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Koffas S, Pantelis AG, Lapatsanis DP. Hypocalcemia in the Immediate Postoperative Period Following Metabolic Bariatric Surgery - Hype or Harm? Obes Surg 2024; 34:2530-2536. [PMID: 38833132 DOI: 10.1007/s11695-024-07312-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 05/19/2024] [Accepted: 05/23/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Hypocalcemia post-metabolic bariatric surgery (MBS) is a known long-term complication after hypoabsorptive procedures. However, data on immediate postoperative calcium are limited. Our aim was to evaluate the prevalence of hypocalcemia on the 1st postoperative day after MBS and correlate it with potential associated factors. MATERIALS AND METHODS We analyzed data from all consecutive index MBS over 1 year. We collected data on demographics and on preoperative and postoperative values of serum calcium (TC), albumin, adjusted calcium (AC-Payne formula), magnesium, phosphorus, preoperative vitamin-D, and postoperative 24-h urine output, intravenous fluids (IVF), bolus intravenous furosemide, and creatine phosphokinase (CPK). Continuous data are expressed as means ± SD (range). Categorical data are presented as frequencies (%). Linear regression was implemented to designate potential correlations. RESULTS The cohort included 86 patients (58.1% females). The mean preoperative TC was 9.4mg/dL ± 0.4 (8.5-10.5) and mean postoperative TC 7.8mg/dL ± 0.6 (6.3-9.3, 17.0% decrease). The mean preoperative AC was 10.1mg/dL ± 0.4 (9.2-11.2) and mean postoperative AC 8.5mg/dL ± 0.6 (7.0-10.0, 15.8% decrease). Seventy-three patients (84.8%) had abnormally low TC (< 8.5mg/dL), and 43 (50%) abnormally low AC. There was only weak correlation between postoperative TC and AC with magnesium (r = 0.258), phosphorus (r = 0.269), vitamin-D (-0.163), 24-h urine output (r = -0.168), IVF (r = -0.237), bolus furosemide (r = 0.155), and mean operative time (r = 0.010). CONCLUSIONS In our cohort of patients, hypocalcemia was a real problem but we did not find any significant correlation with the examined factors. Further studies are warranted to validate our findings and investigate other potential correlations.
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Affiliation(s)
- Stefanos Koffas
- 4th Department of General Surgery, Evaggelismos General Hospital of Athens, Ipsilantou 45-47, 106 76, Athens, Greece
| | - Athanasios G Pantelis
- Obesity and Metabolic Disorders Surgical Department, Athens Medical Group Psychiko Clinic, 1 Andersen Str., 115 25, Athens, Greece.
| | - Dimitris P Lapatsanis
- Obesity and Metabolic Disorders Surgical Department, Athens Medical Group Psychiko Clinic, 1 Andersen Str., 115 25, Athens, Greece
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2
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Li X, He W, Song Q, Ding Q, Zhang X, Zeng Z, Deng W, Deng G, Guan L, Hong W, Liu Y, Shu F, Xu L, Tan N, Ma J, Jiang L. The Prognostic Value of Serum Calcium Levels in Elderly Dilated Cardiomyopathy Patients. Glob Heart 2024; 19:25. [PMID: 38434155 PMCID: PMC10906334 DOI: 10.5334/gh.1304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/05/2024] [Indexed: 03/05/2024] Open
Abstract
Background It is unclear whether serum calcium on admission is associated with clinical outcomes in dilated cardiomyopathy (DCM). In this study, we conducted a retrospective study spanning a decade to investigate the prognostic value of baseline calcium in elderly patients with DCM. Methods A total of 1,089 consecutive elderly patients (age ≥60 years) diagnosed with DCM were retrospectively enrolled from January 2010 to December 2019. Univariate and multivariate analyses were performed to investigate the association of serum calcium with their clinical outcomes. Results In this study, the average age of the subjects was 68.36 ± 6.31 years. Receiver operating characteristic (ROC) curve analysis showed that serum calcium level had a great sensitivity and specificity for predicting in-hospital death, with an AUC of 0.732. Kaplan-Meier survival analysis showed that patients with a serum calcium >8.62 mg/dL had a better prognosis than those with a serum calcium ≤8.62 mg/dL (log-rank χ2 40.84, p < 0.001). After adjusting for several common risk factors, a serum calcium ≤8.62 mg/dL was related to a higher risk of long-term mortality (HR: 1.449; 95% CI: 1.115~1.882; p = 0.005). Conclusions Serum calcium level could be served as a simple and affordable tool to evaluate patients' prognosis in DCM.
