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Dutta P, Hakimi S, Layton AT. How the kidney regulates magnesium: a modelling study. ROYAL SOCIETY OPEN SCIENCE 2024; 11:231484. [PMID: 38511086 PMCID: PMC10951724 DOI: 10.1098/rsos.231484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/23/2024] [Accepted: 02/15/2024] [Indexed: 03/22/2024]
Abstract
The kidneys are crucial for maintaining Mg2+ homeostasis. Along the proximal tubule and thick ascending limb, Mg2+ is reabsorbed paracellularly, while along the distal convoluted tubule (DCT), Mg2+ is reabsorbed transcellularly via transient receptor potential melastatin 6 (TRPM6). TRPM6 and other renal transporter expressions are regulated by sex hormones. To investigate renal Mg2 handling, we have developed sex-specific computational models of electrolyte transport along rat superficial nephron. Model simulations indicated that along the proximal tubule and thick ascending limb, Mg2+ and Na+ transport occur parallelly, but they are dissociated along the DCT. In addition, our models predicted higher paracellular Mg2+ permeability in females to attain similar cortical thick ascending limb fractional Mg2+ reabsorption in both sexes. Furthermore, DCT fractional Mg2+ reabsorption is higher in females than in males, allowing females to better fine-tune Mg2+ excretion. We validated our models by simulating the administration of three classes of diuretics. The model predicted significantly increased, marginally increased and significantly decreased Mg2+ excretions for loop, thiazide and K-sparing diuretics, respectively, aligning with experimental findings. The models can be used to conduct in silico studies on kidney adaptations to Mg2+ homeostasis alterations during conditions such as pregnancy, diabetes and chronic kidney disease.
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Affiliation(s)
- Pritha Dutta
- Department of Applied Mathematics, University of Waterloo, Waterloo, OntarioN2L 3G1, Canada
| | - Shervin Hakimi
- Department of Applied Mathematics, University of Waterloo, Waterloo, OntarioN2L 3G1, Canada
| | - Anita T. Layton
- Department of Applied Mathematics, University of Waterloo, Waterloo, OntarioN2L 3G1, Canada
- Department of Biology, University of Waterloo, Waterloo, OntarioN2L 3G1, Canada
- Cheriton School of Computer Science, University of Waterloo, Waterloo, OntarioN2L 3G1, Canada
- School of Pharmacology, University of Waterloo, Waterloo, OntarioN2L 3G1, Canada
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Düğer H, Uçan B, Çalışkan M, Bostan H, Demirci T, Gül Ü, Çakal E, Kızılgül M. Hypomagnesemia may be associated with symptomatic disease in patients with primary hyperparathyroidism. Endocrine 2024; 83:466-472. [PMID: 37922091 DOI: 10.1007/s12020-023-03577-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/14/2023] [Indexed: 11/05/2023]
Abstract
AIM Magnesium (Mg) homeostasis is closely related to calcium (Ca) metabolism. Hypercalcemia inhibits the reabsorption of Mg from the kidneys, leading to hypomagnesemia. Therefore, patients with primary hyperparathyroidism (PHPT) are predisposed to hypomagnesemia. However, there are few studies on the clinical significance of hypomagnesemia in PHPT. The aim of this study was to retrospectively evaluate the association of hypomagnesemia with the clinical outcomes of PHPT. MATERIALS AND METHODS A retrospective evaluation was made of the data of 538 consecutive patients (478 females, 60 males) diagnosed with PHPT in our center. RESULTS The mean age of the study population was 56.5 ± 11.66 years. The mean serum Mg level was 2 ± 0.26 mg/dl. Asymptomatic disease was present in 241 (44%) patients. Symptomatic patients with osteoporosis, Ca level ≥11.2 mg/dl, and estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 had lower levels of Mg (p < 0.05). Hypomagnesemia was detected in 129 of 538 patients (23.9%). The patients with hypomagnesemia had a higher rate of symptomatic disease (80% vs. 48%, p < 0.0001). The serum parathormone (PTH) level was found to be higher in patients with hypomagnesemia and the lumbar and femur T-scores and serum vitamin D levels were lower (p < 0.05). Patients with hypomagnesemia had higher rates of kidney stones (34% vs. 21%, p = 0.003) and osteoporosis (74% vs. 32%, p < 0.001). Multivariate logistic regression analysis revealed that hypomagnesemia had a significant effect on the development of symptomatic disease (OR:6.88, CI 95%: 5.20-11.27, p < 0.001). CONCLUSIONS The current study results demonstrate that hypomagnesemia may be associated with a higher risk of osteoporosis and kidney stones in PHPT patients. Routine evaluation of serum Mg may predict the clinical outcomes of PHPT.
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Affiliation(s)
- Hakan Düğer
- Health Sciences University, Dışkapı Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Türkiye.
| | - Bekir Uçan
- Health Sciences University, Dışkapı Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Türkiye
| | - Mustafa Çalışkan
- Düzce State Hospital, Department of Endocrinology and Metabolism, Düzce, Türkiye
| | - Hayri Bostan
- Health Sciences University, Dışkapı Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Türkiye
| | - Taner Demirci
- Sakarya Training and Research Hospital, Department of Endocrinology and Metabolism, Sakarya, Türkiye
| | - Ümran Gül
- Health Sciences University, Dışkapı Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Türkiye
| | - Erman Çakal
- Health Sciences University, Dışkapı Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Türkiye
| | - Muhammed Kızılgül
- Health Sciences University, Dışkapı Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Türkiye
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Vrielinck J, Janssens GPJ, Chantziaras I, Cools A, Maes D. Urolithiasis Problems in Finishing Pigs. Vet Sci 2023; 10:688. [PMID: 38133239 PMCID: PMC10748364 DOI: 10.3390/vetsci10120688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023] Open
Abstract
This paper describes cases of urolithiasis in fattening pigs on two farms (A and B). Bladder rupture due to urethral obstruction with calculi was the principal finding during the necropsy of the pigs. An in-depth diagnostic examination was performed to elucidate possible pathophysiological mechanisms, namely Fourier-transform infrared spectrophotometry (FT-IR) analysis of the uroliths, blood analysis (farm A: 5 samples, farm B: 10 samples) for assessing concentrations of minerals, the bone resorption marker cross-linked C-telopeptide of type 1 collagen (CTX), parathyroid hormone (PTH), and vitamin D components, biochemical urinalysis (farm A: 5 samples, farm B: 7 samples), microscopic examination of urinary sediment (Farms A and B: 7 samples each), mineral composition of the feed, and analysis of the drinking water. Calcium carbonate was the main component found in stones from both farms, and calcium carbonate and struvite were the main components found in crystals from farms A and B, respectively. On farm A, urinary calcium excretion and urinary pH were high; on farm B, urinary phosphorus was high and urinary calcium was low with a normal urinary pH. The mineral compositions of the feed and drinking water were similar on both farms and could therefore not explain the difference between the two farms. Disturbances in calcium and phosphorus absorption and homeostasis might have been involved in these problems. Further research should focus on the calcium, phosphorus, and vitamin D levels in the feed and take into account other factors, such as the absorption and excretion of minerals due to gut and urinary microbiota.
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Affiliation(s)
- Joris Vrielinck
- Faculty of Veterinary Medicine, Ghent University, 9000 Ghent, Belgium; (G.P.J.J.); (I.C.)
- Veterinary Practice, Hospitaalstraat 38, 8906 Ieper-Elverdinge, Belgium
| | - Geert P. J. Janssens
- Faculty of Veterinary Medicine, Ghent University, 9000 Ghent, Belgium; (G.P.J.J.); (I.C.)
| | - Ilias Chantziaras
- Faculty of Veterinary Medicine, Ghent University, 9000 Ghent, Belgium; (G.P.J.J.); (I.C.)
| | - An Cools
- Faculty of Veterinary Medicine, Ghent University, 9000 Ghent, Belgium; (G.P.J.J.); (I.C.)
| | - Dominiek Maes
- Faculty of Veterinary Medicine, Ghent University, 9000 Ghent, Belgium; (G.P.J.J.); (I.C.)
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Rosner MH, Ha N, Palmer BF, Perazella MA. Acquired Disorders of Hypomagnesemia. Mayo Clin Proc 2023; 98:581-596. [PMID: 36872194 DOI: 10.1016/j.mayocp.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 03/06/2023]
Abstract
Magnesium disorders are common in clinical practice and when present can manifest clinically as cardiovascular, neuromuscular, or other organ dysfunction. Hypomagnesemia is far more common than hypermagnesemia, which is largely seen in patients with reduced glomerular filtration rates receiving magnesium-containing medications. In addition to inherited disorders of magnesium handling, hypomagnesemia is also seen with excessive gastrointestinal or renal losses and due to medications such as amphotericin B, aminoglycosides, and cisplatin. Laboratory assessment of body magnesium stores largely relies on the measurement of serum magnesium levels that are a poor proxy for total body stores but does correlate with the development of symptoms. Replacement of magnesium can be challenging, with oral replacement strategies being generally more effective at slowly replacing body stores but intravenous replacement being more effective at treating the more life-threatening and severe cases of hypomagnesemia. We conducted a thorough review of the literature using PubMed (1970-2022) and the search terms magnesium, hypomagnesemia, drugs, medications, treatment, and therapy. In the absence of clear data on optimal management of hypomagnesemia, we have made recommendations on magnesium replacement based on our clinical experience.
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Affiliation(s)
- Mitchell H Rosner
- Division of Nephrology, University of Virginia Health, Charlottesville.
| | - Nam Ha
- Division of Nephrology, University of Virginia Health, Charlottesville
| | - Biff F Palmer
- Division of Nephrology, University of Texas Southwestern Medical Center, Dallas
| | - Mark A Perazella
- Section of Nephrology, Yale University School of Medicine and Section of Nephrology, West Haven VA Medical Center, West Haven, CT
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Proton pump inhibitors use and risk of incident nephrolithiasis. Urolithiasis 2022; 50:401-409. [PMID: 35499617 DOI: 10.1007/s00240-022-01326-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 04/10/2022] [Indexed: 12/14/2022]
Abstract
Proton pump inhibitors (PPIs) are widely prescribed medications that have effects on both enteric and urinary solute handling with an unknown effect on risk of nephrolithiasis. Our objectives were to examine the association between PPI exposure and incident nephrolithiasis and to determine its effect on 24H urine chemistry. We performed a single-center retrospective study on patients diagnosed with gastroesophageal reflux disease (GERD) without a history of kidney stones. Exposure to PPIs was abstracted, and then subsequent kidney stone diagnoses were identified. Multivariable Cox models with time-varying covariates were used to estimate the hazard of PPI use on incident nephrolithiasis. We used multivariable linear regression to analyze a subset of patients who went through 24-h urine analysis. We identified n = 55,765 PPI-naïve GERD patients without prior kidney stone diagnoses of whom 40,866 (73.2%) were exposed to PPI over a median of 3 year follow up. On multivariable analysis, PPI use was associated with higher risk of incident kidney stone diagnoses (HR 1.19, 95% CI 1.06-1.34). Among 593 patients with GERD with 24-H urine data, the PPI-exposed group (n = 307) had significantly lower mean urinary citrate (mean 3.0 vs 3.4 mmol, p = 0.029) and urinary magnesium (mean 3.6 vs 4.3 mmol, p < 0.001) on multivariable analyses. Exposure to PPIs is associated with an increased risk of kidney stones among patients with GERD. Hypomagnesemia and hypocitraturia associated with PPI exposure may contribute to kidney stone risk.
