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Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial. Lancet Diabetes Endocrinol 2024; 12:39-50. [PMID: 38061371 PMCID: PMC7615591 DOI: 10.1016/s2213-8587(23)00321-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001). INTERPRETATION Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor. FUNDING Boehringer Ingelheim and Eli Lilly.
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T, Tamori Y, Tamura R, Tamura Y, Tan CHH, Tan EZZ, Tanabe A, Tanabe K, Tanaka A, Tanaka A, Tanaka N, Tang S, Tang Z, Tanigaki K, Tarlac M, Tatsuzawa A, Tay JF, Tay LL, Taylor J, Taylor K, Taylor K, Te A, Tenbusch L, Teng KS, Terakawa A, Terry J, Tham ZD, Tholl S, Thomas G, Thong KM, Tietjen D, Timadjer A, Tindall H, Tipper S, Tobin K, Toda N, Tokuyama A, Tolibas M, Tomita A, Tomita T, Tomlinson J, Tonks L, Topf J, Topping S, Torp A, Torres A, Totaro F, Toth P, Toyonaga Y, Tripodi F, Trivedi K, Tropman E, Tschope D, Tse J, Tsuji K, Tsunekawa S, Tsunoda R, Tucky B, Tufail S, Tuffaha A, Turan E, Turner H, Turner J, Turner M, Tuttle KR, Tye YL, Tyler A, Tyler J, Uchi H, Uchida H, Uchida T, Uchida T, Udagawa T, Ueda S, Ueda Y, Ueki K, Ugni S, Ugwu E, Umeno R, Unekawa C, Uozumi K, Urquia K, Valleteau A, Valletta C, van Erp R, Vanhoy C, Varad V, Varma R, Varughese A, Vasquez P, Vasseur A, Veelken R, Velagapudi C, Verdel K, Vettoretti S, Vezzoli G, Vielhauer V, Viera R, Vilar E, Villaruel S, Vinall L, Vinathan J, Visnjic M, Voigt E, von-Eynatten M, Vourvou M, Wada J, Wada J, Wada T, Wada Y, Wakayama K, Wakita Y, Wallendszus K, Walters T, Wan Mohamad WH, Wang L, Wang W, Wang X, Wang X, Wang Y, Wanner C, Wanninayake S, Watada H, Watanabe K, Watanabe K, Watanabe M, Waterfall H, Watkins D, Watson S, Weaving L, Weber B, Webley Y, Webster A, Webster M, Weetman M, Wei W, Weihprecht H, Weiland L, Weinmann-Menke J, Weinreich T, Wendt R, Weng Y, Whalen M, Whalley G, Wheatley R, Wheeler A, Wheeler J, Whelton P, White K, Whitmore B, Whittaker S, Wiebel J, Wiley J, Wilkinson L, Willett M, Williams A, Williams E, Williams K, Williams T, Wilson A, Wilson P, Wincott L, Wines E, Winkelmann B, Winkler M, Winter-Goodwin B, Witczak J, Wittes J, Wittmann M, Wolf G, Wolf L, Wolfling R, Wong C, Wong E, Wong HS, Wong LW, Wong YH, Wonnacott A, Wood A, Wood L, Woodhouse H, Wooding N, Woodman A, Wren K, Wu J, Wu P, Xia S, Xiao H, Xiao X, Xie Y, Xu C, Xu Y, Xue H, Yahaya H, Yalamanchili H, Yamada A, Yamada N, Yamagata K, Yamaguchi M, Yamaji Y, Yamamoto A, Yamamoto S, Yamamoto S, Yamamoto T, Yamanaka A, Yamano T, Yamanouchi Y, Yamasaki N, Yamasaki Y, Yamasaki Y, Yamashita C, Yamauchi T, Yan Q, Yanagisawa E, Yang F, Yang L, Yano S, Yao S, Yao Y, Yarlagadda S, Yasuda Y, Yiu V, Yokoyama T, Yoshida S, Yoshidome E, Yoshikawa H, Young A, Young T, Yousif V, Yu H, Yu Y, Yuasa K, Yusof N, Zalunardo N, Zander B, Zani R, Zappulo F, Zayed M, Zemann B, Zettergren P, Zhang H, Zhang L, Zhang L, Zhang N, Zhang X, Zhao J, Zhao L, Zhao S, Zhao Z, Zhong H, Zhou N, Zhou S, Zhu D, Zhu L, Zhu S, Zietz M, Zippo M, Zirino F, Zulkipli FH. Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial. Lancet Diabetes Endocrinol 2024; 12:51-60. [PMID: 38061372 DOI: 10.1016/s2213-8587(23)00322-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.
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Saponaro F, Cetani F, Repaci A, Pagotto U, Cipriani C, Pepe J, Minisola S, Cipri C, Vescini F, Scillitani A, Salcuni A, Palmieri S, Eller-Vainicher C, Chiodini I, Madeo B, Kara E, Castellano E, Borretta G, Gianotti L, Romanelli F, Camozzi V, Faggiano A, Corbetta S, Cianferotti L, Brandi ML, De Feo ML, Palermo A, Vezzoli G, Maino F, Scalese M, Marcocci C. Clinical presentation and management of patients with primary hyperparathyroidism in Italy. J Endocrinol Invest 2018; 41:1339-1348. [PMID: 29616419 DOI: 10.1007/s40618-018-0879-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Evaluation of the phenotype of primary hyperparathyroidism (PHPT), adherence to International Guidelines for parathyroidectomy (PTx), and rate of surgical cure. METHOD From January 2014-January 2016, we performed a prospective, multicenter study in patients with newly diagnosed PHPT. Biochemical and instrumental data were collected at baseline and during 1-year follow-up. RESULTS Over the first year we enrolled 604 patients (age 61 ± 14 years), mostly women (83%), referred for further evaluation and treatment advice. Five hundred sixty-six patients had sporadic PHPT (93.7%, age 63 ± 13 years), the remaining 38 (6.3%, age 41 ± 17 years) had familial PHPT. The majority of patients (59%) were asymptomatic. Surgery was advised in 281 (46.5%). Follow-up data were available in 345 patients. Eighty-seven of 158 (55.1%) symptomatic patients underwent PTx. Sixty-five (53.7%) of 121 asymptomatic patients with at least one criterion for surgery underwent PTx and 56 (46.3%) were followed without surgery. Negative parathyroid imaging studies predicted a conservative approach [symptomatic PHPT: OR 18.0 (95% CI 4.2-81.0) P < 0.001; asymptomatic PHPT: OR 10.8, (95% CI 3.1-37.15) P < 0.001). PTx was also performed in 16 of 66 (25.7%) asymptomatic patients without surgical criteria. Young age, serum calcium concentration, 24 h urinary calcium, positive parathyroid imaging (either ultrasound or MIBI scan positive in 75% vs. 16.7%, P = 0.001) were predictors of parathyroid surgery. Almost all (94%) of patients were cured by PTx. CONCLUSIONS Italian endocrinologists do not follow guidelines for the management of PHPT. Negative parathyroid imaging studies are strong predictors of a non-surgical approach. PTx is successful in almost all patients.