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Affiliation(s)
- Xinyi Li
- School of Medicine, South China University of Technology, Guangzhou 510006, China
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Wenfei He
- Department of Cardiology, Guangdong Provincial People’s Hospital’s Nanhai Hospital, The Second People’s Hospital of Nanhai District, Foshan 528000, China
| | - Qiqi Song
- School of Medicine, South China University of Technology, Guangzhou 510006, China
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Qingshan Ding
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Xiaonan Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Zhigang Zeng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Weiping Deng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Gang Deng
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Lichang Guan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Wanzi Hong
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Yaoxin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Fen Shu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Lishu Xu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
| | - Jinjin Ma
- School of Medicine, South China University of Technology, Guangzhou 510006, China
| | - Lei Jiang
- School of Medicine, South China University of Technology, Guangzhou 510006, China
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, China
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3
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Ebeling PR, Nguyen HH, Aleksova J, Vincent AJ, Wong P, Milat F. Secondary Osteoporosis. Endocr Rev 2022; 43:240-313. [PMID: 34476488 DOI: 10.1210/endrev/bnab028] [Citation(s) in RCA: 100] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Indexed: 02/07/2023]
Abstract
Osteoporosis is a global public health problem, with fractures contributing to significant morbidity and mortality. Although postmenopausal osteoporosis is most common, up to 30% of postmenopausal women, > 50% of premenopausal women, and between 50% and 80% of men have secondary osteoporosis. Exclusion of secondary causes is important, as treatment of such patients often commences by treating the underlying condition. These are varied but often neglected, ranging from endocrine to chronic inflammatory and genetic conditions. General screening is recommended for all patients with osteoporosis, with advanced investigations reserved for premenopausal women and men aged < 50 years, for older patients in whom classical risk factors for osteoporosis are absent, and for all patients with the lowest bone mass (Z-score ≤ -2). The response of secondary osteoporosis to conventional anti-osteoporosis therapy may be inadequate if the underlying condition is unrecognized and untreated. Bone densitometry, using dual-energy x-ray absorptiometry, may underestimate fracture risk in some chronic diseases, including glucocorticoid-induced osteoporosis, type 2 diabetes, and obesity, and may overestimate fracture risk in others (eg, Turner syndrome). FRAX and trabecular bone score may provide additional information regarding fracture risk in secondary osteoporosis, but their use is limited to adults aged ≥ 40 years and ≥ 50 years, respectively. In addition, FRAX requires adjustment in some chronic conditions, such as glucocorticoid use, type 2 diabetes, and HIV. In most conditions, evidence for antiresorptive or anabolic therapy is limited to increases in bone mass. Current osteoporosis management guidelines also neglect secondary osteoporosis and these existing evidence gaps are discussed.
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Affiliation(s)
- Peter R Ebeling
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia
| | - Hanh H Nguyen
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Department of Endocrinology and Diabetes, Western Health, Victoria 3011, Australia
| | - Jasna Aleksova
- Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Amanda J Vincent
- Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria 3168, Australia
| | - Phillip Wong
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
| | - Frances Milat
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria 3168, Australia.,Department of Endocrinology, Monash Health, Clayton, Victoria 3168, Australia.,Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia
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4
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Nazer LH, Brown ART, Awad W. Iatrogenic Toxicities in the Intensive Care Unit. Crit Care Clin 2021; 37:625-641. [PMID: 34053710 DOI: 10.1016/j.ccc.2021.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Drug-induced iatrogenic toxicities are common in critically ill patients and have been associated with increased morbidity and mortality. Early recognition and management of iatrogenic toxicities is essential; however, the diagnosis is usually complicated by the underlying critical illness, comorbidities, and administration of multiple medications. This article reviews several types of iatrogenic toxicities associated with medications that are commonly used in critically ill patients. The mechanism of the iatrogenic toxicities, clinical presentation, and diagnosis, as well as management are discussed.
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Affiliation(s)
- Lama H Nazer
- King Hussein Cancer Center, Queen Rania Al-Abdallah Street, PO Box 1269, Amman 11941, Jordan.
| | - Anne Rain T Brown
- University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Wedad Awad
- King Hussein Cancer Center, Queen Rania Al-Abdallah Street, PO Box 1269, Amman 11941, Jordan
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5
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Hypercalcemia induced pancreatitis as a rare presentation of primary hyperparathyroidism. Acta Gastroenterol Belg 2021; 84:367-370. [PMID: 34217190 DOI: 10.51821/84.2.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Acute pancreatitis (AP) is an inflammatory process of the pancreas. It is a relatively common cause of acute upper abdominal pain and is potentially associated with high morbidity and mortality. Underlying hypercalcemia as a cause of AP is very rare. We present a case of a hypercalcemia-induced acute pancreatitis with an underlying parathyroid adenoma in an 81-year-old woman with no previous symptoms of hypercalcemia. The parathyroid adenoma was semi-urgently surgically resected with normalization of calcium-levels. This case report summarizes the causes of acute pancreatitis and hypercalcemia and its management.
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6
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Schmitz T, Thilo C, Linseisen J, Heier M, Peters A, Kuch B, Meisinger C. Low serum calcium is associated with higher long-term mortality in myocardial infarction patients from a population-based registry. Sci Rep 2021; 11:2476. [PMID: 33510279 PMCID: PMC7843683 DOI: 10.1038/s41598-021-81929-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/11/2021] [Indexed: 01/29/2023] Open
Abstract
Calcium plays an essential role in physiology of the cardiovascular system. Aberrations from normal serum calcium levels are known to be associated with several cardiovascular diseases. Its possible role as a predictor for long-term mortality after acute myocardial infarction (AMI) is still uncertain. In this study, a total of 3732 patients (aged 25–74 years) with incident AMI surviving at least 28 days after AMI was included. The median follow-up time was 6.0 years. Admission total serum calcium levels were divided into quartiles. The Kaplan–Meier-Curve suggested a division of the follow up time in two different time periods. So, Cox regression models were calculated to assess association between admission serum calcium levels and all-cause long-term mortality with two observation periods: 28–2500 days and > 2500 days. The final model was adjusted for various comorbidities, clinical characteristics, in-hospital treatment and medication. The third quartile (normal-high Calcium levels) served as the reference group. The fully adjusted Cox-regression model shows significantly higher mortality risk for low serum calcium (quartile 1) within the timeframe 28–2500 days after the event (OR 1.53 [1.19–1.98]). The other groups did not differ significantly from each other. In the later observation period (from 2500 days until death or censoring) no more significant differences were seen between the four calcium quartiles. In summary, low serum calcium is an independent predictor of adverse outcome in the first 2500 days (about 7 years) after AMI. On later points in time this effect attenuates, so that no more significant differences can be observed.