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Chan JW, Yanase F, See E, McCue C, Yong ZT, Talbot LJ, Flanagan JP, Eastwood GM. A pilot study of the pharmacokinetics of continuous magnesium infusion in critically ill patients. CRIT CARE RESUSC 2022; 24:29-38. [PMID: 38046838 PMCID: PMC10692660 DOI: 10.51893/2022.1.oa4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: The pharmacokinetics and haemodynamic effect of continuous magnesium infusion in non-cardiac intensive care unit (ICU) patients are poorly understood. We aimed to measure serum and urine magnesium levels during bolus and continuous infusion in critically ill adults, compare serum levels with those of a control population, and assess its haemodynamic effect. Design: Pharmacokinetic study Setting: A single tertiary adult ICU. Participants: Mechanically ventilated adults requiring vasopressor support. Intervention: A 10 mmol bolus of magnesium sulfate followed by 1.5-3 mmol/h infusion for 24 hours. Main outcome measures: The primary outcome was the change in total serum magnesium concentration. The main secondary outcome was mean arterial pressure (MAP)- adjusted vasopressor dose. Results: We matched 31 treated patients with 93 controls. Serum total magnesium concentration increased from a median 0.94 mmol/L (interquartile range [IQR], 0.83-1.10 mmol/L) to 1.38 mmol/L (IQR, 1.25-1.69 mmol/L; P < 0.001) and stabilised between a median 1.64 mmol/L (IQR, 1.38-1.88 mmol/L) at 7 hours and 1.77 mmol/L (IQR, 1.53-1.85 mmol/L) at 25 hours. This was significantly greater than in the control group (P < 0.001). The MAP-adjusted vasopressor dose decreased during magnesium infusion (P < 0.001). Conclusion: In critically ill patients, a magnesium sulfate bolus followed by continuous infusion achieved moderately elevated levels of total serum magnesium with a decrease in MAP-adjusted vasopressor dose. Trial registration number: ACTRN12619000925145.
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Affiliation(s)
- Jian Wen Chan
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Fumitaka Yanase
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Emily See
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Australia
| | - Claire McCue
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Zhen-Ti Yong
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
| | - Lachlan J. Talbot
- Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | | | - Glenn M. Eastwood
- Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia
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Abstract
Magnesium (Mg2+) is the second most abundant intracellular and fourth extracellular cation found in the body and is involved in a wide range of functions in the human cell and human physiology. Its role in most of the enzyme processes (ATP-ases)-stabilisation of nucleic acids (DNA, RNA), regulation of calcium and potassium ion channels, proliferation, glucose metabolism and apoptosis-make it one of the most important cations in the cell. Three pathogenetic mechanisms are mainly implicated in the development of hypomagnesaemia: reduced food intake, decreased intestinal absorption and increased renal excretion of Mg2+. This review presents the function of Mg2+, how it is handled in the kidney and the drugs that cause hypomagnesaemia. The frequency and the number of drugs like diuretics and proton-pump inhibitors (PPIs) that are used daily in medical practice are discussed in order to prevent and treat adverse effects by providing an insight into Mg2+ homeostasis.
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Affiliation(s)
- Periklis Katopodis
- Department of Biosciences, College of Health and Life Sciences, Brunel University London, Uxbridge, London, UB8 3PH, UK.
| | - Emmanouil Karteris
- Department of Biosciences, College of Health and Life Sciences, Brunel University London, Uxbridge, London, UB8 3PH, UK
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Liamis G, Hoorn EJ, Florentin M, Milionis H. An overview of diagnosis and management of drug-induced hypomagnesemia. Pharmacol Res Perspect 2021; 9:e00829. [PMID: 34278747 PMCID: PMC8287009 DOI: 10.1002/prp2.829] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 03/18/2021] [Accepted: 06/01/2021] [Indexed: 12/29/2022] Open
Abstract
Magnesium (Mg) is commonly addressed as the "forgotten ion" in medicine. Nonetheless, hypomagnesemia should be suspected in clinical practice in patients with relevant symptomatology and also be considered a predisposing factor for the development of other electrolyte disturbances. Furthermore, chronic hypomagnesemia has been associated with diabetes mellitus and cardiovascular disease. Hypomagnesemia as a consequence of drug therapy is relatively common, with the list of drugs inducing low serum Mg levels expanding. Culprit medications linked to hypomagnesemia include antibiotics (e.g. aminoglycosides, amphotericin B), diuretics, antineoplastic drugs (cisplatin and cetuximab), calcineurin inhibitors, and proton pump inhibitors. In recent years, the mechanisms of drug-induced hypomagnesemia have been unraveled through the discovery of key Mg transporters in the gut and kidney. This narrative review of available literature focuses on the pathogenetic mechanisms underlying drug-induced hypomagnesemia in order to increase the insight of clinicians toward early diagnosis and effective management.
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Affiliation(s)
- George Liamis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Ewout J Hoorn
- Division of Nephrology and Transplantation, Department of Internal Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Matilda Florentin
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
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Herber V, Okutan B, Antonoglou G, Sommer NG, Payer M. Bioresorbable Magnesium-Based Alloys as Novel Biomaterials in Oral Bone Regeneration: General Review and Clinical Perspectives. J Clin Med 2021; 10:jcm10091842. [PMID: 33922759 PMCID: PMC8123017 DOI: 10.3390/jcm10091842] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 02/07/2023] Open
Abstract
Bone preservation and primary regeneration is a daily challenge in the field of dental medicine. In recent years, bioresorbable metals based on magnesium (Mg) have been widely investigated due to their bone-like modulus of elasticity, their high biocompatibility, antimicrobial, and osteoconductive properties. Synthetic Mg-based biomaterials are promising candidates for bone regeneration in comparison with other currently available pure synthetic materials. Different alloys based on Mg were developed to fit clinical requirements. In parallel, advances in additive manufacturing offer the possibility to fabricate experimentally bioresorbable metallic porous scaffolds. This review describes the promising clinical results of resorbable Mg-based biomaterials for bone repair in osteosynthetic application and discusses the perspectives of use in oral bone regeneration.
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Affiliation(s)
- Valentin Herber
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria; (G.A.); (M.P.)
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6, 8036 Graz, Austria; (B.O.); (N.G.S.)
- Correspondence:
| | - Begüm Okutan
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6, 8036 Graz, Austria; (B.O.); (N.G.S.)
| | - Georgios Antonoglou
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria; (G.A.); (M.P.)
| | - Nicole G. Sommer
- Department of Orthopaedics and Traumatology, Medical University of Graz, Auenbruggerplatz 5/6, 8036 Graz, Austria; (B.O.); (N.G.S.)
| | - Michael Payer
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria; (G.A.); (M.P.)
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Takvam M, Wood CM, Kryvi H, Nilsen TO. Ion Transporters and Osmoregulation in the Kidney of Teleost Fishes as a Function of Salinity. Front Physiol 2021; 12:664588. [PMID: 33967835 PMCID: PMC8098666 DOI: 10.3389/fphys.2021.664588] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 03/24/2021] [Indexed: 12/13/2022] Open
Abstract
Euryhaline teleosts exhibit major changes in renal function as they move between freshwater (FW) and seawater (SW) environments, thus tolerating large fluctuations in salinity. In FW, the kidney excretes large volumes of water through high glomerular filtration rates (GFR) and low tubular reabsorption rates, while actively reabsorbing most ions at high rates. The excreted product has a high urine flow rate (UFR) with a dilute composition. In SW, GFR is greatly reduced, and the tubules reabsorb as much water as possible, while actively secreting divalent ions. The excreted product has a low UFR, and is almost isosmotic to the blood plasma, with Mg2+, SO42–, and Cl– as the major ionic components. Early studies at the organismal level have described these basic patterns, while in the last two decades, studies of regulation at the cell and molecular level have been implemented, though only in a few euryhaline groups (salmonids, eels, tilapias, and fugus). There have been few studies combining the two approaches. The aim of the review is to integrate known aspects of renal physiology (reabsorption and secretion) with more recent advances in molecular water and solute physiology (gene and protein function of transporters). The renal transporters addressed include the subunits of the Na+, K+- ATPase (NKA) enzyme, monovalent ion transporters for Na+, Cl–, and K+ (NKCC1, NKCC2, CLC-K, NCC, ROMK2), water transport pathways [aquaporins (AQP), claudins (CLDN)], and divalent ion transporters for SO42–, Mg2+, and Ca2+ (SLC26A6, SLC26A1, SLC13A1, SLC41A1, CNNM2, CNNM3, NCX1, NCX2, PMCA). For each transport category, we address the current understanding at the molecular level, try to synthesize it with classical knowledge of overall renal function, and highlight knowledge gaps. Future research on the kidney of euryhaline fishes should focus on integrating changes in kidney reabsorption and secretion of ions with changes in transporter function at the cellular and molecular level (gene and protein verification) in different regions of the nephrons. An increased focus on the kidney individually and its functional integration with the other osmoregulatory organs (gills, skin and intestine) in maintaining overall homeostasis will have applied relevance for aquaculture.
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Affiliation(s)
- Marius Takvam
- Department of Biological Sciences, University of Bergen, Bergen, Norway.,NORCE, Norwegian Research Centre, NORCE Environment, Bergen, Norway
| | - Chris M Wood
- Department of Zoology, University of British Columbia, Vancouver, BC, Canada
| | - Harald Kryvi
- Department of Biological Sciences, University of Bergen, Bergen, Norway
| | - Tom O Nilsen
- Department of Biological Sciences, University of Bergen, Bergen, Norway.,NORCE, Norwegian Research Centre, NORCE Environment, Bergen, Norway
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11
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Erbaş İM, Altincik SA, Çatli G, Ünüvar T, Özhan B, Abaci A, Anik A. Does fludrocortisone treatment cause hypomagnesemia in children with primary adrenal insufficiency? Turk J Med Sci 2021; 51:231-237. [PMID: 33155789 PMCID: PMC7991856 DOI: 10.3906/sag-2008-167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 11/05/2020] [Indexed: 11/18/2022] Open
Abstract
Background/aim Aldosterone is a mineralocorticoid that secreted from adrenal glands and a known factor to increase magnesium excretion by direct and indirect effects on renal tubular cells. Although the frequency of hypomagnesemia was found to be approximately 5% in adult studies, there is no study in the literature investigating the frequency of hypomagnesemia in children by using fludrocortisone, which has a mineralocorticoid activity. Materials and methods A multi-center retrospective study was conducted, including children who were under fludrocortisone treatment for primary adrenal insufficiency and applied to participant pediatric endocrinology outpatient clinics. Results Forty-three patients (58.1% male, 41.9% prepubertal) included in the study, whose median age was 9.18 (0.61-19) years, and the most common diagnosis among the patients was a salt-wasting form of congenital adrenal hyperplasia (67.4%). Mean serum magnesium level was 2.05 (±0.13) mg/dL, and hypomagnesemia was not observed in any of the patients treated with fludrocortisone. None of the patients had increased urinary excretion of magnesium. Conclusion Unlike the studies performed in adults, we could not find any evidence of magnesium wasting effect of fludrocortisone treatment with normal or even high doses in children and adolescents.
