline can be used as biochemical markers to assess bone changes in post menopausal women

Metabolic factors for urolithiasis in acromegalic patients

Acromegaly is associated with metabolic disturbances of calcium and phosphorus which can also contribute to renal lithogenesis. In order to characterize these disturbances more precisely, an oral calcium load test was performed on 14 active acromegalic patients. Serum and urinary levels of calcium, phosphorus, uric acid, creatinine and urinary cyclic AMP were determined. Of the 14 patients, 5 (36%) presented hypercalciuria, 5 (36%) presented intestinal calciumhyperabsorption and 6 (43%) had uric acid hyperexcretion. Two patients (14%) presented nephrolithiasis. The medical records of 32 additional acromegalic patients with or without active disease were reviewed for a history of previous stones, which was observed in three cases (9.5%). The present data suggest that nephrolithiasis occurs more frequently among acromegalic patients because of the underlying metabolic disturbances of calcium presented by this population

Diagnóstico do hiperparatireoidismo primário / Diagnosis of primary hyperparathyroidism

O hiperparatireoidismo primário é uma afecçäo freqüente que pode incidir em todas as idades, mas que aparece com maior freqüência nos indivíduos com mais de 40 anos e do sexo feminino. Seu diagnóstico se baseia num sinal laboratorial chave, que é hipercalcemia. Esta situaçäo pode produzir uma infinidade de sinais e sintomas de graus e intensidades variáveis, indo desde uma simples, astenia até as formas graves com comprometimento ósseo intenso ou litíases urinárias de repetiçäo. Devido a esse grande polimorfismo de apresentaçäo e sendo a única forma de diagnosticar-se as formas leves e moderadas do hiperparatireoidismo, a determinaçäo sistemática da calcemia em todo consultante parece-nos justificável

Hiperparatiroidismo primario: informe de 12 casos de adenomas hiperfuncionantes; pruebas diagnósticas / Primary hyperthyroidism: report of 12 cases of hyperfunctioning adenomas; diagnostic tests

Se presenta la metodología y se discuten los resultados de un conjunto de pruebas bioquímicas para el diagnóstico de hiperparatiroidismo primario, utilizado en una serie de 12 pacientes atendidos en el Instituto Nacional de Endocrinología. Como principales alteraciones de la homeostasis calciofosfórica se encontró: hipercalcemia con hipofosforemia, hipercalciuria, aumento del aclaramiento renal de fósforo, disminución de la reabsorción tubular de fósforo aumento del cloro plasmático con reserva alcalina normal o baja a pesar de la hipercalcemia; baja densidad urinaria resistente al pitresin exógeno y elevación de la fosfatasa alcalina plasmática. Las alteraciones en el control paratiroideo de la secreción de parathormona se comprobaron por las irregularidades en los resultados de la prueba de frenaje paratiroideo con sobrecarga de calcio y las pruebas de estimulación paratiroidea con EDTA-Na2 y prednisona

Distúrbios do cálcio e do fósforo induzidos pelo uso prolongada de hidróxido de alumínio / Disorders of calcium and phosphorus induced by prolonged use of aluminum hydroxide

O hidróxido de aluminio, um dos fármacos mais utilizados na terapêutica antiácida, forma na luz intestinal, fosfatos de alumínio inabsorvíveis. O presente trabalho avalia a variaçäo das concentraçöes plasmáticas e urinárias de cálcio e fósforo em ratos adultos e velhos quando comparados com ratos controle, apresentaram uma diminuiçäo da fosfatúaria e um aumento da calciúria estatisticamente significantes, sem no entanto provocar variaçöes significantes na fosfatemia ou na calcemia

Quantificaçäo dos íons cálcio e fósforo na urina e no sangue, durante o processo de reparo em feridas de extraçäo dental, em ratos com hipertensäo renal crônica / Calcium and phosphorus measurements in urine and blood serum during the healing process of tooth extraction wounds in rats with renovascular hypertension

Foram estudadas, através da espectrofotometria, as concentraçöes dos íons cálcio e fósforo na urina e no soro sangüíneo, durante as etapas do processo de reparo em feridas de extraçäo dental (histologicamente) em ratos com hipertensäo renal pelo modelo de Goldblatt um rim, um "clip", seguido de um Grupo Controle. Tanto as dosagens quanto a análise histológica foram realizadas aos 3, 6, 9, 12, 18 e 21 dias pós-extraçäo. Nossos resultados mostraram que a hipertensäo renovascular induziu um atraso significativo no processo de reparo alveolar que começa a evidenciar-se a partir do 9§ dia pós-extraçäo dental. Näo foi verificada participaçäo efetiva dos íons cálcio e fósforo nesse atraso