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Affiliation(s)
- Timo Schmitz
- MONIKA/KORA Myocardial Infarction Registry, University Hospital of Augsburg, Augsburg, Germany. .,LMU München at UNIKA-T Augsburg, Augsburg, Germany.
| | - Christian Thilo
- Department of Cardiology, University Hospital of Augsburg, Augsburg, Germany
| | - Jakob Linseisen
- LMU München at UNIKA-T Augsburg, Augsburg, Germany.,IRG Clinical Epidemiology, Helmholtz Zentrum München, Oberschleißheim, Germany
| | - Margit Heier
- KORA Study Centre, University Hospital of Augsburg, Augsburg, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, Oberschleißheim, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, Oberschleißheim, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Bernhard Kuch
- Department of Internal Medicine, Hospital Nördlingen, Nördlingen, Germany
| | - Christa Meisinger
- LMU München at UNIKA-T Augsburg, Augsburg, Germany.,IRG Clinical Epidemiology, Helmholtz Zentrum München, Oberschleißheim, Germany
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7
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Runova GE, Golounina OO, Glinkina IV, Sych YP, Fadeev VV. [Differential diagnosis of normocalcemic hyperparathyroidism and idiopathic hypercalciuria on the example of clinical case]. PROBLEMY ENDOKRINOLOGII 2020; 66:13-17. [PMID: 33481363 DOI: 10.14341/probl12677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
Idiopathic hypercalciuria is a heterogeneous generalized disorder caused by various defects in calcium transport and increased urinary calcium excretion. The main etiopathogenetic factors are violations of vitamin D metabolism, changes in the sensitivity of calcitriol receptors and violations of the processes of calcium reabsorption in the proximal tubules and in the ascending knee of the Henle loop. This article presents a clinical observation of patient with idiopathic hypercalciuria, initially high levels of parathyroid hormone (PTH) in the absence of hyperparathyroidism. Therapy with thiazide diuretics allowed to achieve normalization of daily urinary calcium excretion and reducing PTH. Despite the low prevalence of idiopathic hypercalciuria, differential diagnosis of this metabolic disorder should be carried out with mandatory consideration of clinical and laboratory data, as well as with diseases that may cause increased PTH production.
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Affiliation(s)
- G E Runova
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - O O Golounina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - I V Glinkina
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - Yu P Sych
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
| | - V V Fadeev
- I.M. Sechenov First Moscow State Medical University (Sechenov University)
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8
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Abstract
Parathyroid independent hypercalcemia is characterized by suppressed parathyroid hormone (PTH) in the presence of hypercalcemia. Well known causes and mechanisms are redistribution of calcium from the skeleton, by malignant diseases; inadequately increased intestinal calcium uptake mediated by increased vitamin D activity, and reduced renal elimination due to medications. Frequent and infrequent causes are discussed, and more recent mechanistic models presented in this review. Most hypercalcemic conditions are stable and in equilibrium between the different organs, whereas the utmost severe cases are characterized by rapid rising calcium levels and renal failure, resulting in a vicious circle where a disequilibrium state is developed. Management and treatment depends on the underlying condition and severity. The aim of this review is to discuss non-parathyroid hypercalcemic conditions as seen in the modern clinic, with a focus on areas where recent gain of knowledge has been achieved.
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Affiliation(s)
- Jens Bollerslev
- Section of Specialized Endocrinology, Division of Medicine, Oslo University Hospital, Norway; Faculty of Medicine, University in Oslo, Oslo, Norway.
| | - Mikkel Pretorius
- Section of Specialized Endocrinology, Division of Medicine, Oslo University Hospital, Norway; Faculty of Medicine, University in Oslo, Oslo, Norway
| | - Ansgar Heck
- Section of Specialized Endocrinology, Division of Medicine, Oslo University Hospital, Norway; Faculty of Medicine, University in Oslo, Oslo, Norway
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9
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Risk of cardiovascular mortality predicted by the serum calcium level and calcification score at the initiation of dialysis. Clin Exp Nephrol 2018; 22:957-966. [PMID: 29302867 DOI: 10.1007/s10157-017-1527-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/22/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The relationship between serum corrected calcium (CCa) level and vessel calcification at dialysis initiation and survival has seldom been evaluated. Therefore, we evaluated the efficacy of CCa levels and the calcification score at the initiation of dialysis for predicting all-cause and cardiovascular (CV) mortality in patients with end-stage renal disease (ESRD). METHODS The study group included 407 patients with ESRD, who started hemodialysis between January 2009 and December 2016 at the Red Cross Ishinomaki Hospital. The primary outcomes were the 1- and 3-year all-cause and CV mortality rate, with the association between CCa level and CVD-specific mortality evaluated using the Kaplan-Meier method and Cox proportional hazard regression analysis. RESULTS Patients with a high initial CCa level were at higher risk for CVD-related, but not all-cause, mortality than patients with a low initial CCa level [hazard ratio (HR) 2.81; 95% confidence interval 1.05-7.55]. The HR for CVD-related mortality was also higher for patients with an Agatston vessel calcification score > 2000 (HR 13.9; 95% CI 1.63-118.2). Overall, the 3-year CVD-free rate was 88.2% (range 76.4-94.3%). Higher CCa level was associated with a higher Agatston score and cardiac valve calcification. CONCLUSION High serum CCa levels and an Agatston score > 2000 are independent risk factors of CVD mortality due to advanced vessel calcification.