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Affiliation(s)
- F Saponaro
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy
| | - F Cetani
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy
| | - A Repaci
- Division of Endocrinology Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - U Pagotto
- Division of Endocrinology Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - C Cipriani
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - J Pepe
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - S Minisola
- Department of Internal Medicine and Medical Disciplines, 'Sapienza' University, Rome, Italy
| | - C Cipri
- Endocrinology and Metabolism, Unit University-Hospital of Udine, Udine, Italy
| | - F Vescini
- Endocrinology and Metabolism, Unit University-Hospital of Udine, Udine, Italy
| | - A Scillitani
- Endocrinology Unit, "Casa Sollievo della Sofferenza," IRCCS, San Giovanni Rotondo, Italy
| | - A Salcuni
- Endocrinology Unit, "Casa Sollievo della Sofferenza," IRCCS, San Giovanni Rotondo, Italy
| | - S Palmieri
- Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - C Eller-Vainicher
- Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - I Chiodini
- Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - B Madeo
- Unit of Endocrinology, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - E Kara
- Unit of Endocrinology, Azienda Ospedaliero-Universitaria di Modena, Ospedale Civile di Baggiovara, Modena, Italy
| | - E Castellano
- Division of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - G Borretta
- Division of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - L Gianotti
- Division of Endocrinology, Diabetes and Metabolism, Santa Croce and Carle Hospital, Cuneo, Italy
| | - F Romanelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - V Camozzi
- Endocrine Unit, University of Padova, Padua, Italy
| | - A Faggiano
- Endocrinology, Federico II University of Naples, Naples, Italy
| | - S Corbetta
- Endocrinology Service, Department of Biomedical Sciences for Health, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - L Cianferotti
- Department of Internal Medicine, University of Florence, Florence, Italy
| | - M L Brandi
- Department of Internal Medicine, University of Florence, Florence, Italy
| | - M L De Feo
- Endocrinology Unit, Careggi Hospital and University of Florence, Florence, Italy
| | - A Palermo
- Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy
| | - G Vezzoli
- Nephrology and Dialysis Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - F Maino
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - M Scalese
- Institute of Clinical Physiology, National Council of Research, Pisa, Italy
| | - C Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy.
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Abdelfattah EM, Vezzoli G, Buczkowski G, Makagon MM. Essential oils: effects of application rate and modality on potential for combating northern fowl mite infestations. Med Vet Entomol 2018; 32:304-310. [PMID: 29498419 DOI: 10.1111/mve.12300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 12/09/2017] [Accepted: 12/25/2017] [Indexed: 06/08/2023]
Abstract
The northern fowl mite (NFM), Ornithonyssus sylviarum (Mesostigmata: Macronyssidae), is the primary blood-feeding ectoparasite found on poultry in the U.S.A. Three experiments were conducted in vitro to test the acaricidal properties of cade, garlic, lavender, lemongrass, pine and thyme essential oils against NFM, and to evaluate whether these effects are altered by adjusting oil application rates and application modality (direct vs. vapour contact). Applied at the rate of 0.21 mg/cm2 , the essential oils of cade, thyme, lemongrass and garlic resulted in higher NFM mortality at 24 h post-application than lavender and pine oils, and the untreated and ethanol-treated controls. Cade and thyme were the most consistent and fast-acting of the essential oils in terms of toxicity to NFM. Cade applied at 0.21 mg/cm2 and 0.11 mg/cm2 and thyme applied at 0.21 mg/cm2 were effective in eliminating NFM within 2 h through direct contact. The modality of application did not affect the efficacy of cade and thyme essential oils. The results suggest that essential oils may be utilized as alternatives to chemical pesticides and could be used as fumigants for the control of NFM.
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Affiliation(s)
- E M Abdelfattah
- Department of Animal Science, University of California Davis, Davis, CA, U.S.A
- Department of Animal Hygiene, Behaviour and Management, Faculty of Veterinary Medicine, Benha University, Benha, Egypt
| | - G Vezzoli
- Department of Animal Science, University of California Davis, Davis, CA, U.S.A
- Department of Animal Sciences, Purdue University, West Lafayette, IN, U.S.A
| | - G Buczkowski
- Department of Entomology, Purdue University, West Lafayette, IN, U.S.A
| | - M M Makagon
- Department of Animal Science, University of California Davis, Davis, CA, U.S.A
- Department of Animal Sciences, Purdue University, West Lafayette, IN, U.S.A
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Hu J, Hester P, Makagon M, Vezzoli G, Gates R, Xiong Y, Cheng H. Cooled perch effects on performance and well-being traits in caged White Leghorn hens. Poult Sci 2016; 95:2737-2746. [DOI: 10.3382/ps/pew248] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/28/2016] [Accepted: 06/06/2016] [Indexed: 01/02/2023] Open
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Vezzoli G, Dogliotti E, Terranegra A, Arcidiacono T, Macrina L, Tavecchia M, Pivari F, Mingione A, Brasacchio C, Nouvenne A, Meschi T, Cusi D, Spotti D, Montanari E, Soldati L. Dietary style and acid load in an Italian population of calcium kidney stone formers. Nutr Metab Cardiovasc Dis 2015; 25:588-593. [PMID: 25921845 DOI: 10.1016/j.numecd.2015.03.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 03/05/2015] [Accepted: 03/11/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS Animal protein intake may cause an acid load that predisposes individuals to stones by influencing calcium and citrate excretion. These associations were not confirmed in recent studies. Therefore the present study was aimed to compare acid load of diet in stone formers and controls. METHODS AND RESULTS Participants to the study were 157 consecutive calcium stone formers and 144 controls. Diet was analyzed in these subjects using a software that evaluated nutrient intake from a three-day food intake diary. This software also estimated the potential renal acid load (PRAL, mEq/day). Twenty-four-hour urine excretion of ions and citrate was measured in stone formers. Stone former diet had lower intake of glucose, fructose, potassium and fiber and higher PRAL in comparison with controls. The multinomial logistic regression analysis showed that stone risk decreased in association with the middle and the highest tertiles of fiber intake and increased in association with the highest tertile of PRAL. The linear multiple regression analysis showed that calcium excretion was associated with the sodium excretion and that citrate excretion was associated with the PRAL and animal protein intake in stone formers. CONCLUSION Our findings suggest that stone formers may undergo a greater dietary acid load sustained by a low vegetable intake and base provision. Dietary acid load does not appear as the main determinant of calcium excretion, but may promote stone risk by decreasing citrate excretion. Sodium intake may predispose to stones by stimulating calcium excretion.