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Affiliation(s)
- İbrahim Mert Erbaş
- Department of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Selda Ayça Altincik
- Department of Pediatric Endocrinology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Gönül Çatli
- Department of Pediatric Endocrinology, Faculty of Medicine, İzmir Kâtip Çelebi University, İzmir, Turkey
| | - Tolga Ünüvar
- Department of Pediatric Endocrinology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
| | - Bayram Özhan
- Department of Pediatric Endocrinology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ayhan Abaci
- Department of Pediatric Endocrinology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - Ahmet Anik
- Department of Pediatric Endocrinology, Faculty of Medicine, Aydın Adnan Menderes University, Aydın, Turkey
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Magnesium in Aging, Health and Diseases. Nutrients 2021; 13:nu13020463. [PMID: 33573164 PMCID: PMC7912123 DOI: 10.3390/nu13020463] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 12/15/2022] Open
Abstract
Several changes of magnesium (Mg) metabolism have been reported with aging, including diminished Mg intake, impaired intestinal Mg absorption and renal Mg wasting. Mild Mg deficits are generally asymptomatic and clinical signs are usually non-specific or absent. Asthenia, sleep disorders, hyperemotionality, and cognitive disorders are common in the elderly with mild Mg deficit, and may be often confused with age-related symptoms. Chronic Mg deficits increase the production of free radicals which have been implicated in the development of several chronic age-related disorders. Numerous human diseases have been associated with Mg deficits, including cardiovascular diseases, hypertension and stroke, cardio-metabolic syndrome and type 2 diabetes mellitus, airways constrictive syndromes and asthma, depression, stress-related conditions and psychiatric disorders, Alzheimer's disease (AD) and other dementia syndromes, muscular diseases (muscle pain, chronic fatigue, and fibromyalgia), bone fragility, and cancer. Dietary Mg and/or Mg consumed in drinking water (generally more bioavailable than Mg contained in food) or in alternative Mg supplements should be taken into consideration in the correction of Mg deficits. Maintaining an optimal Mg balance all through life may help in the prevention of oxidative stress and chronic conditions associated with aging. This needs to be demonstrated by future studies.
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Dominguez LJ, Veronese N, Barbagallo M. Magnesium and Hypertension in Old Age. Nutrients 2020; 13:E139. [PMID: 33396570 PMCID: PMC7823889 DOI: 10.3390/nu13010139] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/27/2020] [Accepted: 12/29/2020] [Indexed: 12/15/2022] Open
Abstract
Hypertension is a complex condition in which various actors and mechanisms combine, resulting in cardiovascular and cerebrovascular complications that today represent the most frequent causes of mortality, morbidity, disability, and health expenses worldwide. In recent decades, there has been an exceptional number of experimental, epidemiological, and clinical studies confirming a close relationship between magnesium deficit and high blood pressure. Multiple mechanisms may help to explain the bulk of evidence supporting a protective effect of magnesium against hypertension and its complications. Hypertension increases sharply with advancing age, hence older persons are those most affected by its negative consequences. They are also more frequently at risk of magnesium deficiency by multiple mechanisms, which may, at least in part, explain the higher frequency of hypertension and its long-term complications. The evidence for a favorable effect of magnesium on hypertension risk emphasizes the importance of broadly encouraging the intake of foods such as vegetables, nuts, whole cereals and legumes, optimal dietary sources of magnesium, and avoiding processed foods, which are very poor in magnesium and other fundamental nutrients, in order to prevent hypertension. In some cases, when diet is not enough to maintain an adequate magnesium status, magnesium supplementation may be of benefit and has been shown to be well tolerated.
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Affiliation(s)
| | | | - Mario Barbagallo
- Geriatric Unit, Department of Medicine, University of Palermo, 90100 Palermo, Italy; (L.J.D.); (N.V.)
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14
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Yurista SR, Silljé HHW, van Goor H, Hillebrands JL, Heerspink HJL, de Menezes Montenegro L, Oberdorf-Maass SU, de Boer RA, Westenbrink BD. Effects of Sodium-Glucose Co-transporter 2 Inhibition with Empaglifozin on Renal Structure and Function in Non-diabetic Rats with Left Ventricular Dysfunction After Myocardial Infarction. Cardiovasc Drugs Ther 2020; 34:311-321. [PMID: 32185580 PMCID: PMC7242237 DOI: 10.1007/s10557-020-06954-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background The use of sodium–glucose co-transporter 2 inhibitors (SGLT2i) is currently expanding to cardiovascular risk reduction in non-diabetic subjects, but renal (side-)effects are less well studied in this setting. Methods Male non-diabetic Sprague Dawley rats underwent permanent coronary artery ligation to induce MI, or sham surgery. Rats received chow containing empagliflozin (EMPA) (30 mg/kg/day) or control chow. Renal function and electrolyte balance were measured in metabolic cages. Histological and molecular markers of kidney injury, parameters of phosphate homeostasis and bone resorption were also assessed. Results EMPA resulted in a twofold increase in diuresis, without evidence for plasma volume contraction or impediments in renal function in both sham and MI animals. EMPA increased plasma magnesium levels, while the levels of glucose and other major electrolytes were comparable among the groups. Urinary protein excretion was similar in all treatment groups and no histomorphological alterations were identified in the kidney. Accordingly, molecular markers for cellular injury, fibrosis, inflammation and oxidative stress in renal tissue were comparable between groups. EMPA resulted in a slight increase in circulating phosphate and PTH levels without activating FGF23–Klotho axis in the kidney and bone mineral resorption, measured with CTX-1, was not increased. Conclusions EMPA exerts profound diuretic effects without compromising renal structure and function or causing significant electrolyte imbalance in a non-diabetic setting. The slight increase in circulating phosphate and PTH after EMPA treatment was not associated with evidence for increased bone mineral resorption suggesting that EMPA does not affect bone health. Electronic supplementary material The online version of this article (10.1007/s10557-020-06954-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Salva R Yurista
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Herman H W Silljé
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan-Luuk Hillebrands
- Department of Pathology and Medical Biology, Division of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hiddo J L Heerspink
- Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Luiz de Menezes Montenegro
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Silke U Oberdorf-Maass
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - B Daan Westenbrink
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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15
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Walker P, Parnell S, Dillon RC. Epsom Salt Ingestion Leading to Severe Hypermagnesemia Necessitating Dialysis. J Emerg Med 2020; 58:767-770. [PMID: 32389435 DOI: 10.1016/j.jemermed.2020.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/13/2020] [Accepted: 04/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Hypermagnesemia is an often overlooked electrolyte abnormality that has a myriad of presenting symptoms. It has been observed after both accidental and intentional ingestions of magnesium-containing compounds, and as in the case presented, Epsom salts, which are primarily magnesium sulfate. CASE REPORT A 56-year-old man presented to the emergency department reporting weakness after an ingestion of Epsom salts used as a laxative and was found to be bradycardic and hypotensive. He subsequently developed altered mental status and respiratory depression necessitating intubation. His magnesium level was found to be > 3.91 mmol/L (> 9.5 mg/dL). He was given multiple doses of calcium gluconate and generous i.v. fluids with furosemide, with minimal improvement. However, his magnesium level corrected rapidly after initiation of dialysis, and 3 days later he was discharged home in good condition with normal neurologic function. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Keeping a high level of suspicion for, and quickly recognizing, hypermagnesemia allows for prompt initiation of treatment, which can avoid significant hemodynamic or respiratory compromise. Mainstays of treatment are i.v. calcium and i.v. fluids. Loop diuretics may be given as an adjunct as well. Dialysis should be considered in cases of severe hypermagnesemia because it results in rapid correction of magnesium levels.
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Affiliation(s)
- Philip Walker
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Samuel Parnell
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ryan C Dillon
- Department of Pharmaceutical Services, Vanderbilt University Medical Center, Nashville, Tennessee
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16
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Capolongo G, Suzumoto Y, D'Acierno M, Simeoni M, Capasso G, Zacchia M. ERK1,2 Signalling Pathway along the Nephron and Its Role in Acid-base and Electrolytes Balance. Int J Mol Sci 2019; 20:E4153. [PMID: 31450703 PMCID: PMC6747339 DOI: 10.3390/ijms20174153] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/14/2019] [Accepted: 08/22/2019] [Indexed: 12/17/2022] Open
Abstract
Mitogen-activated protein kinases (MAPKs) are intracellular molecules regulating a wide range of cellular functions, including proliferation, differentiation, apoptosis, cytoskeleton remodeling and cytokine production. MAPK activity has been shown in normal kidney, and its over-activation has been demonstrated in several renal diseases. The extracellular signal-regulated protein kinases (ERK 1,2) signalling pathway is the first described MAPK signaling. Intensive investigations have demonstrated that it participates in the regulation of ureteric bud branching, a fundamental process in establishing final nephron number; in addition, it is also involved in the differentiation of the nephrogenic mesenchyme, indicating a key role in mammalian kidney embryonic development. In the present manuscript, we show that ERK1,2 signalling mediates several cellular functions also in mature kidney, describing its role along the nephron and demonstrating whether it contributes to the regulation of ion channels and transporters implicated in acid-base and electrolytes homeostasis.
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Affiliation(s)
- Giovanna Capolongo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | | | | | - Mariadelina Simeoni
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
| | - Giovambattista Capasso
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
- Biogem Scarl, 83031 Ariano Irpino, Italy
| | - Miriam Zacchia
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy.
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Sato T, Shimizu Y, Odashima K, Sano Y, Yamamoto A, Mukai T, Ikeo N, Takahashi T, Kumamoto H. In vitro and in vivo analysis of the biodegradable behavior of a magnesium alloy for biomedical applications. Dent Mater J 2019; 38:11-21. [PMID: 30158349 DOI: 10.4012/dmj.2017-324] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The present study was designed to investigate the biodegradation behavior of Mg alloy plates in the maxillofacial region. For in vitro analysis, the plates were immersed in saline solution and simulated body fluid. For in vivo, the plates were implanted into the tibia, head, back, abdominal cavity, and femur and assessed at 1, 2, and 4 weeks after implantation. After implantation, the plate volumes and the formed insoluble salt were measured via micro-computed tomography. SEM/EDX analysis of the insoluble salt and histological analysis of the surrounding tissues were performed. The volume loss of plates in the in vitro groups was higher than that in the in vivo groups. The volume loss was fastest in the abdomen, followed by the head, back, tibia, and femur. There were no statistically significant differences in the insoluble salt volume of the all implanted sites. The corrosion of the Mg alloy will be affected to the surrounding tissue responses. The material for the plate should be selected based on the characteristic that Mg alloys are decomposed relatively easily in the maxillofacial region.