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10
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Sandal S, Bansal P, Cantarovich M. The evidence and rationale for the perioperative use of loop diuretics during kidney transplantation: A comprehensive review. Transplant Rev (Orlando) 2017; 32:92-101. [PMID: 29242033 DOI: 10.1016/j.trre.2017.11.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/08/2017] [Accepted: 11/14/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE Loop diuretics (LD) attenuate ischemic injury in nephrons. They are thought to decrease delayed graft function (DGF) during kidney transplantation (KT). This review aimed to summarize the current evidence for the perioperative use of LD during KT. METHODS We performed an analysis of all articles that were published since the inception of Medline and Embase: 26 studies were selected for inclusion. Scope was LD use during the perioperative phase of KT only. RESULTS Six animal studies demonstrated mixed results in terms of renal function and survival. Of the 20 studies performed in humans, 4 were randomized clinical trials. The risk of bias was mostly unclear. Evidence supporting the role of LD to increase diuresis was mixed and to prevent DGF was weak. There was poor evidence to support LD use to improve initial and long-term graft function. No data on patient survival could be found. Overall, there was a lack of any robust clinical evidence for LD use perioperatively during KT. IMPLICATIONS There is poor evidence to support the perioperative use of LD during KT. Well-designed trials are needed to further explore their safety and efficacy, and we summarize several rationales. Pragmatic rationales include volume management. There is evidence to suggest that LD have a vasodilatory effect, and decrease edema, congestion and oxygen requirements. Lastly, there are several theoretical rationales to explore LD use during KT, in particular, attenuating ischemia-reperfusion injury and modulating autophagy.
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Affiliation(s)
- Shaifali Sandal
- Division of Nephrology and Multi-Organ Transplant Program, McGill University Health Centre, 1001 boul. Decarie, Montreal, QC, Canada. H4A 3J1.
| | - Pannya Bansal
- Michigan State University College of Osteopathic Medicine, East Fee Hall, 965 Fee Rd, East Lansing, MI 48825, USA
| | - Marcelo Cantarovich
- Division of Nephrology and Multi-Organ Transplant Program, McGill University Health Centre, 1001 boul. Decarie, Montreal, QC, Canada. H4A 3J1
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11
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Selvaraj S, Oh JH, Spanel R, Länger F, Han HY, Lee EH, Yoon S, Borlak J. The pathogenesis of diclofenac induced immunoallergic hepatitis in a canine model of liver injury. Oncotarget 2017; 8:107763-107824. [PMID: 29296203 PMCID: PMC5746105 DOI: 10.18632/oncotarget.21201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/31/2017] [Indexed: 12/19/2022] Open
Abstract
Hypersensitivity to non-steroidal anti-inflammatory drugs is a common adverse drug reaction and may result in serious inflammatory reactions of the liver. To investigate mechanism of immunoallergic hepatitis beagle dogs were given 1 or 3 mg/kg/day (HD) oral diclofenac for 28 days. HD diclofenac treatment caused liver function test abnormalities, reduced haematocrit and haemoglobin but induced reticulocyte, WBC, platelet, neutrophil and eosinophil counts. Histopathology evidenced hepatic steatosis and glycogen depletion, apoptosis, acute lobular hepatitis, granulomas and mastocytosis. Whole genome scans revealed 663 significantly regulated genes of which 82, 47 and 25 code for stress, immune response and inflammation. Immunopathology confirmed strong induction of IgM, the complement factors C3&B, SAA, SERPING1 and others of the classical and alternate pathway. Alike, marked expression of CD205 and CD74 in Kupffer cells and lymphocytes facilitate antigen presentation and B-cell differentiation. The highly induced HIF1A and KLF6 protein expression in mast cells and macrophages sustain inflammation. Furthermore, immunogenomics discovered 24, 17, 6 and 11 significantly regulated marker genes to hallmark M1/M2 polarized macrophages, lymphocytic and granulocytic infiltrates; note, the latter was confirmed by CAE staining. Other highly regulated genes included alpha-2-macroglobulin, CRP, hepcidin, IL1R1, S100A8 and CCL20. Diclofenac treatment caused unprecedented induction of myeloperoxidase in macrophages and oxidative stress as shown by SOD1/SOD2 immunohistochemistry. Lastly, bioinformatics defined molecular circuits of inflammation and consisted of 161 regulated genes. Altogether, the mechanism of diclofenac induced liver hypersensitivity reactions involved oxidative stress, macrophage polarization, mastocytosis, complement activation and an erroneous programming of the innate and adaptive immune system.