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Affiliation(s)
- G Vezzoli
- Nephrology and Dialysis Unit, Postgraduate School of Nephrology, Vita Salute University, San Raffaele Scientific Institute, 20132 Milan, Italy.
| | - E Dogliotti
- Department of Health Sciences, Università degli Studi di Milano, San Paolo Hospital, 20142 Milan, Italy
| | - A Terranegra
- Department of Health Sciences, Università degli Studi di Milano, San Paolo Hospital, 20142 Milan, Italy; Sidra Medical and Research Center, Doha, Qatar
| | - T Arcidiacono
- Nephrology and Dialysis Unit, Postgraduate School of Nephrology, Vita Salute University, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - L Macrina
- Nephrology and Dialysis Unit, Postgraduate School of Nephrology, Vita Salute University, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - M Tavecchia
- Department of Health Sciences, Università degli Studi di Milano, San Paolo Hospital, 20142 Milan, Italy
| | - F Pivari
- Department of Health Sciences, Università degli Studi di Milano, San Paolo Hospital, 20142 Milan, Italy
| | - A Mingione
- Nephrology and Dialysis Unit, Postgraduate School of Nephrology, Vita Salute University, San Raffaele Scientific Institute, 20132 Milan, Italy; Department of Health Sciences, Università degli Studi di Milano, San Paolo Hospital, 20142 Milan, Italy
| | - C Brasacchio
- Department of Health Sciences, Università degli Studi di Milano, San Paolo Hospital, 20142 Milan, Italy
| | - A Nouvenne
- Department of Clinical Sciences, University of Parma, Parma, Italy
| | - T Meschi
- Department of Clinical Sciences, University of Parma, Parma, Italy
| | - D Cusi
- Department of Health Sciences, Università degli Studi di Milano, San Paolo Hospital, 20142 Milan, Italy
| | - D Spotti
- Nephrology and Dialysis Unit, Postgraduate School of Nephrology, Vita Salute University, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - E Montanari
- Urology, Department of Health Sciences, Università degli Studi di Milano, San Paolo Hospital, 20142 Milan, Italy
| | - L Soldati
- Department of Health Sciences, Università degli Studi di Milano, San Paolo Hospital, 20142 Milan, Italy
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Quarto di Palo F, Palazzi P, Vazzola A, Scabini M, Vezzoli G, Elli A, Bianchi G. Acute tubular necrosis and arterial hypertension in renal transplant patients treated with ciclosporin. Contrib Nephrol 2015; 51:133-6. [PMID: 3552409 DOI: 10.1159/000413109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Cusi D, Ferrari P, Salardi S, Ferrandi M, Tripodi G, Barlassina C, Niutta E, Vezzoli G, Guidi E, Bianchi G. A primary kidney abnormality in essential hypertension. Contrib Nephrol 2015; 54:1-8. [PMID: 3568675 DOI: 10.1159/000413207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Vezzoli G, Elli A, Palazzi P, Cusi D, Cova T, Menghetti D, Scabini M, Ortolani S, Soldati L, Surian M. Plasma membrane Ca-ATPase in idiopathic hypercalciuria. Contrib Nephrol 2015; 58:148-51. [PMID: 2961511 DOI: 10.1159/000414505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- G Vezzoli
- Istituto di Scienze Mediche, Università di Milano, Italia
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Alexander RT, Samuel S, Wiebe N, Bello A, Klarenbach S, Curhan GC, Tonelli M, Hemmelgarn B, Mingione A, Terranegra A, Aloia A, Arcidiacono T, Brasacchio C, Hou J, Dell'Antonio G, Vezzoli G, Soldati L, Shimizu T, Hasegawa H, Takayanagi K, Ikari A, Noiri C, Iwashita T, Tayama Y, Asakura J, Anzai N, Sano T, Ogawa T, Matsuda A, Mitarai T. Renal physiology and kidney stones. Nephrol Dial Transplant 2013. [DOI: 10.1093/ndt/gft175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Marie-Lucile F, Laure-Helene N, Yosr C, Anne M, Fadi F, Levi C, Levi C, Meas-Yedid V, Daniliuc C, Karras A, Olivo-Marin JC, Mouthon L, Guiard E, Roland M, Guillevin L, Jacquot C, Nochy D, Thervet E, Chen Q, Skerka C, Uzonyi B, Lindner S, Licht C, Hoppe B, Riedl M, Kirschfink M, Habbich S, Wolf G, Strain L, Goodship TH, Zipfel PF, Kfoury H, Alsuwaida A, Alsaad K, Alhejaili F, Alghonaim M, Alwakeel J, Husain S, Aloudah N, Besso L, Besso L, Tamagnone M, Daidola G, Burdese M, Repetto L, Pasquale G, Colla L, Biancone L, Stratta P, Segoloni GP, Bacalja J, Bauer Segvic AM, Bulimbasic S, Pacic A, Knotek M, Sabljar Matovinovic M, Galesic K, Galesic Ljubanovic D, Zakharova E, Stolyarevich E, Vorobjova O, Tamouza H, Chemouny JM, Flamant M, Raskova Kafkova L, Demion M, Laurent M, Walker F, Julian BA, Tissandie E, Tiwari MK, Novak J, Camara NO, Benhamou M, Vrtovsnik F, Monteiro RC, Moura IC, Samavat S, Ahmadpoor P, Torbati P, Ghaderi R, Poorrezagholi F, Samadian F, Nafar M, MII A, MII A, Shimizu A, Kaneko T, Yasuda F, Fukui M, Masuda Y, Iino Y, Katayama Y, Muller C, Markovic-Lipkovski J, Simic-Ogrizovic S, Naumovic R, Cirovic S, Mitrovic D, Muller G, Wozniak A, Janicka-Jedynska M, Zurawski J, Kaczmarek E, Zachwieja J, Khilji S, Khilji S, Dorman T, O'kelly P, Lampty L, Leung K, Shadivan A, Varghese C, Walshe J, Saito T, Kawano M, Saeki T, Mizushima I, Yamaguchi Y, Imai N, Nakashima H, Umehara H, Shvetsov M, Popova O, Chebotareva N, Ivanov A, Bobkova I, Cremasco D, Ceol M, Peruzzi L, Mazzucco G, Giuseppina M, Vezzoli G, Cristofaro R, D'angelo A, Anglani F, Del Prete D, Coppolino G, Comi N, Bolignano D, Piraina V, Talarico R, Colombo A, Lucisano G, Fuiano G, Bernich P, Lupo A, Of Renal Biopsies TR, Rastaldi MP, Jercan OC, Messa P, Alexandru D, Mogoanta L, Jercan OC, Shvetsov M, Ivanov A, Uribe Villegas V, Popova O. Renal histopathology. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rainone F, Arcidiacono T, Terranegra A, Aloia A, Dogliotti E, Mingione A, Spotti D, Francucci CM, Soldati L, Vezzoli G. Calcium sensing receptor and renal mineral ion transport. J Endocrinol Invest 2011; 34:8-12. [PMID: 21985973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Calcium sensing receptor (CaSR) is a component of the C family of the G protein-coupled receptors. It is ubiquitously expressed in human and mammal cells but is more expressed in parathyroid glands and kidney cells. It is located on the cell plasma membrane and senses the changes of extracellular calcium concentrations. Thus, it may modify cell functions according to serum calcium levels. CaSR has a key role in calcium homeostasis because it allows parathyroid glands and kidney to regulate PTH secretion and calcium reabsorption in order to keep serum calcium concentration within the normal range. CaSR appears as an important player in the regulation of renal calcium handling and body calcium metabolism. Thus, CaSR may protect human tissues against calcium excess. In kidneys, its protective effect includes the stimulation of diuresis and phosphate retention, along with the potential prevention of calcium precipitation and deposition in kidney tubules and interstitium.
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Affiliation(s)
- F Rainone
- Nephrology and Dialysis Unit, Vita Salute University, San Raffaele Scientific Institute, Milan, Italy
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Stekrova J, Reiterova J, Elisakova V, Merta M, Kohoutova M, Tesar V, Suvakov S, Damjanovic T, Dimkovic N, Pljesa S, Savic-Radojevic A, Pljesa-Ercegovac M, Matic M, Djukic T, Coric V, Simic T, Gigante M, d'Altilia M, Montemurno E, Schirinzi A, Bruno F, Netti GS, Ranieri E, Stallone G, Infante B, Grandaliano G, Gesualdo L, Maritati F, Alberici F, Bonatti F, Oliva E, Sinico RA, Moroni G, Leoni A, Gregorini G, Jeannin G, Possenti S, Tumiati B, Grasselli C, Brugnano R, Salvarani C, Fraticelli P, Pavone L, Pesci A, Guida G, Neri TM, Buzio C, Malerba G, Martorana D, Vaglio A, Santucci L, Candiano G, Cremasco D, Tosetto E, Del Prete D, Bruschi M, Ghiggeri GM, Anglani F, Rainone F, Soldati L, Terranegra A, Arcidiacono T, Aloia A, Dogliotti E, Vezzoli G, Maruniak-Chudek I, Zenker M, Chudek J, Reiterova J, Obeidova L, Stekrova J, Lnenicka P, Tesar V, Iwanitskiy LV, Krasnova TN, Samokhodskaya LM, Bernasconi AR, Albarracin L, Liste AA, Politei JM, Heguilen RM, Kaito H, Nozu K, Nakanishi K, Hashimura Y, Shima Y, Ninchoji T, Yoshikawa N, Iijima K, Matsuo M, Hur E, Gungor O, Bozkurt D, Bozgul SMK, Caliskan H, Dusunur F, Basci A, Akcicek F, Duman S, Li Y, Wang C, Nan L, Hruskova Z, Brabcova I, Lanska V, Honsova E, Hanzal V, Borovicka V, Reiterova J, Rysava R, Zachoval R, Viklicky O, Tesar V, Miltenberger-Miltenyi G, Almeida E, Calado J, Carvalho F, Pereira S, Teixeira C, Jorge S, Viana H, Gomes da Costa A, Yang CS, Tseng MH, Yang SS, Lin SH. Genetic diseases and molecular genetics. Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Vezzoli G, Terranegra A, Arcidiacono T, Gambaro G, Milanesi L, Mosca E, Soldati L. Calcium kidney stones are associated with a haplotype of the calcium-sensing receptor gene regulatory region. Nephrol Dial Transplant 2010; 25:2245-52. [DOI: 10.1093/ndt/gfp760] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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15
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Vezzoli G. P3.194 Perturbation of tyrosine by cationic charge. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70758-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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16
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Tosetto E, Ceol M, Mezzabotta F, Ammenti A, Peruzzi L, Caruso MR, Barbano G, Vezzoli G, Colussi G, Vergine G, Giordano M, Glorioso N, Degortes S, Soldati L, Sayer J, D'Angelo A, Anglani F. Novel mutations of the CLCN5 gene including a complex allele and A 5′ UTR mutation in Dent disease 1. Clin Genet 2009; 76:413-6. [DOI: 10.1111/j.1399-0004.2009.01212.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Paloschi V, Arcidiacono T, Stella P, Rainone F, Terranegra A, Dogliotti E, Soldati L, Vezzoli G. [What do we know after ten years of genetic research into calcium kidney stones?]. G Ital Nefrol 2009; 26:64-72. [PMID: 19255965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Genetic studies of calcium kidney stones have so far assessed single candidate genes by testing linkage disequilibrium or association between a locus and stone disease. They showed the possible involvement of the calciumsensing receptor gene, vitamin D receptor gene, and bicarbonate-sensitive adenylate cyclase gene. In addition to research in humans, the study of different strains of knock-out mice let us include the gene of phosphate reabsorption carrier NPT2, caveolin-1, protein NHERF-1 modulating calcium and urate reabsorption, osteopontin and Tamm-Horsfall protein among the possible determinants. However, the interactions between genes and also between environmental factors and genes are generally considered fundamental in calcium stone formation. Thus, the genetic studies carried out to date have not led to a significant growth of the knowledge about the causes of calcium kidney stones, even though they have allowed us to assess the size of the problem and define criteria to address it. Further knowledge of the causes of calcium stones may be obtained using the instruments that modern biotechnology and bioinformatics have made available to researchers.