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Affiliation(s)
- Takumi Sato
- Division of Oral and Maxillofacial Surgery, Department of Oral and Medicine and Surgery, Graduate School of Dentistry, Tohoku University
| | - Yoshinaka Shimizu
- Division of Oral Pathology, Department of Oral Medicine and Surgery, Graduate School of Dentistry, Tohoku University
| | - Kenji Odashima
- Division of Oral and Maxillofacial Surgery, Department of Oral and Medicine and Surgery, Graduate School of Dentistry, Tohoku University
| | - Yuya Sano
- Division of Oral Pathology, Department of Oral Medicine and Surgery, Graduate School of Dentistry, Tohoku University
| | - Akiko Yamamoto
- Biometals Group, Biomaterials Unit, Nano-life Field, International Center for Materials Nanoarchitectonics, National Institute for Materials Science
| | - Toshiji Mukai
- Department of Mechanical Engineering, Kobe University
| | - Naoko Ikeo
- Department of Mechanical Engineering, Kobe University
| | - Tetsu Takahashi
- Division of Oral and Maxillofacial Surgery, Department of Oral and Medicine and Surgery, Graduate School of Dentistry, Tohoku University
| | - Hiroyuki Kumamoto
- Division of Oral Pathology, Department of Oral Medicine and Surgery, Graduate School of Dentistry, Tohoku University
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18
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Abu-Amna M, Bar-Sela G. Increase in cetuximab-induced skin rash and hypomagnesemia in patients receiving concomitant treatment with proton pump inhibitors (PPIs): a possible drug interaction? Cancer Chemother Pharmacol 2018; 83:545-550. [PMID: 30547192 DOI: 10.1007/s00280-018-3758-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/06/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION In a previous study, we found that co-administration of proton pump inhibitors (PPIs) with cetuximab was associated with increased skin toxicity. Both these drugs can induce hypomagnesemia. The aim of this study was to retrospectively explore the possible influence of PPI drugs on cetuximab skin toxicity and the potential synergistic effect of hypomagnesemia. PATIENTS AND METHODS The files of all eligible patients treated with cetuximab during 2015-2016 with metastatic colorectal carcinoma (mCRC) or head and neck (H&N) carcinoma were reviewed. The concomitant use of PPIs was defined if a drug belonging to that class was included in the patient's chronic medications list. RESULTS One hundred eighteen patients (61 with H&N carcinoma, 57 with mCRC) were included in the study, and 58 of the 118 patients received PPIs concomitantly with cetuximab. Skin toxicity of any grade was reported in 33/58 (56.9%) patients on PPIs compared with 22/60 (36.7%) patients (p = 0.08) with grade 3-4 in 19/58 (32.8%) and 2/60 (3.3%), respectively (p = 0.001). Hypomagnesemia (Mg serum level < 1.2 mg/dL) was reported in 14/58 (25.9%) PPI-treated patients, compared with 5/60 (10.4%) patients not on PPIs (p = 0.08). Grade 3-4 skin toxicity or hypomagnesemia (Mg < 0.9 mg/dL) was reported in 23/58 (39.7%) patients on concomitant treatment with PPIs, compared with 3/60 (5%) patients not on PPIs (p = 0.001). CONCLUSIONS Both the rate and the severity of cetuximab-induced skin toxicity and hypomagnesemia were increased by chronic concomitant administration of PPIs. A prospective study is needed to confirm the possible interaction between cetuximab and PPIs.
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Affiliation(s)
| | - Gil Bar-Sela
- Center for Malignant Diseases, Emek Medical Center, 21 Yitzhak Rabin Blvd, 1834111, Afula, Israel. .,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
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19
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Abstract
Conventional therapy of hypoparathyroidism consists of oral calcium and either activated vitamin D or vitamin D supplements at varying doses. Although adjusting dosing of calcium and/or activated vitamin D or vitamin D itself, the serum calcium should be obtained weekly or monthly depending on the clinical situation. Calcium supplementation in hypoparathyroidism usually consists of calcium carbonate because it is 40% elemental calcium by weight. However, calcium citrate (21% elemental calcium) is indicated for patients with achlorhydria and proton pump inhibitor therapy. Many clinicians prefer to uptitrate the activated form of vitamin D to reduce the amount of calcium supplementation.
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Affiliation(s)
- Muriel Babey
- Department of Medicine, Highland Hospital, 1411 East 31st Street, Oakland, CA 94602, USA
| | - Maria-Luisa Brandi
- Department of Surgery and Translational Medicine, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Dolores Shoback
- Endocrine Research Unit, Department of Medicine, San Francisco Department of Veterans Affairs Medical Center, University of California, San Francisco, 111N, 1700 Owens Street, 3rd Floor Room 369, San Francisco, CA 94158, USA.
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20
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Drižiene Ž, Stakisaitis D, Balsiene J. Magnesium Urinary Excretion in Diabetic Adolescents. ACTA MEDICA (HRADEC KRÁLOVÉ) 2018. [DOI: 10.14712/18059694.2018.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: to define peculiarities of urinary magnesium (Mg) excretion in diabetic adolecents; to elucidate gender-related differences in Mg urinary excretion; to determine urinary Mg excretion differences between diabetic and age-matched healthy children. The diurnal, nocturnal and 24–h urinary Mg level in adolescent boys and girls (aged 13–17 years) with type I diabetes mellitus (DM) and in age-matched control groups of healthy boys and girls was examined. Additionally the adolescent girls were examined during different phases of their menstrual cycle. Results: Diurnal, overnight and 24–h Mg urinary excretion in diabetic adolescent boys and girls was significantly higher than in healthy ones. In diabetic boys 24 h Mg excretion was higher than in diabetic girls (4.59±1.4 vs. 3.34±1.5 mmol; p<0.05). The investigation showed gender-related differences in Mg urinary excretion in healthy adolescents: 24–h Mg urinary excretion was significantly higher in boys than in girls (2.66±0.9 vs. 2.1±0.9 mmol; p<0.05). The level of Mg in the nocturnal urine of boys and girls was significantly higher than in diurnal. Urine Mg was negatively related to height in adolescent girls. Conclusion: Diabetic adolescents excrete significantly more Mg with urine as compared to healthy ones.
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21
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Elkheshen A, Billah M, Shahbaz A, Zarghamravanbakhsh P, Nabi U, Sachmechi I. A Rare Case Report of Extra-adrenal Pheochromocytoma with Normal Blood Pressure: Is that Possible? Cureus 2018; 10:e3167. [PMID: 30357026 PMCID: PMC6197536 DOI: 10.7759/cureus.3167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Extra-adrenal pheochromocytoma is uncommon and usually secreting nor-epinephrine. We are presenting a possible case of extra-adrenal pheochromocytoma in a 68-year-old male who was admitted to Queens Hospital Center complaining of shortness of breath for two days. Physical examination was unremarkable except tachycardia. Ventilation/perfusion (V/Q) scan showed the intermediate probability for pulmonary thromboembolism. Computed tomography (CT) chest confirmed the presence of old embolism and showed the 1.1 cm nodule in the left upper lobe. He suddenly collapsed and went into cardio-respiratory failure and attempts to resuscitate were futile. Results for pheochromocytoma workup received after the patient has passed away and it showed elevated levels of 24-hour urine metanephrine, normetanephrine, and Vanillylmandelic acid (VMA). In our patient, CT abdomen did not identify any mass in the adrenal gland or at the bifurcation of the aorta. The extra-adrenal tumor can secrete enough epinephrine to negate the hypertensive effect of norepinephrine. The clinician should be aware of the possibility that tachycardia could be a presenting symptom in pheochromocytoma although the patient is normotensive.
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Affiliation(s)
- Ahmed Elkheshen
- Internal Medicine, The Icahn School of Medicine at Mount Sinai, New York, USA
| | - Masud Billah
- Internal Medicine, Icahn School of Medicine, Mount Sinai/ Queens Hospital Center, New York, USA
| | - Amir Shahbaz
- Internal Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, New York, USA
| | | | - Usman Nabi
- Diagnostic Radiology, Hamad General Hospital, Doha, QAT
| | - Issac Sachmechi
- Internal Medicine, Icahn School of Medicine at Mount Sinai/Queens Hospital Center, New York, USA
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22
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Malik S, Lambert E, Zhang J, Wang T, Clark HL, Cypress M, Goldman BI, Porter GA, Pena S, Nino W, Gray DA. Potassium conservation is impaired in mice with reduced renal expression of Kir4.1. Am J Physiol Renal Physiol 2018; 315:F1271-F1282. [PMID: 30110571 DOI: 10.1152/ajprenal.00022.2018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
To better understand the role of the inward-rectifying K channel Kir4.1 (KCNJ10) in the distal nephron, we initially studied a global Kir4.1 knockout mouse (gKO), which demonstrated the hypokalemia and hypomagnesemia seen in SeSAME/EAST syndrome and was associated with reduced Na/Cl cotransporter (NCC) expression. Lethality by ~3 wk, however, limits the usefulness of this model, so we developed a kidney-specific Kir4.1 "knockdown" mouse (ksKD) using a cadherin 16 promoter and Cre-loxP methodology. These mice appeared normal and survived to adulthood. Kir4.1 protein expression was decreased ~50% vs. wild-type (WT) mice by immunoblotting, and immunofluorescence showed moderately reduced Kir4.1 staining in distal convoluted tubule that was minimal or absent in connecting tubule and cortical collecting duct. Under control conditions, the ksKD mice showed metabolic alkalosis and relative hypercalcemia but were normokalemic and mildly hypermagnesemic despite decreased NCC expression. In addition, the mice had a severe urinary concentrating defect associated with hypernatremia, enlarged kidneys with tubulocystic dilations, and reduced aquaporin-3 expression. On a K/Mg-free diet for 1 wk, however, ksKD mice showed marked hypokalemia (serum K: 1.5 ± 0.1 vs. 3.0 ± 0.1 mEq/l for WT), which was associated with renal K wasting (transtubular K gradient: 11.4 ± 0.8 vs. 1.6 ± 0.4 in WT). Phosphorylated-NCC expression increased in WT but not ksKD mice on the K/Mg-free diet, suggesting that loss of NCC adaptation underlies the hypokalemia. In conclusion, even modest reduction in Kir4.1 expression results in impaired K conservation, which appears to be mediated by reduced expression of activated NCC.
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Affiliation(s)
- Sundeep Malik
- Department of Pharmacology and Physiology, School of Medicine, University of Rochester , Rochester, New York
| | - Emily Lambert
- Nephrology Division, Department of Medicine, University of Rochester , Rochester, New York
| | - Junhui Zhang
- Department of Cellular and Molecular Physiology, Yale University School of Medicine , New Haven, Connecticut
| | - Tong Wang
- Department of Cellular and Molecular Physiology, Yale University School of Medicine , New Haven, Connecticut
| | - Heather L Clark
- Nephrology Division, Department of Medicine, University of Rochester , Rochester, New York
| | - Michael Cypress
- Nephrology Division, Department of Medicine, University of Rochester , Rochester, New York
| | - Bruce I Goldman
- Pathology and Laboratory Medicine, University of Rochester , Rochester, New York
| | - George A Porter
- Cardiology Division, Department of Pediatrics, University of Rochester , Rochester, New York
| | - Salvador Pena
- Nephrology Division, Department of Medicine, University of Rochester , Rochester, New York
| | - Wilson Nino
- Nephrology Division, Department of Medicine, University of Rochester , Rochester, New York
| | - Daniel A Gray
- Nephrology Division, Department of Medicine, University of Rochester , Rochester, New York
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Kieboom BCT, Zietse R, Ikram MA, Hoorn EJ, Stricker BH. Thiazide but not loop diuretics is associated with hypomagnesaemia in the general population. Pharmacoepidemiol Drug Saf 2018; 27:1166-1173. [PMID: 30095199 DOI: 10.1002/pds.4636] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 06/22/2018] [Accepted: 07/16/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE Hypomagnesaemia has been associated with various adverse outcomes. Loop and thiazide diuretics promote urinary magnesium excretion. However, it is unknown if this links to hypomagnesaemia. We study if loop or thiazide diuretic use affects serum magnesium levels and if it associates with hypomagnesaemia. In addition, we study the effect of combining a potassium-sparing diuretic with a thiazide diuretic on the presence of hypomagnesaemia. METHODS The study performed a cross-sectional analysis within 9820 participants from the prospective Rotterdam Study. Hypomagnesaemia was defined as a serum magnesium level ≤0.72 mmol/L. Participants were categorized by defined daily dose (DDD), and all analyses were adjusted for age, sex, BMI, eGFR, serum potassium levels, proton pump inhibitor use, and comorbidities. RESULTS Loop diuretic use was associated with higher serum magnesium levels (<1 DDD: 0.004 mmol/L 95% CI: -0.008; 0.017; 1 DDD: 0.023 mmol/L 95% CI: 0.013; 0.032; >1 DDD: 0.043 mmol/L 95% CI: 0.028; 0.057). Thiazide diuretic use was associated with lower serum magnesium levels (<1 DDD: -0.013 mmol/L 95% CI: -0.023; -0.002; ≥1 DDD: -0.018 mmol/L 95% CI: -0.028; -0.010), resulting in an increased odds ratio of hypomagnesaemia of 3.14 (95% CI: 1.67; 5.92) and 2.74 (95% CI: 1.57; 4.77), respectively. These effects were predominantly seen in participants using diuretics for more than 390 days. Combining thiazide diuretics with a potassium-sparing agent was not associated with lower serum magnesium levels or hypomagnesaemia. CONCLUSIONS Thiazide diuretic use is associated with lower serum magnesium levels and an increased risk of hypomagnesaemia. This increased risk is not seen in participants using a combination of thiazide diuretics with a potassium-sparing agent. The use of loop diuretics is not associated with an increased risk of hypomagnesaemia.