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Affiliation(s)
- Saravanakumar Selvaraj
- Centre for Pharmacology and Toxicology, Hannover Medical School, 30625 Hannover, Germany
| | - Jung-Hwa Oh
- Department of Predictive Toxicology, Korea Institute of Toxicology, 34114 Gajeong-ro, Yuseong, Daejeon, Republic of Korea
| | - Reinhard Spanel
- Centre for Pharmacology and Toxicology, Hannover Medical School, 30625 Hannover, Germany.,Institute of Pathology, 41747 Viersen, Germany
| | - Florian Länger
- Institute of Pathology, Hannover Medical School, 30625 Hannover, Germany
| | - Hyoung-Yun Han
- Department of Predictive Toxicology, Korea Institute of Toxicology, 34114 Gajeong-ro, Yuseong, Daejeon, Republic of Korea
| | - Eun-Hee Lee
- Department of Predictive Toxicology, Korea Institute of Toxicology, 34114 Gajeong-ro, Yuseong, Daejeon, Republic of Korea
| | - Seokjoo Yoon
- Department of Predictive Toxicology, Korea Institute of Toxicology, 34114 Gajeong-ro, Yuseong, Daejeon, Republic of Korea
| | - Jürgen Borlak
- Centre for Pharmacology and Toxicology, Hannover Medical School, 30625 Hannover, Germany
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12
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Gandhi SS, Muraresku C, McCormick EM, Falk MJ, McCormack SE. Risk factors for poor bone health in primary mitochondrial disease. J Inherit Metab Dis 2017; 40:673-683. [PMID: 28451918 PMCID: PMC5659975 DOI: 10.1007/s10545-017-0046-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/21/2017] [Accepted: 04/04/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Primary mitochondrial disease is caused by either mitochondrial or nuclear DNA mutations that impact the function of the mitochondrial respiratory chain. Individuals with mitochondrial disorders have comorbid conditions that may increase their risk for poor bone health. The objective of this retrospective electronic medical record (EMR) review was to examine risk factors for poor bone health in children and adults with primary mitochondrial disease. METHODS Eighty individuals with confirmed clinical and genetic diagnoses of primary mitochondrial disease at the Children's Hospital of Philadelphia (CHOP) were included in this study. Risk factors and bone health outcomes were collected systematically, including: anthropometrics (low BMI), risk-conferring co-morbidities and medications, vitamin D status, nutrition, immobility, fracture history, and, where available, dual energy x-ray absorptiometry (DXA) bone mineral density (BMD) results. RESULTS Of patients 73% (n = 58) had at least one risk factor and 30% (n = 24) had four or more risk factors for poor bone health. The median number of risk factors per participant was 2, with an interquartile interval (IQI 0-4). In the subset of the cohort who were known to have sustained any lifetime fracture (n = 11), a total of 16 fractures were reported, six of which were fragility fractures, indicative of a clinically significant decrease in bone strength. CONCLUSIONS The prevalence of risk factors for poor bone health in primary mitochondrial disease is high. As part of supportive care, practitioners should address modifiable risk factors to optimize bone health, and have a low threshold to evaluate clinical symptoms that could suggest occult fragility fracture.
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Affiliation(s)
- Shifa S Gandhi
- Robert Wood Johnson Medical School, Piscataway Township, NJ, USA
| | - Colleen Muraresku
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth M McCormick
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Marni J Falk
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Shana E McCormack
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Suite 11NW, Philadelphia, PA, 19104, USA.
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13
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Ballhausen BD, Wehner A, Zöllner M, Hartmann K, Unterer S. [Diagnostic approach and management of hypercalcaemia in dogs exemplary of primary hyperparathyroidism]. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2017; 45:122-133. [PMID: 28352923 DOI: 10.15654/tpk-160923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/22/2017] [Indexed: 06/06/2023]
Abstract
Hypercalcaemia can be caused by many different diseases. This article summarizes the causes, pathophysiologic mechanisms and diagnostic procedures as well as treatment recommendations. The main focus is on hypercalcaemia in primary hyperparathyroidism (PH), complemented by a case report. An elevated total calcium level should generally be investigated and verified by measurement of ionized calcium concentration. The further diagnostic approach depends on the phosphate level. Tumour screening, measurement of parathormone and parathromone-related protein and sonography of parathyroid glands may be necessary. If the calcium-phosphate-product exceeds 60 mg/dl, there is a risk of tissue mineralisation and a rapid treatment of hypercalcaemia is required. For acute therapy, sodium chloride infusion, furosemide and glucocorticoids can be used. Glucocorticoids should only be given after strict indication and after a definite diagnosis. For long-term management, bisphosphates, particularly alendronate, are increasingly used successfully. Causal therapy of PH can be performed by parathyreoidectomy, heat ablation or ethanol ablation. Thereafter, particularly in cases of severe preoperative hypercalcaemia, hypocalcaemia can occur. Treatment is performed using vitamin D3 (calcitriol), which may also be given preoperatively in cases of severe hypercalcaemia. A concomitant oral calcium supplementation using calcium carbonate as medication of choice is contentious. Due to a potential relapse after successful excision of the affected parathyroid gland in PH, the serum calcium level should be monitored periodically.
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Affiliation(s)
- B Désirée Ballhausen
- Dr. B. Désirée Ballhausen, Tierärztliche Fachklinik für Kleintiere, Keferloher Straße 25, 85540 Haar, E-Mail:
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14
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Tsvetov G, Hirsch D, Shimon I, Benbassat C, Masri-Iraqi H, Gorshtein A, Herzberg D, Shochat T, Shraga-Slutzky I, Diker-Cohen T. Thiazide Treatment in Primary Hyperparathyroidism-A New Indication for an Old Medication? J Clin Endocrinol Metab 2017; 102:1270-1276. [PMID: 28388724 DOI: 10.1210/jc.2016-2481] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 12/09/2016] [Indexed: 02/13/2023]
Abstract
CONTEXT There is no therapy for control of hypercalciuria in nonoperable patients with primary hyperparathyroidism (PHPT). Thiazides are used for idiopathic hypercalciuria but are avoided in PHPT to prevent exacerbating hypercalcemia. Nevertheless, several reports suggested that thiazides may be safe in patients with PHPT. OBJECTIVE To test the safety and efficacy of thiazides in PHPT. DESIGN Retrospective analysis of medical records. SETTING Endocrine clinic at a tertiary hospital. PATIENTS Fourteen male and 58 female patients with PHPT treated with thiazides. INTERVENTIONS Data were compared for each patient before and after thiazide administration. MAIN OUTCOME MEASURES Effect of thiazide on urine and serum calcium levels. RESULTS Data are given as mean ± standard deviation. Treatment with hydrochlorothiazide 12.5 to 50 mg/d led to a decrease in mean levels of urine calcium (427 ± 174 mg/d to 251 ± 114 mg/d; P < 0.001) and parathyroid hormone (115 ± 57 ng/L to 74 ± 36 ng/L; P < 0.001), with no change in serum calcium level (10.7 ± 0.4 mg/dL off treatment, 10.5 ± 1.2 mg/dL on treatment, P = 0.4). Findings were consistent over all doses, with no difference in the extent of reduction in urine calcium level or change in serum calcium level by thiazide dose. CONCLUSION Thiazides may be effective even at a dose of 12.5 mg/d and safe at doses of up to 50 mg/d for controlling hypercalciuria in patients with PHPT and may have an advantage in decreasing serum parathyroid hormone level. However, careful monitoring for hypercalcemia is required.