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Affiliation(s)
- V Paloschi
- Unita' di Nefrologia e Dialisi, Istituto Scientifico San Raffaele, Universita' Vita Salute, Milano, Italy
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Arcidiacono T, Paloschi V, Rainone F, Terranegra A, Dogliotti E, Aloia A, Soldati L, Vezzoli G. Renal osteodystrophy and vascular calcification. J Endocrinol Invest 2009; 32:21-6. [PMID: 19724162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
Chronic kidney disease (CKD) is characterized by phosphate retention and reduced synthesis of 1.25(OH)2-vitamin D stimulating parathyroid hyperplasia. These changes cause a complex osteopathy, defined as renal osteodystrophy, and vascular calcification. Renal osteodystrophy increases the risk of fracture and causes deformities and disability. Vascular calcification occurs in a large proportion of hemodialysis patients and is a marker of arteriopathy. Calcifying arteriopathy induces arterial stiffness and contributes to the high cardiovascular mortality and morbidity among CKD patients. Vascular calcification results from a process of local bone formation induced by osteoblast-like cells developing in the vascular wall from resident cells. Osteoblast differentiation of resident vascular cells may be mediated by metabolic factors and may be induced by high concentrations of phosphate. Therefore, phosphate retention appears as the most detrimental factor affecting arteries in CKD patients. There is no specific therapy to revert soft tissue calcification, but calcification must be prevented in the early stages of CKD.
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Affiliation(s)
- T Arcidiacono
- Nephrology and Dialysis Unit, Scientific Institute San Raffaele Hospital, Vita Salute University, Via Olgettina 60, 20132 Milan, Italy.
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Arcidiacono T, Terranegra A, Biasion R, Soldati L, Vezzoli G. [Calcium kidney stones. Diagnostic and preventive prospects]. G Ital Nefrol 2007; 24:535-546. [PMID: 18278757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Kidney stone disease is one of the main causes of hospitalization in Italy. Its prevalence increased in the last century and is probably still increasing. The pathogenesis of the disease is not known, although two main theories have been elaborated. The first hypothesizes that hydroxyapatite deposition in the interstitium of the renal papillae (Randall's plaque) precedes urinary calcium oxalate precipitation on the ulcered surface of the papilla to form a stone. The second presumes the tubular lumen of Bellini's duct to be the site where calcium-oxalate salts precipitate to form the nucleus for stone formation within the urinary tract. These pathogenetic processes may be favored by different dietary and genetic factors. The genes involved are not known, although many studies have been performed. Polymorphisms of genes coding for the vitamin D receptor, calcium-sensing receptor, interleukin-1 receptor antagonist, and urokinase were found to be associated with kidney stones, but these results have not been replicated. Different nutrients are suspected to predispose patients to calcium kidney stone disease. A high intake of animal proteins, sodium, vitamin C and oxalate has been implicated in stone formation, whereas calcium, alkalis and phytate may have a protective effect. The prevention of calcium stone formation is based on the recognition of risk factors like those already mentioned here. Furthermore, a family history of kidney stones may be useful in identifying subjects predisposed to become calcium stone formers. However, the expectations of the scientific community are turned to the advances in genetics and to the findings of genetic studies, which may provide diagnostic tools and criteria to define the risk profile of the single individual.
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Affiliation(s)
- T Arcidiacono
- Unità di Nefrologia e Dialisi, Istituto Scientifico San Raffaele, Università Vita Salute, Milano, Italy
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Vezzoli G, Terranegra A, Arcidiacono T, Biasion R, Coviello D, Syren ML, Paloschi V, Giannini S, Mignogna G, Rubinacci A, Ferraretto A, Cusi D, Bianchi G, Soldati L. R990G polymorphism of calcium-sensing receptor does produce a gain-of-function and predispose to primary hypercalciuria. Kidney Int 2007; 71:1155-62. [PMID: 17332735 DOI: 10.1038/sj.ki.5002156] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
An association between the R990G polymorphism of the CaSR gene, coding for calcium-sensing receptor, and primary hypercalciuria was found in kidney stone formers. To confirm this relationship, we investigated hypercalciuric women without stones and studied the effect of CaSR gene in human embryonic kidney cells (HEK-293). We genotyped for CaSR A986S, R990G, and Q1011E polymorphisms, 119 normocalciuric and 124 hypercalciuric women with negative history of kidney stones. Homozygous (n=2) or heterozygous (n=21) women for the 990G allele considered as one group had an increased risk to be hypercalciuric (odds ratio=5.2; P=0.001) and higher calcium excretion (P=0.005) in comparison with homozygous women for the 990R allele (n=220). HEK-293 cells were transfected with the variant allele at the three CaSR gene polymorphisms and with the most common allele with no variants. The transient increment of intracellular calcium caused by the stepwise increase of extracellular calcium was evaluated in stable transfected cells loaded with fura-2 AM. The extracellular calcium concentration producing the half-maximal intracellular calcium response was lower in HEK-293 cells transfected with the 990G allele than in those transfected with the wild-type allele (P=0.0001). Our findings indicate that R990G polymorphism results in a gain-of-function of the calcium-sensing receptor and increased susceptibility to primary hypercalciuria.
