ABSTRACT
Abnormalities of calcium homeostasis are a recognized feature of end-stage renal disease. The treatment of choice is renal transplantation, but this does not always result in normalization of the biochemical profile. Persistent hypercalcaemia is well documented and our study was undertaken to investigate the status of the calcium regulating hormones in renal patients post-transplantation. Serum calcium, parathyroid hormone, 1,25-dihydroxyvitamin D (1,25(OH)2D) and osteocalcin concentrations were measured in post-transplant patients. Twenty per cent of the patients had subnormal 1,25(OH)2D concentrations while 55% had biochemical evidence of hyperparathyroidism but only 5% were hypercalcaemic. Time elapsed since transplantation was not correlated with any of the analytes investigated and there was no relationship between persistent impairment of renal function and abnormalities of calcium homeostasis.
Subject(s)
Calcium/blood , Kidney Transplantation , Adult , Aged , Calcitriol/blood , Homeostasis , Humans , Middle Aged , Osteocalcin/blood , Parathyroid Hormone/bloodABSTRACT
A study has been undertaken to document in detail some of the changes that occur following parathyroidectomy in chronic renal failure patients. In an attempt to predict more precisely the timing of the post-operative hypocalcaemia, serum parathyroid hormone (PTH) concentrations were measured in six patients with renal osteodystrophy undergoing subtotal parathyroidectomy [5] and total parathyroidectomy [1]. The values obtained were related to post-operative changes in serum calcium and albumin concentrations. The intact-PTH concentration in serum was shown to decline rapidly post-operatively while the C-terminal PTH followed a more gradual course. Neither total nor ionised serum calcium concentrations exhibited a correspondingly dramatic fall after parathyroidectomy and the serum albumin concentration remained unaltered.
Subject(s)
Chronic Kidney Disease-Mineral and Bone Disorder/blood , Parathyroid Hormone/blood , Adult , Calcium/blood , Chronic Kidney Disease-Mineral and Bone Disorder/surgery , Female , Humans , Hypocalcemia/blood , Hypocalcemia/etiology , Male , Middle Aged , Parathyroidectomy/adverse effects , Peptide Fragments/blood , Serum Albumin/metabolism , Time FactorsABSTRACT
This study has shown that it is possible to measure vitamin D metabolites and vitamin D binding protein (DBP) in synovial fluid as well as serum. Significant amounts of 25-OHD, 24,25-(OH)2D, and DBP are present in synovial fluid. The 25-OHD and DBP maintain a serum:synovial fluid ratio of approximately 2:1 irrespective of the type of joint disease, whereas no such relationship was detected for 24,25-(OH)2D. The possible reasons for these findings are diffusion of the metabolites into synovial fluid or local production from suitable precursors, or both.
Subject(s)
Arthritis, Rheumatoid/metabolism , Synovial Fluid/analysis , Vitamin D-Binding Protein/metabolism , Vitamin D/metabolism , 24,25-Dihydroxyvitamin D 3 , Calcifediol/metabolism , Dihydroxycholecalciferols/metabolism , Humans , Osteoarthritis/metabolismABSTRACT
In a general medical unit 27% of 104 admissions and 17% of bed occupancy were attributed to alcohol consumption, although only 10 of these 28 patients had classical alcohol-related conditions. Questioning on the amount of alcohol consumed was the most accurate method of screening for these patients. The brief MAST questionnaire, mean red cell volume, gamma-glutamyl transferase, aspartate transaminase and urate were all inadequate as screening tests. Only 13% of the admissions were defined as 'problem drinkers' on the brief MAST questionnaire, suggesting that harmful effects of alcohol are not confined to 'alcoholics'. Clinical suspicion and questions on the level of alcohol consumption are more efficient than questionnaire, biochemical or haematological screening tests in detecting alcohol-related medical problems.