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Affiliation(s)
- Gloria Tsvetov
- Institute of Endocrinology, Diabetes and Metabolism, and
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978 Israel
| | - Dania Hirsch
- Institute of Endocrinology, Diabetes and Metabolism, and
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978 Israel
| | - Ilan Shimon
- Institute of Endocrinology, Diabetes and Metabolism, and
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978 Israel
| | - Carlos Benbassat
- Institute of Endocrinology, Diabetes and Metabolism, and
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978 Israel
| | | | - Alexander Gorshtein
- Institute of Endocrinology, Diabetes and Metabolism, and
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978 Israel
| | - Dana Herzberg
- Institute of Endocrinology, Diabetes and Metabolism, and
| | - Tzippy Shochat
- Statistical Consulting Unit, Rabin Medical Center - Beilinson Hospital, Petach Tikva, 4941492 Israel
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Griebeler ML, Kearns AE, Ryu E, Thapa P, Hathcock MA, Melton LJ, Wermers RA. Thiazide-Associated Hypercalcemia: Incidence and Association With Primary Hyperparathyroidism Over Two Decades. J Clin Endocrinol Metab 2016; 101:1166-73. [PMID: 26751196 PMCID: PMC4803175 DOI: 10.1210/jc.2015-3964] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Thiazide diuretics, the antihypertensive agent prescribed most frequently worldwide, are commonly associated with hypercalcemia. However, the epidemiology and clinical features are poorly understood. OBJECTIVE To update the incidence of thiazide-associated hypercalcemia and clarify its clinical features. PATIENTS AND METHODS In a population-based descriptive study, Olmsted County, Minnesota, residents with thiazide-associated hypercalcemia were identified through the Rochester Epidemiology Project and the Mayo Clinic Laboratory Information System from 2002-2010 and were added to the historical cohort beginning in 1992. MAIN OUTCOME Incidence rates were adjusted to the 2010 United States white population. RESULTS Overall, 221 Olmsted County residents were identified with thiazide-associated hypercalcemia an average of 5.2 years after initiation of treatment. Subjects were older (mean age, 67 years) and primarily women (86.4%). The incidence of thiazide-associated hypercalcemia increased after 1997 and peaked in 2006 with an annual incidence of 20 per 100,000, compared to an overall rate of 12 per 100,000 in 1992-2010. Severe hypercalcemia was not observed in the cohort despite continuation of thiazide treatment in 62.4%. Of patients discontinuing thiazides, 71% continued to have hypercalcemia. Primary hyperparathyroidism was diagnosed in 53 patients (24%), including five patients who underwent parathyroidectomy without thiazide discontinuation. CONCLUSIONS Many patients with thiazide-associated hypercalcemia have underlying primary hyperparathyroidism. Additionally, a sharp rise in thiazide-associated hypercalcemia incidence began in 1998, paralleling the increase observed in primary hyperparathyroidism in this community. Case ascertainment bias from targeted osteoporosis screening is the most likely explanation.
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Affiliation(s)
- Marcio L Griebeler
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (M.L.G., A.E.K., R.A.W.); and Divisions of Biomedical Statistics and Informatics (E.R., P.T., M.A.H.) and Epidemiology (L.J.M.), Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905; and Sanford University of South Dakota Medical Center (M.L.G.), Sioux Falls, South Dakota 57117
| | - Ann E Kearns
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (M.L.G., A.E.K., R.A.W.); and Divisions of Biomedical Statistics and Informatics (E.R., P.T., M.A.H.) and Epidemiology (L.J.M.), Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905; and Sanford University of South Dakota Medical Center (M.L.G.), Sioux Falls, South Dakota 57117
| | - Euijung Ryu
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (M.L.G., A.E.K., R.A.W.); and Divisions of Biomedical Statistics and Informatics (E.R., P.T., M.A.H.) and Epidemiology (L.J.M.), Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905; and Sanford University of South Dakota Medical Center (M.L.G.), Sioux Falls, South Dakota 57117
| | - Prabin Thapa
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (M.L.G., A.E.K., R.A.W.); and Divisions of Biomedical Statistics and Informatics (E.R., P.T., M.A.H.) and Epidemiology (L.J.M.), Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905; and Sanford University of South Dakota Medical Center (M.L.G.), Sioux Falls, South Dakota 57117
| | - Matthew A Hathcock
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (M.L.G., A.E.K., R.A.W.); and Divisions of Biomedical Statistics and Informatics (E.R., P.T., M.A.H.) and Epidemiology (L.J.M.), Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905; and Sanford University of South Dakota Medical Center (M.L.G.), Sioux Falls, South Dakota 57117
| | - L Joseph Melton
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (M.L.G., A.E.K., R.A.W.); and Divisions of Biomedical Statistics and Informatics (E.R., P.T., M.A.H.) and Epidemiology (L.J.M.), Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905; and Sanford University of South Dakota Medical Center (M.L.G.), Sioux Falls, South Dakota 57117
| | - Robert A Wermers
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine (M.L.G., A.E.K., R.A.W.); and Divisions of Biomedical Statistics and Informatics (E.R., P.T., M.A.H.) and Epidemiology (L.J.M.), Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905; and Sanford University of South Dakota Medical Center (M.L.G.), Sioux Falls, South Dakota 57117
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16