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Affiliation(s)
- G Vezzoli
- Nephrology and Dialysis Unit, Postgraduate School of Nephrology, Vita Salute University, IRCCS San Raffaele Hospital, Milan, Italy.
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21
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Lolli S, Ferrante V, Vezzoli G, Marelli SP, Cavalchini LG. Effect of rearing systems on combs, wattles and shanks colour in layers: preliminary results. Italian Journal of Animal Science 2007. [DOI: 10.4081/ijas.2007.1s.727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- S. Lolli
- Istituto di Zootecnica Università di Milano, Italy
| | - V. Ferrante
- Istituto di Zootecnica Università di Milano, Italy
| | - G. Vezzoli
- Istituto di Zootecnica Università di Milano, Italy
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Corbetta S, Eller-Vainicher C, Filopanti M, Saeli P, Vezzoli G, Arcidiacono T, Loli P, Syren ML, Soldati L, Beck-Peccoz P, Spada A. R990G polymorphism of the calcium-sensing receptor and renal calcium excretion in patients with primary hyperparathyroidism. Eur J Endocrinol 2006; 155:687-92. [PMID: 17062884 DOI: 10.1530/eje.1.02286] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
CONTEXT Primary hyperparathyroidism (PHPT) shows a great variability in clinical course and severity. Data concerning the association between polymorphic variants of the gene encoding the calcium-sensing receptor (CaSR) and clinical characteristics of PHPT are not conclusive. OBJECTIVE To evaluate the frequency of three polymorphisms; A986S, R990G, and Q1011E of CaSR in patients with PHPT and to correlate the genotypes with clinical and biochemical parameters. PATIENTS AND METHODS The study included 94 consecutive unrelated patients referred to our Departments for PHPT diagnosis and management between 2000 and 2005 and 137 age and sex-matched healthy subjects. Patients and controls were genotyped according to standard procedures. Due to the rarity of 990G allele, homozygous and heterozygous subjects were grouped in R/G+G/G set. All PHPT patients were studied for calcium metabolism parameters and renal and bone complications. RESULTS The proportion of CaSRvariants was similar in PHPT patients and controls. In PHPT patients, only R990G polymorphism was associated with disease parameters; in comparison with R/R, R/G+G/G patients showed lower mean serum parathyroid hormone (PTH) and phosphate levels (139.9 +/- 62.2 vs 199.9 +/- 136.3 pg/ml, P < 0.05 and 0.69 +/- 0.12 vs 0.81 +/- 0.18 mmol/l, P = 0.031 respectively), higher mean 24-h urine calcium concentration and calcium excretion (9.05 +/- 2.05 vs 6.77 +/- 4.31 mmol/24 h, P = 0.012 and 67 +/- 20 vs 51 +/- 26 mumol/l GF, P = 0.039), and increased prevalence of nephrolithiasis (90.0 vs 44.2%, P = 0.007). CONCLUSIONS The study showed that patients with PHPT, bearing the 990G allele, had lower serum PTH levels and higher urinary calcium excretion in comparison with the other genotype, suggesting an increased sensitivityof the variant receptor to extracellular calcium. Since this variant was associated with increased occurrence of nephrolithiasis, analysis of this polymorphism might help to predict renal complication of the disease.
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Affiliation(s)
- S Corbetta
- Unità Operativa di Endocrinologia e Diabetologia, Department of Medical-Surgical Sciences, University of Milan, Policlinico San Donato IRCCS, San Donato M.se, Milan, Italy
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Soldati L, Adamo D, Manunta P, Stella P, Ciurlino D, Spotti D, Slaviero G, Melandri M, Cusi D, Bianchi G, Vezzoli G. Erythrocyte calcium influx is related to severity of ventricular arrhythmias in uraemic patients. Nephrol Dial Transplant 2001; 16:85-90. [PMID: 11208998 DOI: 10.1093/ndt/16.1.85] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Myocardial disorders are a remarkable cause of morbidity and mortality in chronic haemodialysed patients (HD). They could be favoured by alteration of cell Ca(2+) handling. In previous studies we characterized an erythrocyte Ca(2+) influx, sensitive to membrane potential and inhibited by Ca(2+) antagonists. Since its maximal influx rate was decreased in HD patients, this study investigates if Ca(2+) influx alterations are related to myocardial disorders in HD patients. METHODS Voltage-sensitive erythrocyte Ca(2+) influx was measured in 30 healthy controls and in 53 patients (47 HD patients and six patients with left ventricular hypertrophy and normal kidney function), using fura 2. In 29 HD patients and in six healthy subjects Ca(2+) influx was also determined in the presence of parathyroid hormone (PTH) in vitro. Patients were classified according to Lown's ventricular arrhythmias classification after 24-h Holter electrocardiograph (ECG) monitoring. Forty-six patients underwent echocardiography. RESULTS Voltage-sensitive erythrocyte Ca(2+) influx was significantly reduced in HD patients. Maximal influx rate was significantly higher in HD patients of Lown's classes 3 and 4 (0.789 +/- 0.156 nmol/s, n = 8; P < 0.01) than in patients of classes 1 and 2 (0.499 +/- 0.055 nmol/s, n=15), or without ventricular arrhythmias (0.400 +/- 0.041 nmol/s, n = 24). Maximal influx rate was directly correlated to left ventricular mass index (LVM) (r = 0.353, P < 0.05). Subjects with left ventricular hypertrophy and normal kidney function displayed erythrocyte Ca(2+) influx similar to that of normal subjects. Multiple regression indicates that LVM and Ca(2+) influx were independently related to severity of arrhythmias. When added to the influx assay, PTH increased the maximal influx rate only in patients with ventricular arrhythmias. CONCLUSION Myocardial dysfunction and altered ventricular excitability could be related in uraemic HD patients to alterations of calcium transport, as found in the erythrocyte model. Reduced resistance to PTH could contribute to this phenomenon.