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Affiliation(s)
- Brenda C T Kieboom
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Internal Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.,Inspectorate for Health Care, Utrecht, the Netherlands
| | - Robert Zietse
- Department of Internal Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ewout J Hoorn
- Department of Internal Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.,Department of Internal Medicine, Erasmus MC-University Medical Center Rotterdam, Rotterdam, the Netherlands.,Inspectorate for Health Care, Utrecht, the Netherlands
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24
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Shahbaz A, Aziz K, Fransawy Alkomos M, Nabi U, Zarghamravanbakhsh P, Sachmechi I. Pheochromocytoma Secreting Large Quantities of Both Epinephrine and Norepinephrine Presenting with Episodes of Hypotension and Severe Electrolyte Imbalance. Cureus 2018; 10:e3050. [PMID: 30263879 PMCID: PMC6156118 DOI: 10.7759/cureus.3050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Pheochromocytoma is a rare tumor usually arising from the adrenal medulla (strictly speaking, those arising outside the adrenal gland are called paragangliomas). We report a case of pheochromocytoma presenting as orthostatic hypotension and electrolyte imbalance. A 51-year-old woman was admitted because of vomiting and chest pain. She had fluctuating blood pressure (BP) with episodes of orthostatic hypotension. Computed tomography pulmonary angiogram was performed to rule out pulmonary embolism; it showed a clear chest, but an incidental right suprarenal mass. The biochemical analysis supports the diagnosis of pheochromocytoma. Her electrolyte panel revealed persistently low potassium, calcium, and magnesium levels despite aggressive replacement. We speculated that hypotension was mainly due to vasodilatation caused by excess plasma epinephrine and prescribed doxazosin and a nonselective beta-adrenergic blocker which stabilized BP. The right adrenal tumor excised, and postoperatively she remained hemodynamically stable with no hypotensive episode. Laboratory data taken six weeks after surgery show normal 24-hour urine metanephrine and normetanephrine and normal serum magnesium and calcium levels. This case report highlights the variable presentation of pheochromocytoma. We also discuss the probable mechanisms of electrolyte imbalance in our case.
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Affiliation(s)
- Amir Shahbaz
- Internal Medicine, Icahn School of Medicine at Mount Sinai Queens Hospital Center, New York, USA
| | - Kashif Aziz
- Internal Medicine, Icahn School of Medicine at Mount Sinai Queens Hospital Center, New York, USA
| | - Mina Fransawy Alkomos
- Research, California Institute of Behavioral Neurosciences & Psychology, Sacramento, USA
| | - Usman Nabi
- Diagnostic Radiology, Hamad General Hospital, Doha, QAT
| | | | - Issac Sachmechi
- Internal Medicine, Icahn School of Medicine at Mount Sinai Queens Hospital Center, New York, USA
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25
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Hansen BA, Bruserud Ø. Hypomagnesemia in critically ill patients. J Intensive Care 2018; 6:21. [PMID: 29610664 PMCID: PMC5872533 DOI: 10.1186/s40560-018-0291-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 03/13/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Magnesium (Mg) is essential for life and plays a crucial role in several biochemical and physiological processes in the human body. Hypomagnesemia is common in all hospitalized patients, especially in critically ill patients with coexisting electrolyte abnormalities. Hypomagnesemia may cause severe and potential fatal complications if not timely diagnosed and properly treated, and associate with increased mortality. MAIN BODY Mg deficiency in critically ill patients is mainly caused by gastrointestinal and/or renal disorders and may lead to secondary hypokalemia and hypocalcemia, and severe neuromuscular and cardiovascular clinical manifestations. Because of the physical distribution of Mg, there are no readily or easy methods to assess Mg status. However, serum Mg and the Mg tolerance test are most widely used. There are limited studies to guide intermittent therapy of Mg deficiency in critically ill patients, but some empirical guidelines exist. Further clinical trials and critical evaluation of empiric Mg replacement strategies is needed. CONCLUSION Patients at risk of Mg deficiency, with typical biochemical findings or clinical symptoms of hypomagnesemia, should be considered for treatment even with serum Mg within the normal range.
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Affiliation(s)
| | - Øyvind Bruserud
- Section for Endocrinology, Department of Clinical Science, University of Bergen, Bergen, Norway
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Funato Y, Furutani K, Kurachi Y, Miki H. CrossTalk proposal: CNNM proteins are Na + /Mg 2+ exchangers playing a central role in transepithelial Mg 2+ (re)absorption. J Physiol 2018; 596:743-746. [PMID: 29383719 DOI: 10.1113/jp275248] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Yosuke Funato
- Department of Cellular Regulation, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka 565-0871, Japan
| | - Kazuharu Furutani
- Department of Pharmacology, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan.,Department of Physiology and Membrane Biology, University of California, Davis, CA 95616, USA
| | - Yoshihisa Kurachi
- Department of Pharmacology, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan
| | - Hiroaki Miki
- Department of Cellular Regulation, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka 565-0871, Japan
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Abstract
Magnesium (Mg2+) is an essential mineral without known specific regulatory mechanisms. In ruminants, plasma Mg2+ concentration depends primarily on the balance between Mg2+ absorption and Mg2+ excretion. The primary site of Mg2+ absorption is the rumen, where Mg2+ is apically absorbed by both potential-dependent and potential-independent uptake mechanisms, reflecting involvement of ion channels and electroneutral transporters, respectively. Transport is energised in a secondary active manner by a basolateral Na+/Mg2+ exchanger. Ruminal transport of Mg2+ is significantly influenced by a variety of factors such as high K+ concentration, sudden increases of ammonia, pH, and the concentration of SCFA. Impaired Mg2+ absorption in the rumen is not compensated for by increased transport in the small or large intestine. While renal excretion can be adjusted to compensate precisely for any surplus in Mg2+ uptake, a shortage in dietary Mg2+ cannot be compensated for either via skeletal mobilisation of Mg2+ or via up-regulation of ruminal absorption. In such situations, hypomagnesaemia will lead to decrease of a Mg2+ in the cerebrospinal fluid and clinical manifestations of tetany. Improved knowledge concerning the factors governing Mg2+ homeostasis will allow reliable recommendations for an adequate Mg2+ intake and for the avoidance of possible disturbances. Future research should clarify the molecular identity of the suggested Mg2+ transport proteins and the regulatory mechanisms controlling renal Mg excretion as parameters influencing Mg2+ homeostasis.
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Barbagallo M, Dominguez LJ. Magnesium Role in Health and Longevity. TRACE ELEMENTS AND MINERALS IN HEALTH AND LONGEVITY 2018:235-264. [DOI: 10.1007/978-3-030-03742-0_9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Simić A, Hansen AF, Åsvold BO, Romundstad PR, Midthjell K, Syversen T, Flaten TP. Trace element status in patients with type 2 diabetes in Norway: The HUNT3 Survey. J Trace Elem Med Biol 2017; 41:91-98. [PMID: 28347468 DOI: 10.1016/j.jtemb.2017.03.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 12/25/2022]
Abstract
Several epidemiological studies have indicated that a number of trace elements may play a role in type 2 diabetes (T2D). We investigated the association between prevalent T2D and the concentrations of 25 trace elements in whole blood, and the relationships between T2D duration and blood levels of the trace elements that we found to be related to T2D prevalence. In this population based case-control study, 267 patients with self-reported T2D and 609 controls (frequency matched), were selected from the third Nord-Trøndelag Health Survey. Trace element blood levels were determined by high resolution inductively coupled plasma-mass spectrometry. Multivariable conditional logistic regression and multivariable linear regression were used to estimate associations. The prevalence of T2D was positively associated with boron, calcium and silver, and inversely associated with indium, lead and magnesium (Ptrend<0.05). We found no statistical evidence for associations between blood levels of arsenic, bromine, cadmium, cesium, chromium, copper, gallium, gold, manganese, mercury, molybdenum, nickel, rubidium, selenium, strontium, tantalum, thallium, tin and zinc and T2D prevalence. After corrections for multiple testing, associations remained significant for calcium and lead (Qtrend<0.05), and borderline significant for magnesium, silver and boron. With increasing disease duration, higher calcium levels were observed (P<0.05). This study suggests an association between prevalent T2D and blood levels of boron, calcium, indium, lead, magnesium and silver.