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Piccoli GB, De Pascale A, Randone O, Vigotti FN, Priola AM, Naretto C, Ferraresi M, Aroasio E, Gonella S, Mongilardi E, Scognamiglio S, Consiglio V, Roggero S, Piga A, Roccatello D, Veltri A. Revisiting nephrocalcinosis: A single-centre perspective. A northern Italian experience. Nephrology (Carlton) 2016; 21:97-107. [DOI: 10.1111/nep.12535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2015] [Indexed: 01/19/2023]
Affiliation(s)
- Giorgina Barbara Piccoli
- SS Nephrology; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Agostino De Pascale
- Radiology; ASOU San Luigi; Department of Oncology; University of Torino; Torino Italy
| | - Olga Randone
- SS Nephrology; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Federica Neve Vigotti
- SS Nephrology; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | | | - Carla Naretto
- Interregional Center for Rare Diseases; G Bosco Hospital; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Martina Ferraresi
- SS Nephrology; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Emiliano Aroasio
- Laboratory; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Silvana Gonella
- Laboratory; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Elena Mongilardi
- SS Nephrology; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Stefania Scognamiglio
- SS Nephrology; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Valentina Consiglio
- SS Nephrology; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Simona Roggero
- Microcythemia Unit; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Antonio Piga
- Microcythemia Unit; ASOU San Luigi; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Dario Roccatello
- Interregional Center for Rare Diseases; G Bosco Hospital; Department of Clinical and Biological Sciences; University of Torino; Torino Italy
| | - Andrea Veltri
- Radiology; ASOU San Luigi; Department of Oncology; University of Torino; Torino Italy
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Caudarella R, Vescini F, Rizzoli E, Ulivieri FM. The Effect of Thiazides on Bone Markers, Bone Mineral Density and Fractures. Clin Rev Bone Miner Metab 2015. [DOI: 10.1007/s12018-015-9190-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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18
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Marcocci C, Brandi ML, Scillitani A, Corbetta S, Faggiano A, Gianotti L, Migliaccio S, Minisola S. Italian Society of Endocrinology Consensus Statement: definition, evaluation and management of patients with mild primary hyperparathyroidism. J Endocrinol Invest 2015; 38:577-93. [PMID: 25820553 DOI: 10.1007/s40618-015-0261-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 02/16/2015] [Indexed: 12/21/2022]
Affiliation(s)
- C Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 27, 56127, Pisa, Italy.
| | - M L Brandi
- Department of Surgery and Translational Medicine, University of Florence, Largo Brambilla 3, 50134, Firenze, Italy
| | - A Scillitani
- Unit of Endocrinology, Ospedale "Casa Sollievo della Sofferenza", IRCCS, 71013, San Giovanni Rotondo, FG, Italy
| | - S Corbetta
- Department of Biomedical Sciences for Health, University of Milan, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, MI, Italy
| | - A Faggiano
- Department of Clinical Medicine and Surgery, University "Federico II" of Naples, Via Pansini 5, 80131, Napoli, Italy
| | - L Gianotti
- Section of Endocrinology, Diabetology and Metabolism, Azienda Ospedaliera S.Croce e Carle, Via M Coppino 26, 12100, Cuneo, Italy
| | - S Migliaccio
- Department of Motor Sciences and Health, "Foro Italico" Rome University, Piazza L. de Bosis 6, 00135, Roma, Italy
| | - S Minisola
- Department of Internal Medicine and Medical DIsciplines, "Sapienza" Rome University, Viale del Policlinico 155, 00161, Roma, Italy
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Zahedi K, Barone S, Xu J, Soleimani M. Potentiation of the effect of thiazide derivatives by carbonic anhydrase inhibitors: molecular mechanisms and potential clinical implications. PLoS One 2013; 8:e79327. [PMID: 24260196 PMCID: PMC3832474 DOI: 10.1371/journal.pone.0079327] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 09/29/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Carbonic anhydrase inhibitors (CAI) are mild diuretics, hence not widely used in fluid overloaded states. They are however the treatment of choice for certain non-kidney conditions. Thiazides, specific inhibitors of Na-Cl cotransport (NCC), are mild agents and the most widely used diuretics in the world for control of mild hypertension. HYPOTHESIS In addition to inhibiting the salt reabsorption in the proximal tubule, CAIs down-regulate pendrin, therefore leaving NCC as the major salt absorbing transporter in the distal nephron, and hence allowing for massive diuresis by the inhibitors of NCC in the setting of increased delivery of salt from the proximal tubule. EXPERIMENTAL PROTOCOLS AND RESULTS Daily treatment of rats with acetazolamide (ACTZ), a known CAI, for 10 days caused mild diuresis whereas daily treatment with hydrochlorothiazide (HCTZ) for 4 days caused hardly any diuresis. However, treatment of rats that were pretreated with ACTZ for 6 days with a combination of ACTZ plus HCTZ for 4 additional days increased the urine output by greater than 2 fold (p<0.001, n = 5) compared to ACTZ-treated animals. Sodium excretion increased by 80% in the ACTZ plus HCTZ group and animals developed significant volume depletion, metabolic alkalosis and pre-renal failure. Molecular studies demonstrated ∼75% reduction in pendrin expression by ACTZ. The increased urine output in ACTZ/HCTZ treated rats was associated with a significant reduction in urine osmolality and reduced membrane localization of AQP-2 (aquaporin2). CONCLUSIONS These results indicate that ACTZ down-regulates pendrin expression and leaves NCC as the major salt absorbing transporter in the distal nephron in the setting of increased delivery of salt from the proximal tubule. Despite being considered mild agents individually, we propose that the combination of ACTZ and HCTZ is a powerful diuretic regimen.