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Affiliation(s)
- L Soldati
- Division of Nephrology, Dialysis and Hypertension, San Raffaele Scientific Institute, University of Milan, Italy
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Abstract
Gitelman's syndrome is a renal tubular disorder characterized by a sodium and chloride reabsorption defect in distal tubular cells that determines hypokalemia, metabolic alkalosis, hypomagnesemia, and low calcium excretion. The presence of choroidal calcifications was sought in five patients with Gitelman's syndrome by ophthalmic examination, fluorescein angiography, indocyanine green angiography, and ocular ultrasonography. Calcifications observed in the choroid of two patients were shown by ultrasonography in both patients. Ophthalmic and fluorangiographic examinations detected this alteration in one of the two subjects. Chondrocalcinosis was found in one patient with choroidal calcifications. These findings suggest that precipitation of calcium salts can occur in the choroidal tissue of patients with Gitelman's syndrome. Deposits appeared to be well seen by ultrasonography because of their depth in ocular tissues. Sclerochoroidal calcifications may be favored by the low calcium excretion, which is associated with normal intestinal calcium absorption in patients with Gitelman's syndrome.
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Affiliation(s)
- G Vezzoli
- Divisions of Nephrology, Dialysis, and Hypertension and Ophthalmology, San Raffaele Scientific Institute, University of Milan, Italy.
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Baggio B, Budakovic A, Nassuato MA, Vezzoli G, Manzato E, Luisetto G, Zaninotto M. Plasma phospholipid arachidonic acid content and calcium metabolism in idiopathic calcium nephrolithiasis. Kidney Int 2000; 58:1278-84. [PMID: 10972691 DOI: 10.1046/j.1523-1755.2000.00283.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Reports of an increase in plasma and erythrocyte phospholipid arachidonic acid content and in urinary prostaglandin E2 (PGE2) excretion in patients with idiopathic calcium nephrolithiasis suggested their crucial role in the pathogenesis of hypercalciuria, a well-known risk factor for lithogenesis. METHODS To confirm this hypothesis, 15 healthy subjects and 20 nephrolithiasis patients were evaluated for plasma phospholipid polyunsaturated fatty acid content and PGE2 concentration, serum parathyroid hormone, 25 hydroxyvitamin D3, 1, 25-dihydroxyvitamin D3, and bone-specific alkaline phosphatase levels, as well as urinary excretion of calcium, biochemical markers of bone resorption (hydroxyproline and crossLaps), and intestinal calcium absorption. Furthermore, the effect of a 30-day fish-oil diet supplementation on the previously mentioned parameters was investigated in the patients. RESULTS At baseline, patients compared with controls showed higher levels of plasma phospholipid arachidonic acid content (P = 0.002), PGE2 (P = 0.0004), serum 25-vitamin D3 (P = 0.001), and 1,25-vitamin D3 (P = 0.001), urinary excretion of calcium (P = 0.001), hydroxyproline (P = 0.007), and crossLaps (P = 0.019), as well as intestinal calcium absorption (P = 0.03 at 60 min). Fish oil supplementation induced a reduction in the plasma phospholipid arachidonic acid level (P < 0.0001), and except for serum concentrations of 25-vitamin D3, normalized baseline blood and urinary parameters, including intestinal calcium absorption. A close correlation between plasma PGE2 and serum 1,25-vitamin D3 (P = 0.004) and between phospholipid arachidonic acid and intestinal calcium absorption (P = 0.0002) and calciuria (P = 0.007) was observed, as well as between urine excretion of crossLaps and hydroxyproline (P < 0.0001), crossLaps and calcium (P < 0.0001), and hydroxyproline and calcium (P < 0.0001). CONCLUSIONS These findings indicate that the phospholipid arachidonic acid content anomaly could represent the primary event responsible for the mosaic of metabolic and clinical alterations that are distinctive features of renal stone formers, and suggest that a common pathogenetic mechanism might account for the several forms of hypercalciuria detected in idiopathic calcium nephrolithiasis.
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Affiliation(s)
- B Baggio
- Division of Nephrology, Department of Medical and Surgical Sciences, University of Padua, Italy.
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Abstract
We used the chloride fluorescent probe, 6-methoxy-N-(3-sulfopropyl)quinolinium (SPQ), to study chloride fluxes in human erythrocytes. The SPQ load was made by hypotonic buffer (150 mOsm, 10 min). Intracellular fluorescence was monitored continuously at 360 nm excitation and 410 nm emission wavelengths. The leakage of SPQ out of cells was <5% h(-1) and the Stern-Volmer constant for quenching of intracellular SPQ by Cl was 0.023 mM(-1). The time course of intracellular [Cl] was measured and the influence of PTH, forskolin, and phorbol 12-myristate 13-acetate (PMA) on erythrocyte Cl transport was examined. The results establish a direct method to measure intracellular [Cl] continuously in erythrocytes and show that PTH induces a Cl efflux inhibited by 4, 4'-diisothiocyanatostilbene-2,2'-disulfonate. This effect was similar to those induced by forskolin, which stimulates cAMP generation, and by PMA, which stimulates protein kinase C.
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Affiliation(s)
- L Soldati
- Division of Nephrology, Dialysis and Hypertension, San Raffaele Scientific Institute, University of Milan, Ospedale San Raffaele, Via Olgettina 60, Milan, 20132, Italy.
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Abstract
BACKGROUND Uremia displays increased cytosolic free calcium ([Ca2+]i) in many different cell types, supporting the hypothesis of an altered Ca2+ transport modifying the functional activity of calcium signaling pathway. METHODS Thirty-five hemodialyzed patients and 20 age-matched subjects were studied. Erythrocyte resting [Ca2+]i and Ca2+ influx were measured by the fluorescent Ca2+-sensitive dye fura-2. RESULTS We found an increase of resting [Ca2+]i in erythrocytes from uremic hemodialyzed patients compared with matched healthy controls (103 +/- 2.5 nM, N = 20, vs. 90 +/- 4, N = 20, P < 0.01). Moreover, we found an altered voltage-dependent Ca2+ influx showing a reduced transport rate (0.42 +/- 0.03 nM/second vs. 0.74 +/- 0.08, P < 0.01). High levels of plasma parathyroid hormone (PTH) were related to augmented Ca2+ entry (r = 0.511, P < 0.05), contributing to maintain a high level of [Ca2+]i. Hemodialysis had no effect on cell calcium level and Ca2+ influx indices. The therapy with Ca2+ antagonists did not modify the values of resting [Ca2+]i or Ca2+ influx indices, but the correlation between PTH and influx indices was lost. CONCLUSIONS In conclusion, we found evidence for an alteration of erythrocyte Ca2+ influx caused by uremic toxicity that could be related to some organ disorders in uremia. The chronic increase of cellular calcium may contribute to influx derangement.
