[Microalbuminuria as a risk factor for diabetic osteopathy in patients with IDDM and renal sufficiency]. / Mikroalbuminuria jako czynnik ryzyka osteopatii cukrzycowej u pacjentów z IDDM w okresie wydolnosci nerek.

Disturbances in bone marrow vascularisation can be one of the causes of diabetic osteopathy. The aim of the study was to answers the question if microalbuminuria as a results of capillary injury can be a sign of bone mineralisation disorders in IDDM renal sufficient patients. We examined 60 IDDM patients (30 women without menstruation disturbances; 30 men; age 25-36 years old). All the observed subjects were divided into groups: I-30 normoalbuminuric patients (0-29 mg/24 h); II-30 microabuminuric patients (30-295 mg/24 h). Bone mineral density (BMD) of femoral neck, lumbar spine (L2-L4) and total body was measured by dual energy X-ray absorptiometry (DEXA, Lunar). The biochemical parameters of bone turnover were measured both in serum and urine as follows: osteocalcine, total hydroxyproline (HPR, HPR/Cr), total alkaline phosphatase (AP) with bone fraction, total calcium (Ca, Ca/Cr) and inorganic phosphor (P). Microalbuminuric patients presented more severe bone turnover disturbances, shown by differences in: BMD and Z-score for femoral neck (p < 0.05), serum HPR (p < 0.05), AP (p < 0.05), AP (p < 0.01) and its bone fraction (p < 0.05). We proved the presence of statistically significant correlation coefficients for albuminuria and some densytometric and biochemical bone parameeters. Our results suggest that microalbuminuria can indirectly indicate the dynamic of bone turnover derangement in IDDM course. They are present mostly in the femoral neck, which because of the vascularisation type is particularly susceptible to subalimentation in the diabetic microangiopathy course.

[Bone mineralization in insulin-dependent diabetes mellitus]. / Mineralizacja tkanki kostnej w cukrzycy insulinozaleznej.

One of insulin-dependent diabetes mellitus (IDDM) complications are bone mineral disorders called diabetic osteopathy. Because of many controversies of this subject we took a research of bone mineralisation in IDDM patients before 40 years old. The evaluation of BMD was performed with the use of X-ray dual energy absorptiometry--DEXA in the AP projection for lumbar part of vertebral column (BMD L2-L4), left femur neck (BMD-neck) and total skeleton (BMD-total). Bone tissue metabolism was evaluated with the aid of biochemical tests. The examined group consisted of 99 patients with IDDM (45 women and 54 men), without any other risk factors for changes in bone metabolism. The results were related to: sex, age in which IDDM was diagnosed, duration of IDDM, metabolic control of diabetes and to some IDDM complications. The control group consisted of 113 healthy subjects matched for age, sex, weight, height and calcium diet. We observed that BMD in IDDM patients before 40 years old was significantly lower than in healthy subject. One of some diabetic osteopathy pathomechanism seems to be an advantage of bone resorption over bone formation. Bone demineralisation which was observed to be most pronounced in femur neck, was not related to age, differed in accordance to sex and was higher of age when IDDM appeared was lower. BMD was also related to duration of IDDM and metabolic control of IDDM.

[Effect of low-dose recombinant humane erythropoietin therapy on the quality of life in patients with anemia in the course of end-stage renal failure treated with dialysis]. / Wplyw malych dawek ludzkiej rekombinowanej erytropoetyny na jakosc zycia chorych z niedokrwistoscia w przebiegu schylkowej niewydolnosci nerek leczonych dializami pozaustrojowymi.

The aim of the study was to assess the efficacy of low-dose subcutaneous recombinant human erythropoietin (rHuEpo) therapy in hemodialysis patients with particular emphasis on their quality of life. Twenty five anemic (Ht25%) patients (14 males and 11 females, age 39-13 years) with end-stage renal disease were given rHuEpo (initial dose: 52.5 +/- 2.5 IU/kg/week; maintenance dose: 67.0-10.5 IU/kg/week) once or twice weekly for 12 months. Quality of life, assessed by self-administered questionnaire (1-3 scale), was measured every month. Additionally, sexual functions (-1 up to 3 scale, basal level 0), including libido and sexual satisfaction, and serum sex hormones (testosterone, LH, FSH, prolactin) were evaluated every 6 months. During first 4 months of the therapy there was a significant increase of Ht (21.1 +/- 0.5% vs 28.5 +/- 0.6%; p < 0.0001), which was maintained for the whole study period. From the 3rd month in majority of patients a marked (p < 0.01) improvement in their physical fitness, mood and cold tolerance was noted. Despite a substantial increase in sexual satisfaction (p < 0.01) and libido (p < 0.001), no significant changes in serum sex hormones profile, except transient rise in serum prolactin level, were observed. It is concluded that low-dose rHuEpo therapy for the renal anemia of hemodialysis patients is associated with a sustained significant improvement in their quality of life and sexual functions, despite no significant changes in sex hormones serum levels.