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Affiliation(s)
- Kamyar Zahedi
- Center on Genetics of Transport and the Department of Medicine, University of Cincinnati, Research Services, Veterans Affairs Medical Center, Cincinnati, Ohio
| | - Sharon Barone
- Center on Genetics of Transport and the Department of Medicine, University of Cincinnati, Research Services, Veterans Affairs Medical Center, Cincinnati, Ohio
| | - Jie Xu
- Center on Genetics of Transport and the Department of Medicine, University of Cincinnati, Research Services, Veterans Affairs Medical Center, Cincinnati, Ohio
| | - Manoocher Soleimani
- Center on Genetics of Transport and the Department of Medicine, University of Cincinnati, Research Services, Veterans Affairs Medical Center, Cincinnati, Ohio
- * E-mail:
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20
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Ruiter R, Oei L, Visser LE, Peltenburg HG, Hofman A, Zillikens MC, Uitterlinden AG, Rivadeneira F, Stricker BH. The effect of thiazide and loop diuretics on urinary levels of free deoxypyridinoline: an osteoclastic bone-resorption marker. J Clin Pharm Ther 2013; 38:225-9. [DOI: 10.1111/jcpt.12049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 01/28/2013] [Indexed: 11/27/2022]
Affiliation(s)
- R. Ruiter
- Department of Epidemiology; Erasmus MC; Rotterdam
- Department of Internal Medicine; Groene Hart Ziekenhuis; Gouda
| | - L. Oei
- Department of Internal Medicine; Erasmus MC; Rotterdam
| | - L. E. Visser
- Department of Epidemiology; Erasmus MC; Rotterdam
- Department of Internal Medicine; Erasmus MC; Rotterdam
- Department of Hospital Pharmacy; Erasmus MC; Rotterdam
| | | | - A. Hofman
- Department of Epidemiology; Erasmus MC; Rotterdam
| | | | - A. G. Uitterlinden
- Department of Epidemiology; Erasmus MC; Rotterdam
- Department of Internal Medicine; Erasmus MC; Rotterdam
| | - F. Rivadeneira
- Department of Epidemiology; Erasmus MC; Rotterdam
- Department of Internal Medicine; Erasmus MC; Rotterdam
| | - B. H. Stricker
- Department of Epidemiology; Erasmus MC; Rotterdam
- Department of Internal Medicine; Erasmus MC; Rotterdam
- Drug Safety Unit; Inspectorate of Health Care; The Hague
- Department of Medical Informatics; Erasmus MC; Rotterdam the Netherlands
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Rosa M, Usai P, Miano R, Kim FJ, Agrò EF, Bove P, Micali S. Recent finding and new technologies in nephrolitiasis: a review of the recent literature. BMC Urol 2013; 13:10. [PMID: 23413950 PMCID: PMC3599704 DOI: 10.1186/1471-2490-13-10] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 02/06/2013] [Indexed: 11/24/2022] Open
Abstract
This review summarizes recent literature on advances regarding renal and ureteral calculi, with particular focus in areas of recent advances in the overall field of urolithiasis. Clinical management in everyday practice requires a complete understanding of the issues regarding metabolic evaluation and subgrouping of stone-forming patients, diagnostic procedures, effective treatment regime in acute stone colic, medical expulsive therapy, and active stone removal. In this review we focus on new perspectives in managing nephrolitihiasis and discuss recentadvances, including medical expulsive therapy, new technologies, and refinements of classical therapy such as shock wave lithotripsy, give a fundamental modification of nephrolithiasis management. Overall, this field appears to be the most promising, capable of new developments in ureterorenoscopy and percutaneous approaches. Further improvements are expected from robotic-assisted procedures, such as flexible robotics in ureterorenoscopy.
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Affiliation(s)
- Marco Rosa
- Department of Urology, University of Modena, Via del Pozzo, 71-41124, Modena, Italy
| | - Paolo Usai
- Department of Urology, University of Cagliari, Via Aurelio Nicolodi, 1 09123, Cagliari, Italy
| | - Roberto Miano
- Department of Urology, University “Tor Vergata”, Rome, Italy
| | - Fernando J Kim
- Department of Urology, Denver Health Care Center, 777 Bannock Street, Denver, CO, 80204-4597, USA
| | | | - Pierluigi Bove
- Department of Urology, University “Tor Vergata”, Rome, Italy
| | - Salvatore Micali
- Department of Urology, Denver Health Care Center, 777 Bannock Street, Denver, CO, 80204-4597, USA
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Abstract
There are a substantial number of secondary causes of osteoporosis that can be identified through appropriate evaluation. Unrecognized celiac disease, Monoclonal gamopathy of undetermined significance (MGUS), impaired renal function, diabetes mellitus, and renal tubular acidosis are just a few of the more common secondary causes of osteoporosis. Through targeted laboratory tests, many secondary causes of osteoporosis can be identified.
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Affiliation(s)
- Paul D Miller
- Colorado Center for Bone Research, 3190 South Wadsworth Boulevard, Lakewood, CO 80227, USA.
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Abstract
Magnesium (Mg2+) balance is tightly regulated by the concerted actions of the intestine, bone and kidneys. This balance can be disturbed by a broad variety of drugs. Diuretics, modulators of the EGFR (epidermal growth factor receptor), proton pump inhibitors, antimicrobials, calcineurin inhibitors and cytostatics may all cause hypomagnesaemia, potentially leading to tetany, seizures and cardiac arrhythmias. Conversely, high doses of Mg2+ salts, frequently administered as an antacid or a laxative, may lead to hypermagnesaemia causing various cardiovascular and neuromuscular abnormalities. A better understanding of the molecular mechanisms underlying the adverse effects of these medications on Mg2+ balance will indicate ways of prevention and treatment of these adverse effects and could potentially provide more insight into Mg2+ homoeostasis.
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