Changes in parathyroid hormone in diabetic patients on long-term hemodialysis.

Changes in parathyroid hormone (PTH) and osteocalcin over 3 years were studied in hemodialyzed patients with diabetic nephropathy (HD/DM) and hemodialyzed patients without diabetes (HD/non-DM). In HD/DM patients, concentrations of the carboxyl terminal regions of PTH and osteocalcin in the serum did not change significantly, but in HD/non-DM patients, both concentrations increased significantly. In patients in both groups, the mean concentration of the mid-region of PTH increased significantly. Secondary hyperparathyroidism in HD/DM develops slower than in HD/non-DM.

Clinical availability of serum fructosamine measurement in diabetic patients with uremia. Use as a glycemic index in uremic diabetes.

Serum fructosamine levels were investigated in patients with uremia undergoing various modes of treatment. The serum fructosamine levels correlated positively with the blood glucose levels determined a week or two earlier. The fructosamine levels were significantly affected by the protein concentration, and those corrected for protein concentrations had a closer correlation to the blood glucose levels than did the uncorrected levels. The corrected fructosamine levels were not significantly different between healthy volunteers and nondiabetic patients with uremia on conservative treatment. In an in vitro system, fructosamine concentrations were hardly affected by urea, which is known to influence the level of hemoglobin A1. These results suggest that serum fructosamine measurement can provide us with reliable information on a short-term glycemic condition, even in azotemic patients. To be more precise, the serum level of fructosamine corrected for protein concentration can be an excellent glycemic index which is not susceptible to over- or dehydration and is of high clinical value, especially in the management of diabetic patients with chronic renal failure.

In vivo effect of 1 alpha-hydroxyvitamin D3 on interleukin-2 production in hemodialysis patients.

The immunoregulatory effect of 1 alpha-OHD3, a precursor form of active vitamin D3 1,25 (OH)2D3, was examined in hemodialysis patients. Peripheral blood mononuclear cells (PBM) from hemodialysis patients produced significantly less interleukin-2 (IL-2) than those from normal controls. Four weeks of oral administration of 0.5 micrograms/day of 1 alpha-OHD3 enhanced the IL-2 production of PBM from the patients. This fact suggests that 1 alpha-OHD3 therapy may be useful for the restoration of IL-2 production in hemodialysis patients, and that the vitamin D3 deficiency may be responsible for the impairment of cellular immunity associated with IL-2 production disorder in hemodialysis patients.

The effect of 1 alpha-hydroxyvitamin D3 on cell-mediated immunity in hemodialyzed patients.

The immunoregulatory effect of 1 alpha-hydroxyvitamin D3 (1 alpha OHD3), a precursor form of active vitamin D3, was examined in hemodialyzed patients. Four weeks of oral administration of 0.5 micrograms/day 1 alpha OHD3 markedly enhanced the lymphoproliferative responses to mitogens without influencing lymphocyte counts or the ratios of lymphocyte subpopulations. In fact, these responses were nearly normal after treatment. These results suggest that deficiency of 1,25-dihydroxyvitamin D3 may play a role in the impairment of cellular immunity in hemodialyzed patients, and that administration of 1 alpha OHD3 may have therapeutic immunological benefit.

Acute renal failure in McArdle's disease.

This is a report of a case of acute renal failure associated with McArdle's disease. A 45-year-old man had acute renal failure that required dialysis. His case was subsequently diagnosed as rhabdomyolysis secondary to McArdle's disease, a primary myopathy due to myophosphorylase deficiency. History-taking revealed nothing suspected to be responsible for precipitating the renal failure.

Nutrition and renal osteodystrophy.

Nutritional factors, especially calcium, calorie and fat intakes may be important in the treatment with active vitamin D, so that the effect appears more efficient. Incidence of bone changes, due to hyperparathyroidism in diabetic nephropathy, was less than that in non-diabetic patients under hemodialysis. No effect of control status of diabetes mellitus was demonstrated, regarding incidence of subperiosteal resorption of finger bones. Bone mass was decreased in diabetic patients in whom the control of blood glucose was inadequate.

Abnormal calcium metabolism in hemodialyzed patients with diabetic nephropathy.

Calcium metabolism was studied in hemodialyzed patients with diabetes mellitus nephropathy (HD/DM) and in hemodialyzed nondiabetic patients with chronic glomerulonephritis (HD/non-DM). Incidence of bone changes visible in X-ray films, assessed by changes in the lamina dura and trabecular patterns of mandibulae, was less in HD/DM than in HD/non-DM patients. Serum c-terminal parathyroid hormone was significantly lower in HD/DM than that in HD/non-DM. Serum calcitonin was higher in HD/DM than that in HD/non-DM. The lower level of c-terminal parathyroid hormone would be a reason that bone changes were less in HD/DM than in HD/non-DM patients.