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Affiliation(s)
- Anica Simić
- Department of Chemistry, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Ailin Falkmo Hansen
- Department of Chemistry, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Circulation and Medical Imaging, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjørn Olav Åsvold
- Department of Endocrinology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Pål Richard Romundstad
- Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristian Midthjell
- Department of Public Health and General Practice, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tore Syversen
- Department of Neuroscience, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Trond Peder Flaten
- Department of Chemistry, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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Corre T, Olinger E, Harris SE, Traglia M, Ulivi S, Lenarduzzi S, Belge H, Youhanna S, Tokonami N, Bonny O, Houillier P, Polasek O, Deary IJ, Starr JM, Toniolo D, Gasparini P, Vollenweider P, Hayward C, Bochud M, Devuyst O. Common variants in CLDN14 are associated with differential excretion of magnesium over calcium in urine. Pflugers Arch 2016; 469:91-103. [DOI: 10.1007/s00424-016-1913-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/22/2016] [Indexed: 12/17/2022]
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Bushinsky DA, Spiegel DM, Gross C, Benton WW, Fogli J, Hill Gallant KM, Du Mond C, Block GA, Weir MR, Pitt B. Effect of Patiromer on Urinary Ion Excretion in Healthy Adults. Clin J Am Soc Nephrol 2016; 11:1769-1776. [PMID: 27679518 PMCID: PMC5053784 DOI: 10.2215/cjn.01170216] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/20/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Patiromer is a nonabsorbed potassium-binding polymer that uses calcium as the counterexchange ion. The calcium released with potassium binding has the potential to be absorbed or bind phosphate. Because binding is not specific for potassium, patiromer can bind other cations. Here, we evaluate the effect of patiromer on urine ion excretion in healthy adults, which reflects gastrointestinal ion absorption. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We analyzed the effect of patiromer on urine potassium, sodium, magnesium, calcium, and phosphate in two studies. Healthy adults on controlled diets in a clinical research unit were given patiromer up to 50.4 g/d divided three times a day for 8 days (dose-finding study) or 25.2 g/d in a crossover design as daily or divided (two or three times a day) doses for 18 days (dosing regimen study). On the basis of 24-hour collections, urinary ion excretion during the baseline period (days 5-11) was compared with that during the treatment period (days 13-19; dose-finding study), and the last 4 days of each period were compared across regimens (dosing regimen study). RESULTS In the dose-finding study, patiromer induced a dose-dependent decrease in urine potassium, urine magnesium, and urine sodium (P<0.01 for each). Patiromer at 25.2 g/d decreased urine potassium (mean±SD) by 1140±316 mg/d, urine magnesium by 45±1 mg/d, and urine sodium by 225±145 mg/d. Urine calcium increased in a dose-dependent manner, and urine phosphate decreased in parallel (both P<0.01). Patiromer at 25.2 g/d increased urine calcium by 73±23 mg/d and decreased urine phosphate by 64±40 mg/d. Urine potassium, urine sodium, and urine magnesium were unaffected by dosing regimen, whereas the increase in urine calcium was significantly lower with daily compared with three times a day dosing (P=0.01). Urine phosphate also decreased less with daily compared with two or three times a day dosing (P<0.05). CONCLUSIONS In healthy adults, patiromer reduces urine potassium, urine sodium, urine magnesium, and urine phosphate, while modestly increasing urine calcium. Compared with divided dosing, administration of patiromer once daily provides equivalent reductions in urine potassium, urine sodium, and urine magnesium, with less effect on urine calcium and urine phosphate.
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Affiliation(s)
- David A. Bushinsky
- Division of Nephrology, Department of Medicine, University of Rochester, Rochester, New York
| | | | | | | | | | | | | | | | - Matthew R. Weir
- Division of Nephrology, Department of Medicine, University of Maryland, Baltimore, Maryland; and
| | - Bertram Pitt
- Division of Cardiology, University of Michigan School of Medicine, Ann Arbor, Michigan
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Abstract
With the incorporation of targeted therapies in routine cancer therapy, it is imperative that the array of toxicities associated with these agents be well-recognized and managed, especially since these toxicities are distinct from those seen with conventional cytotoxic agents. This review will focus on these renal toxicities from commonly used targeted agents. This review discusses the mechanisms of these side effects and management strategies. Anti-vascular endothelial growth factor (VEGF) agents including the monoclonal antibody bevacizumab, aflibercept (VEGF trap), and anti-VEGF receptor (VEGFR) tyrosine kinase inhibitors (TKIs) all cause hypertension, whereas some of them result in proteinuria. Monoclonal antibodies against the human epidermal growth factor receptor (HER) family of receptors, such as cetuximab and panitumumab, cause electrolyte imbalances including hypomagnesemia and hypokalemia due to the direct nephrotoxic effect of the drug on renal tubules. Cetuximab may also result in renal tubular acidosis. The TKIs, imatinib and dasatinib, can result in acute or chronic renal failure. Rituximab, an anti-CD20 monoclonal antibody, can cause acute renal failure following initiation of therapy because of the onset of acute tumor lysis syndrome. Everolimus, a mammalian target of rapamycin (mTOR) inhibitor, can result in proteinuria. Discerning the renal adverse effects resulting from these agents is essential for safe treatment strategies, particularly in those with pre-existing renal disease.
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Affiliation(s)
- Anum Abbas
- Department of Internal Medicine, School of Medicine, Creighton University, Omaha, NE, USA
| | - Mohsin M Mirza
- Department of Internal Medicine, School of Medicine, Creighton University, Omaha, NE, USA
| | - Apar Kishor Ganti
- Division of Oncology and Hematology, Department of Internal Medicine, VA-Nebraska Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, NE, USA
| | - Ketki Tendulkar
- Division of Nephrology, Department of Internal Medicine, University of Nebraska Medical Center, 983040 Nebraska Medical Center, Omaha, NE, 68198-3040, USA.
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Long-term in vivo degradation behavior and near-implant distribution of resorbed elements for magnesium alloys WZ21 and ZX50. Acta Biomater 2016; 42:440-450. [PMID: 27343708 DOI: 10.1016/j.actbio.2016.06.025] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 06/17/2016] [Indexed: 11/21/2022]
Abstract
UNLABELLED We report on the long-term effects of degrading magnesium implants on bone tissue in a growing rat skeleton using continuous in vivo micro-Computed Tomography, histological staining and Laser Ablation Inductively Coupled Plasma Mass Spectrometry (LA-ICP-MS). Two different magnesium alloys-one rapidly degrading (ZX50) and one slowly degrading (WZ21)-were used to evaluate the bone response and distribution of released Mg and Y ions in the femur of male Sprague-Dawley rats. Regardless of whether the alloy degrades rapidly or slowly, we found that bone recovers restitutio ad integrum after complete degradation of the magnesium implant. The degradation of the Mg alloys generates a significant increase in Mg concentration in the cortical bone near the remaining implant parts, but the Mg accumulation disappears after the implant degrades completely. The degradation of the Y-containing alloy WZ21 leads to Y enrichment in adjacent bone tissues and in newly formed bone inside the medullary space. Locally high Y concentrations suggest migration not only of Y ions but also of Y-containing intermetallic particles. However, after the full degradation of the implant the Y-enrichment disappears almost completely. Hydrogen gas formation and ion release during implant degradation did not harm bone regeneration in our samples. STATEMENT OF SIGNIFICANCE Magnesium is generally considered to be one of the most attractive base materials for biodegradable implants, and many magnesium alloys have been optimized to adjust implant degradation. Delayed degradation, however, generates prolonged presence in the organism with the risk of foreign body reactions. While most studies so far have only ranged from several weeks up to 12months, the present study provides data for complete implant degradation and bone regeneration until 24months, for two magnesium alloys (ZX50, WZ21) with different degradation characteristics. μCT monitoring, histological staining and LA-ICP-MS illustrate the distribution of the elements in the neighboring bony tissues during implant degradation, and reveal in particular high concentrations of the rare-earth element Yttrium.
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Enokida T, Suzuki S, Wakasugi T, Yamazaki T, Okano S, Tahara M. Incidence and Risk Factors of Hypomagnesemia in Head and Neck Cancer Patients Treated with Cetuximab. Front Oncol 2016; 6:196. [PMID: 27683640 PMCID: PMC5021713 DOI: 10.3389/fonc.2016.00196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 08/22/2016] [Indexed: 02/06/2023] Open
Abstract
Background Hypomagnesemia is a common adverse event during cetuximab (Cmab) treatment. However, few reports have investigated the incidence and risk factors of hypomagnesemia in head and neck cancer patients treated with Cmab. Methods We retrospectively reviewed 131 head and neck cancer patients who received Cmab-containing therapy. Main eligibility criteria were ≥3 Cmab administrations, no prior EGFR-directed therapy, and no prophylactic Mg supplementation. Results Median baseline serum Mg level and number of Cmab administrations were 2.2 mg/dl and 8, respectively. Overall incidence of hypomagnesemia was 50.4% (grade 1, 46.6%; grade 2, 3.1%; grade 3, 0%; and grade 4, 0.8%) and differed between patients treated with palliative chemotherapy and bioradiation (Cmab and radiation) (63 versus 24%; P < 0.01). Independent risk factors were low baseline serum Mg [odds ratio (OR) 161.988, 95% confidence interval (CI) 9.436–2780.895], ≥7 Cmab administrations (OR 3.56, 95% CI 1.16–13.98), and concurrent administration of platinum (cisplatin; OR 23.695, 95% CI 5.219–107.574, carboplatin; OR 5.487, 95% CI 1.831–16.439). Respective incidence of hypomagnesemia in patients in high- (concurrent platinum and ≥7 Cmab administrations) and low-risk (no concurrent platinum and <7 Cmab administrations) groups was 66.0 and 6.6% (P < 0.001, OR 28.0). Conclusion Cmab is associated with a significant risk of hypomagnesemia in patients with head and neck cancer with longer term administration and concurrent platinum therapy. High-risk patients should be treated with particular care.
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Affiliation(s)
- Tomohiro Enokida
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East , Kashiwa , Japan
| | - Shinya Suzuki
- Division of Pharmacy, National Cancer Center Hospital East , Kashiwa , Japan
| | - Tetsuro Wakasugi
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East , Kashiwa , Japan
| | - Tomoko Yamazaki
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East , Kashiwa , Japan
| | - Susumu Okano
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East , Kashiwa , Japan
| | - Makoto Tahara
- Department of Head and Neck Medical Oncology, National Cancer Center Hospital East , Kashiwa , Japan
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Reineke EL, Walton K, Otto CM. Evaluation of an oral electrolyte solution for treatment of mild to moderate dehydration in dogs with hemorrhagic diarrhea. J Am Vet Med Assoc 2016; 243:851-7. [PMID: 24004233 DOI: 10.2460/javma.243.6.851] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the safety and efficacy of an electrolyte solution for oral administration (OES) for the correction of mild to moderate dehydration associated with hemorrhagic diarrhea in dogs. DESIGN Nonrandomized, noncontrolled clinical trial. ANIMALS 20 dogs that had hemorrhagic diarrhea with < 3 episodes of vomiting. PROCEDURES All dogs underwent testing for parvovirus infection, were given maropitant citrate to control emesis, and were offered an OES. Intravenous crystalloid fluid administration was performed when dogs refused the OES or had vomiting, a 5% increase in PCV, 5% decrease in body weight, serum creatinine or BUN concentration higher than at admission, or clinically important alterations in blood electrolyte or serum glucose concentrations. RESULTS 13 (65%) dogs voluntarily consumed the OES; 7 (35%) dogs refused the OES and received a balanced electrolyte solution IV instead. All 13 dogs in the OES group consumed the solution ≤ 5 hours after hospital admission. Eight and 16 hours after admission, PCV and serum total protein and BUN concentrations were significantly lower than at hospital admission in the OES group, whereas no significant changes were identified in venous blood pH, base excess, and concentrations of sodium, potassium, chloride, ionized calcium, ionized magnesium, and lactate. The cost of treatment was significantly less for the OES group than for the IV treated group. CONCLUSIONS AND CLINICAL RELEVANCE Rehydration therapy with an OES was effective and safe in dogs with mild to moderate dehydration associated with hemorrhagic diarrhea. Potential benefits of this treatment approach for gastroenteritis in dogs, compared with traditional IV fluid administration, include lower owner-related veterinary costs and decreased staff time associated with treatment.
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Affiliation(s)
- Erica L Reineke
- Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Kimura G. Importance of inhibiting sodium-glucose cotransporter and its compelling indication in type 2 diabetes: pathophysiological hypothesis. ACTA ACUST UNITED AC 2016; 10:271-8. [DOI: 10.1016/j.jash.2016.01.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/25/2015] [Accepted: 01/05/2016] [Indexed: 01/07/2023]
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William JH, Danziger J. Magnesium Deficiency and Proton-Pump Inhibitor Use: A Clinical Review. J Clin Pharmacol 2015; 56:660-8. [DOI: 10.1002/jcph.672] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 10/30/2015] [Indexed: 12/11/2022]
Affiliation(s)
| | - John Danziger
- Division of Nephrology; Beth Israel Deaconess Medical Center; Boston MA
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Lo L, Patel D, Townsend AR, Price TJ. Pharmacokinetic and pharmacodynamic evaluation of panitumumab in the treatment of colorectal cancer. Expert Opin Drug Metab Toxicol 2015; 11:1907-24. [PMID: 26572750 DOI: 10.1517/17425255.2015.1112787] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Integration of targeted therapy and additional chemotherapy options has improved median overall survival (OS) in patients with unresectable metastatic colorectal cancer (mCRC). Cetuximab and panitumumab are examples of targeted therapies, specifically against the epidermal growth factor receptor (EGFR). This review focuses on Panitumumab, a fully human IgG2 monoclonal antibody, which inhibits key oncogenic downstream cell signalling pathways. Panitumumab and cetuximab have improved tumour response rate, progression-free survival, and OS in mCRC patients in whom the RAS (Rat Sarcoma) gene is of Wild Type (WT) status. AREAS COVERED The EGFR signalling pathway and preclinical, Phase I and Phase II clinical studies on the pharmacokinetic, pharmacodynamic and safety evaluation of panitumumab are presented. Phase III studies utilising panitumumab in the first, second and third line setting in mCRC are also described. EXPERT OPINION Panitumumab exhibits excellent pharmacokinetics and pharmacodynamics by way of uncomplicated dosing, non-existent drug interactions, minimal infusion reactions and manageable side effects, making it a suitable target for combination treatments. However, innate and acquired resistances are still obstacles. To overcome this, experimented strategies are ongoing, particularly in patients with Her-2 and BRAF gene alterations. Novel biomarkers to improve patient selection and second-generation targeted antibodies are in development.
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Affiliation(s)
- Louisa Lo
- a Department of Medical Oncology , The Queen Elizabeth Hospital , Woodville , 5011 , SA , Australia
| | - Dainik Patel
- a Department of Medical Oncology , The Queen Elizabeth Hospital , Woodville , 5011 , SA , Australia
| | - Amanda R Townsend
- a Department of Medical Oncology , The Queen Elizabeth Hospital , Woodville , 5011 , SA , Australia.,b School of Medicine , University of Adelaide , Adelaide , 5000 , SA , Australia
| | - Timothy J Price
- a Department of Medical Oncology , The Queen Elizabeth Hospital , Woodville , 5011 , SA , Australia.,b School of Medicine , University of Adelaide , Adelaide , 5000 , SA , Australia
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Haider DG, Lindner G, Ahmad SS, Sauter T, Wolzt M, Leichtle AB, Fiedler GM, Exadaktylos AK, Fuhrmann V. Hypermagnesemia is a strong independent risk factor for mortality in critically ill patients: results from a cross-sectional study. Eur J Intern Med 2015; 26:504-7. [PMID: 26049918 DOI: 10.1016/j.ejim.2015.05.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/17/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with electrolyte imbalances or disorders have a high risk of mortality. It is unknown if this finding from sodium or potassium disorders extends to alterations of magnesium levels. METHODS AND PATIENTS In this cross-sectional analysis, all emergency room patients between 2010 and 2011 at the Inselspital Bern, Switzerland, were included. A multivariable logistic regression model was performed to assess the association between magnesium levels and in-hospital mortality up to 28days. RESULTS A total of 22,239 subjects were screened for the study. A total of 5339 patients had plasma magnesium concentrations measured at hospital admission and were included into the analysis. A total of 6.3% of the 352 patients with hypomagnesemia and 36.9% of the 151 patients with hypermagnesemia died. In a multivariate Cox regression model hypermagnesemia (HR 11.6, p<0.001) was a strong independent risk factor for mortality. In these patients diuretic therapy revealed to be protective (HR 0.5, p=0.007). Hypomagnesemia was not associated with mortality (p>0.05). Age was an independent risk factor for mortality (both p<0.001). CONCLUSION The study does demonstrate a possible association between hypermagnesemia measured upon admission in the emergency department, and early in-hospital mortality.
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Affiliation(s)
- Dominik G Haider
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, Bern, 3010, Switzerland.
| | - Gregor Lindner
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, Bern, 3010, Switzerland
| | - Sufian S Ahmad
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, Bern, 3010, Switzerland
| | - Thomas Sauter
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, Bern, 3010, Switzerland
| | - Michael Wolzt
- Department of Clinical Pharmacology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | | | - Georg-Martin Fiedler
- Center of Laboratory Medicine, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, Bern, 3010, Switzerland
| | - Valentin Fuhrmann
- Department of Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Martinistraße 5220246 Hamburg, Germany
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Abstract
The distal convoluted tubule (DCT) is a short nephron segment, interposed between the macula densa and collecting duct. Even though it is short, it plays a key role in regulating extracellular fluid volume and electrolyte homeostasis. DCT cells are rich in mitochondria, and possess the highest density of Na+/K+-ATPase along the nephron, where it is expressed on the highly amplified basolateral membranes. DCT cells are largely water impermeable, and reabsorb sodium and chloride across the apical membrane via electroneurtral pathways. Prominent among this is the thiazide-sensitive sodium chloride cotransporter, target of widely used diuretic drugs. These cells also play a key role in magnesium reabsorption, which occurs predominantly, via a transient receptor potential channel (TRPM6). Human genetic diseases in which DCT function is perturbed have provided critical insights into the physiological role of the DCT, and how transport is regulated. These include Familial Hyperkalemic Hypertension, the salt-wasting diseases Gitelman syndrome and EAST syndrome, and hereditary hypomagnesemias. The DCT is also established as an important target for the hormones angiotensin II and aldosterone; it also appears to respond to sympathetic-nerve stimulation and changes in plasma potassium. Here, we discuss what is currently known about DCT physiology. Early studies that determined transport rates of ions by the DCT are described, as are the channels and transporters expressed along the DCT with the advent of molecular cloning. Regulation of expression and activity of these channels and transporters is also described; particular emphasis is placed on the contribution of genetic forms of DCT dysregulation to our understanding.
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Affiliation(s)
- James A McCormick
- Division of Nephrology & Hypertension, Oregon Health & Science University, & VA Medical Center, Portland, Oregon, United States
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Kladnitsky O, Rozenfeld J, Azulay-Debby H, Efrati E, Zelikovic I. The claudin-16 channel gene is transcriptionally inhibited by 1,25-dihydroxyvitamin D. Exp Physiol 2014; 100:79-94. [PMID: 25557732 DOI: 10.1113/expphysiol.2014.083394] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 10/20/2014] [Indexed: 01/12/2023]
Abstract
NEW FINDINGS What is the central question of this study? In the kidney, the bulk of the filtered Mg(2+) is reabsorbed in the thick ascending limb by paracellular conductance, mediated by the tight junction protein, claudin-16, which is encoded by the gene CLDN16. The role of 1,25-dihydroxyvitamin D [1,25(OH)2 VitD] in renal Mg(2+) handling is unclear. We aimed to explore the molecular mechanisms underlying the effect of 1,25(OH)2 VitD on claudin-16-mediated Mg(2+) transport. What is the main finding and its importance? Paracellular, claudin-16-mediated Mg(2+) transport is transcriptionally repressed by 1,25(OH)2 VitD, probably via a Ca(2+)-sensing receptor-dependent mechanism. This renal effect of 1,25(OH)2 VitD may serve as an adaptive mechanism to the 1,25(OH)2 VitD-induced enteric hyperabsorption of dietary Mg(2+). Magnesium is reabsorbed in the thick ascending limb by paracellular conductance, mediated by the CLDN16-encoded tight junction protein, claudin-16. However, the role of 1,25-dihydroxyvitamin D [1,25(OH)2 VitD] in renal Mg(2+) handling is unclear. We have shown that Mg(2+) depletion increases and 1,25(OH)2 VitD inhibits CLDN16 transcription. We have now explored further the molecular mechanisms underlying the effect of 1,25(OH)2 VitD on claudin-16-mediated Mg(2+) transport. Adult mice received parenteral 1,25(OH)2 VitD or 1,25(OH)2 VitD combined with either high-Mg(2+) or low-Mg(2+) diets. Administration of 1,25(OH)2 VitD enhanced urinary excretion of Mg(2+) and Ca(2+). The 1,25(OH)2 VitD also increased renal Ca(2+)-sensing receptor (CaSR) mRNA and decreased renal claudin-16 and claudin-19 mRNA and claudin-16 protein, but did not affect renal claudin-2 mRNA. The 1,25(OH)2 VitD reversed the expected increase in claudin-16 mRNA in Mg(2+)-depleted animals. Comparably treated HEK 293 cells showed similar changes in claudin-16 mRNA, but 1,25(OH)2 VitD did not alter mRNA of the TRPM6 Mg(2+) channel. A luciferase reporter vector containing 2.5 kb of 5'-flanking DNA sequence from human CLDN16 (hCLDN16) was transfected into HEK 293 and OK cells. The hCLDN16 promoter activity was modestly decreased by 1,25(OH)2 VitD, but markedly inhibited in HEK 293 cells coexpressing CaSR. Coexpression in OK cells of dominant-negative CaSR completely abolished inhibition of hCLDN16 promoter activity by 1,25(OH)2 VitD. The 1,25(OH)2 VitD-induced decrease in hCLDN16 promoter activity was attenuated in Mg(2+)-depleted HEK 293 cells. In conclusion, 1,25(OH)2 VitD transcriptionally inhibits claudin-16 expression by a mechanism sensitive to CaSR and Mg(2+). This renal effect of 1,25(OH)2 VitD may serve as an adaptive response to the 1,25(OH)2 VitD-induced increase in intestinal Mg(2+) absorption.
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Affiliation(s)
- Orly Kladnitsky
- Laboratory of Developmental Nephrology, Department of Physiology and Biophysics, Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Abstract
Magnesium's most important role is in the release of chemical energy. Although most magnesium is stored outside of the extracellular fluid compartment, the regulated value is blood magnesium concentration. Cellular magnesium and bone magnesium do not play a major role in the defense of blood magnesium concentration; the major role is played by the kidney, where the renal tubule matches the urinary magnesium excretion and the net entry of magnesium into the extracellular fluid. In the kidney, magnesium is reabsorbed in the proximal tubule, the thick ascending limb of the loop of Henle, and the distal convoluted tubule. Magnesium absorption is mainly paracellular in the proximal tubule and in the thick ascending limb of the loop of Henle, whereas it is transcellular in the distal convoluted tubule. Several hormones and extracellular magnesium itself alter the distal tubular handling of magnesium, but the hormone(s) regulating extracellular magnesium concentration remains unknown.
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Affiliation(s)
- Pascal Houillier
- Université Paris-Descartes, Sorbonne Paris-Cité, F-75006 Paris, France
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Naljayan M, Kumar S, Steinman T, Reisin E. Hypomagnesemia and hypokalemia: a successful oral therapeutic approach after 16 years of potassium and magnesium intravenous replacement therapy. Clin Kidney J 2014; 7:214-6. [PMID: 25852875 PMCID: PMC4377789 DOI: 10.1093/ckj/sfu014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 02/11/2014] [Indexed: 11/25/2022] Open
Affiliation(s)
- Mihran Naljayan
- Division of Nephrology and Hypertension, Department of Medicine , Louisiana State University Health Sciences Center , New Orleans, LA , USA
| | - Suresh Kumar
- Division of Nephrology and Hypertension , Louisiana State University Health Sciences Center , New Orleans, LA , USA
| | - Theodore Steinman
- Harvard Medical School , Beth Israel Deaconess Medical Center , Boston, MA , USA
| | - Efrain Reisin
- Division of Nephrology and Hypertension , Louisiana State University Health Sciences Center , New Orleans, LA , USA
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Walker J, Shadanbaz S, Woodfield TBF, Staiger MP, Dias GJ. Magnesium biomaterials for orthopedic application: A review from a biological perspective. J Biomed Mater Res B Appl Biomater 2014; 102:1316-31. [DOI: 10.1002/jbm.b.33113] [Citation(s) in RCA: 206] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 11/22/2013] [Accepted: 01/07/2014] [Indexed: 01/01/2023]
Affiliation(s)
- Jemimah Walker
- Department of Anatomy and Structural Biology; University of Otago; Dunedin New Zealand
| | - Shaylin Shadanbaz
- Department of Anatomy and Structural Biology; University of Otago; Dunedin New Zealand
| | | | - Mark P. Staiger
- Department of Mechanical Engineering; University of Canterbury; Christchurch New Zealand
| | - George J. Dias
- Department of Anatomy and Structural Biology; University of Otago; Dunedin New Zealand
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Sharma P, Chung C, Vizcaychipi M. Magnesium: The Neglected Electrolyte? A Clinical Review. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/pp.2014.57086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lainez S, Schlingmann KP, van der Wijst J, Dworniczak B, van Zeeland F, Konrad M, Bindels RJ, Hoenderop JG. New TRPM6 missense mutations linked to hypomagnesemia with secondary hypocalcemia. Eur J Hum Genet 2013; 22:497-504. [PMID: 23942199 DOI: 10.1038/ejhg.2013.178] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 06/20/2013] [Accepted: 07/11/2013] [Indexed: 11/09/2022] Open
Abstract
Despite recent progress in our understanding of renal magnesium (Mg(2+)) handling, the molecular mechanisms accounting for transepithelial Mg(2+) transport are still poorly understood. Mutations in the TRPM6 gene, encoding the epithelial Mg(2+) channel TRPM6 (transient receptor potential melastatin 6), have been proven to be the molecular cause of hypomagnesemia with secondary hypocalcemia (HSH; OMIM 602014). HSH manifests in the newborn period being characterized by very low serum Mg(2+) levels (<0.4 mmol/l) accompanied by low serum calcium (Ca(2+)) concentrations. A proportion of previously described TRPM6 mutations lead to a truncated TRPM6 protein resulting in a complete loss-of-function of the ion channel. In addition, five-point mutations have been previously described. The aim of this study was to complement the current clinical picture by adding the molecular data from five new missense mutations found in five patients with HSH. To this end, patch-clamp analysis and cell surface measurements were performed to assess the effect of the various mutations on TRPM6 channel function. All mutant channels, expressed in HEK293 cells, showed loss-of-function, whereas no severe trafficking impairment to the plasma membrane surface was observed. We conclude that the new TRPM6 missense mutations lead to dysregulated intestinal/renal Mg(2+) (re)absorption as a consequence of loss of TRPM6 channel function.
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Affiliation(s)
- Sergio Lainez
- 1] Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Molecular Life Sciences, Nijmegen, The Netherlands [2] Department of Pharmacology, University of Cambridge, Cambridge, UK
| | | | - Jenny van der Wijst
- MRC Protein Phosphorylation Unit, College of Life Sciences, University of Dundee, Dundee, Scotland, UK
| | - Bernd Dworniczak
- Department of Human Genetics, Westfaelische Wilhelms Universität, Münster, Germany
| | - Femke van Zeeland
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Martin Konrad
- Department of General Pediatrics, University Hospital Münster, Münster, Germany
| | - René J Bindels
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Molecular Life Sciences, Nijmegen, The Netherlands
| | - Joost G Hoenderop
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen Centre for Molecular Life Sciences, Nijmegen, The Netherlands
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Disorders of calcium and magnesium balance: a physiology-based approach. Pediatr Nephrol 2013; 28:1195-206. [PMID: 23142866 DOI: 10.1007/s00467-012-2350-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Revised: 10/02/2012] [Accepted: 10/08/2012] [Indexed: 01/20/2023]
Abstract
Disorders of calcium and magnesium balance are physiologically interesting and clinically challenging. In this review, we attempt to bridge the gap between physiology and practice by providing a physiology-based approach to understanding hypocalcemia, hypercalcemia and hypomagnesemia. Calcium and, to a lesser extent, magnesium balance is achieved through a complex interplay between the parathyroid gland, bone, the intestine and the kidney. Our understanding of the molecular physiology of calcium and magnesium balance has grown considerably following the discovery of the calcium-sensing receptor (CaSR) and the main intestinal and renal transporters for calcium and magnesium, namely, the transient receptor potential channels TRPV5, TRPV6 and TRPM6. The regulation of parathyroid hormone (PTH) secretion by CaSR and the subsequent effects of PTH and vitamin D on TRPV5 constitute an increasingly characterized regulatory loop. In contrast, no truly magnesiotropic hormones have been identified, although the recently established interactions between the epidermal growth factor and TRPM6 suggest a possible candidate. Overall, the aim of this review is to illustrate the clinical disorders of calcium and magnesium balance from the perspective of their integrated physiology.
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Kim N, Cheema-Dhadli S, Hare GMT, Chong CK, Halperin ML, Kamel KS, Mazer CD. Non-natriuretic doses of furosemide: potential use for decreasing the workload of the renal outer medulla with minimal magnesium wasting in the rat. Nephron Clin Pract 2013; 122:7-12. [PMID: 23548701 DOI: 10.1159/000346741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 12/21/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Since furosemide (FS) inhibits active Na(+) reabsorption by medullary thick ascending limb (mTAL) in the renal outer medulla, it may decrease its work during periods of low O2 supply to deep in the renal outer medulla. This study was designed to demonstrate that there may be a dose of FS would reduce its metabolic work while preventing the excessive loss of magnesium (Mg(2+)). Mg(2+) is important because the ATP needed to perform work must have bound Mg(2+) to it. METHODS Rats were injected intraperitoneally with a range of doses of FS. The measured outcomes were urine flow rate and parameters of functions of the mTAL (i.e. urine and renal papillary osmolality and urinary excretion of Na(+), Cl(-), K(+) and Mg(2+), and concentrations of Mg(2+) in serum). RESULTS The urine flow rate increased significantly starting at 2.4 mg FS/kg. The renal papillary osmolality decreased at ≥0.4 mg FS/kg, and the large detectable natriuresis started at 1.6 mg FS/kg. At this latter dose, the urinary excretion of Mg(2+) rose significantly. CONCLUSION In rats, the non-natriuretic dose of FS may reduce the work of the mTAL. The earliest indicator of reduced work in the mTAL appears to be a decrease in urine osmolality rather than a rise in urine flow rate. Higher doses of FS should be avoided, as they induce high rates of Mg(2+) excretion, which can deplete the body of this essential electrolyte.
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Affiliation(s)
- Namhee Kim
- Department of Anesthesia, Division of Nephrology, University of Toronto, St. Michael's Hospital, Keenan Research Centre in the Li Ka Shing Knowledge Institute, Toronto, Ont., Canada
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Florentin M, Elisaf MS. Proton pump inhibitor-induced hypomagnesemia: A new challenge. World J Nephrol 2012; 1:151-4. [PMID: 24175253 PMCID: PMC3782221 DOI: 10.5527/wjn.v1.i6.151] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Revised: 05/27/2012] [Accepted: 09/25/2012] [Indexed: 02/06/2023] Open
Abstract
Proton pump inhibitors (PPIs) are commonly used in clinical practice for the prevention and treatment of peptic ulcer, gastritis, esophagitis and gastroesophageal reflux. Hypomagnesemia has recently been recognized as a side effect of PPIs. Low magnesium levels may cause symptoms from several systems, some of which being potentially serious, such as tetany, seizures and arrhythmias. It seems that PPIs affect the gastrointestinal absorption of magnesium. Clinicians should be vigilant in order to timely consider and prevent or reverse hypomagnesemia in patients who take PPIs, especially if they are prone to this electrolyte disorder.
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Affiliation(s)
- Matilda Florentin
- Matilda Florentin, Moses S Elisaf, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina 45110, Greece
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50
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Gómez-García I, Stuiver M, Ereño J, Oyenarte I, Corral-Rodríguez MA, Müller D, Martínez-Cruz LA. Purification, crystallization and preliminary crystallographic analysis of the CBS-domain pair of cyclin M2 (CNNM2). Acta Crystallogr Sect F Struct Biol Cryst Commun 2012; 68:1198-203. [PMID: 23027747 PMCID: PMC3497979 DOI: 10.1107/s1744309112035348] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 08/09/2012] [Indexed: 05/13/2024]
Abstract
This work describes the purification and preliminary crystallographic analysis of the CBS-domain pair of the murine CNNM2 magnesium transporter (formerly known as ancient domain protein 2; ACDP2), which consists of a pair of cystathionine β-synthase (CBS) motifs and has 100% sequence identity to its human homologue. CNNM proteins represent the least-studied members of the eight different types of magnesium transporters identified to date in mammals. In humans, the CNNM family is encoded by four genes: CNNM1-4. CNNM1 acts as a cytosolic copper chaperone, whereas CNNM2 and CNNM4 have been associated with magnesium handling. Interestingly, mutations in the CNNM2 gene cause familial dominant hypomagnesaemia (MIM:607803), a rare human disorder characterized by renal and intestinal magnesium (Mg(2+)) wasting, which may lead to symptoms of Mg(2+) depletion such as tetany, seizures and cardiac arrhythmias. This manuscript describes the preliminary crystallographic analysis of two different crystal habits of a truncated form of the protein containing its regulatory CBS-domain pair, which has been reported to host the pathological mutation T568I in humans. The crystals belonged to space groups P2(1)2(1)2 and I222 (or I2(1)2(1)2(1)) and diffracted X-rays to 2.0 and 3.6 Å resolution, respectively, using synchrotron radiation.
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Affiliation(s)
- Inmaculada Gómez-García
- Structural Biology Unit, CIC bioGUNE, Parque Tecnológico de Bizkaia, Edificio 800, 48160 Derio, Bizkaia, Spain
| | - Marchel Stuiver
- Department of Pediatric Nephrology, Charité Universitätsmedizin, 13353 Berlin, Germany
| | - June Ereño
- Structural Biology Unit, CIC bioGUNE, Parque Tecnológico de Bizkaia, Edificio 800, 48160 Derio, Bizkaia, Spain
| | - Iker Oyenarte
- Structural Biology Unit, CIC bioGUNE, Parque Tecnológico de Bizkaia, Edificio 800, 48160 Derio, Bizkaia, Spain
| | | | - Dominik Müller
- Department of Pediatric Nephrology, Charité Universitätsmedizin, 13353 Berlin, Germany
| | - Luis Alfonso Martínez-Cruz
- Structural Biology Unit, CIC bioGUNE, Parque Tecnológico de Bizkaia, Edificio 800, 48160 Derio, Bizkaia, Spain
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