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Affiliation(s)
- L Soldati
- Division of Nephrology, Dialysis and Hypertension, San Raffaele Scientific Institute, University of Milan, Italy.
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Vezzoli G, Caumo A, Baragetti I, Zerbi S, Bellinzoni P, Centemero A, Rubinacci A, Moro G, Adamo D, Bianchi G, Soldati L. Study of calcium metabolism in idiopathic hypercalciuria by strontium oral load test. Clin Chem 1999; 45:257-61. [PMID: 9931049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Calcium excretion and absorption were evaluated in hypercalciuric calcium stone formers by the study of Sr2+ excretion and absorption after an oral load. Ca2+ stone formers (n = 140) were studied, and the results were compared in the 83 of them who had idiopathic hypercalciuria and in the 57 who had Ca2+ excretion within reference values. Hypercalciuric patients showed increased renal Sr2+ clearance (CRE; 5.26 +/- 0.358 vs 3.29 +/- 0.277 mL/min; P <0.001), whereas Sr2+ absorption [assessed as the area under the serum concentration-time curve (AUC)] was increased at 30 and 60 min (1.53 +/- 0.087 vs 1.21 +/- 0.071 mmol. L-1. min; P <0.05), but not at 240 min after the load. In hypercalciuric patients, the AUCs were positively correlated with urinary Sr2+ fractional excretion (P <0. 001). Conversely, in normocalciuric patients plasma parathyroid hormone (PTH) was negatively correlated with the AUCs (P <0.01) and CRE (P <0.05), whereas 1,25-dihydroxyvitamin D plasma concentrations normalized to PTH were positively correlated with the AUCs (P <0.05). The results of Sr2+ load tests suggest that in the hypercalciuric population, Ca2+ absorption is altered predominantly in the duodenum and that the normal regulation exerted by calciotropic hormones on tubular and enteral Ca2+ handling is lost.
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Affiliation(s)
- G Vezzoli
- Address correspondence to this author at: Divisione Nefrologia, Dialisi e Ipertensione, Ospedale San Raffaele, Via Olgettina 60, 20132 Milano, Italy.
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Vezzoli G, Baragetti I, Zerbi S, Caumo A, Soldati L, Bellinzoni P, Centemero A, Rubinacci A, Moro G, Bianchi G. Strontium absorption and excretion in normocalciuric subjects: relation to calcium metabolism. Clin Chem 1998; 44:586-90. [PMID: 9510866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The relationships of Sr intestinal absorption and renal excretion with biohumoral factors regulating Ca metabolism were studied in 47 normocalciuric subjects with Ca kidney stones. Sr concentrations were measured in serum and urine after an oral load of stable Sr (30.2 mumol/kg body wt). Enteral absorption of the ion (9.77 +/- 0.438 mmol.L-1.min, 240 min after Sr administration), expressed as the area under the plasma concentration-time curve (AUC), and renal clearance (CRE) in these subjects during the test (2.80 +/- 0.336 mL/min) were not different from values for 27 controls. CRE was not correlated with AUCs. Plasma concentrations of parathyroid hormone (PTH) negatively correlated with AUCs (P < 0.01) and correlated with CRE after one outlier was excluded (P < 0.05). Plasma concentrations of 1,25-dihydroxyvitamin D correlated positively with AUCs (P < 0.01) when normalized to the plasma concentration of PTH. Multiple stepwise regression showed that PTH and phosphatemia were significantly related to AUC values at 240 min (P < 0.01). These findings suggest that Sr absorption and excretion reflect the regulation of Ca metabolism, but some differences in renal handling of the two ions may exist.
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Affiliation(s)
- G Vezzoli
- Division of Nephrology Dialysis and Hypertension, San Raffaele Scientific Institute, Milan, Italy.
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Bettinelli A, Vezzoli G, Colussi G, Bianchetti MG, Sereni F, Casari G. Genotype-phenotype correlations in normotensive patients with primary renal tubular hypokalemic metabolic alkalosis. J Nephrol 1998; 11:61-9. [PMID: 9589375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Among the different forms of hereditary renal tubulopathies associated with hypokalemia, metabolic alkalosis and normotension, two main types of disorders have been identified: Gitelman disease, which appears to be a homogeneous post-Henle's loop disorder, and Bartter syndrome, a heterogeneous Henle loop disorder. A specific gene has been found responsible for Gitelman disease, encoding the thiazide-sensitive Na-Cl cotransporter (TSC) of the distal convoluted tubule. From a phenotypic point of view the characteristic findings of this disease are hypocalciuria, hypomagnesemia and tetanic crises appearing during childhood or later. Many subjects are asymptomatic. At least three different genes have been shown to be responsible for Bartter syndrome, characterized by mutations in the proteins encoding respectively the bumetanide-sensitive Na-K-2Cl cotransporter, the inwardly-rectifying renal potassium channel and a renal chloride channel, all protein transports located in the ascending limb of Henle's loop. Mutations in the first two transport proteins have been demonstrated in patients with the hypercalciuric forms of Bartter syndrome associated with nephrocalcinosis (respectively Bartter syndrome type I and II), who were often born after pregnancies complicated by polyhydramnios and premature delivery. Mutations in the gene encoding a renal chloride channel were recently recognized in patients with a Henle tubular defect not associated with nephrocalcinosis (Bartter syndrome type III). Most of the latter group of patients were normo-hypercalciuric and presented dehydration and life-threatening hypotension in the first year of life. However, these three genes do not explain all the patients with Bartter syndrome which unlike Gitelman disease, appears to be a very heterogeneous disorder. Clearance studies, especially if done during furosemide and/or hydrochlorothiazide administration, have been helpful in identifying the site of tubular involvement. Considering both phenotypic and genotypic data, we propose a clinical-pathophysiological and molecular approach to diagnose the different tubulopathies associated with hypokalemic metabolic alkalosis.
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Affiliation(s)
- A Bettinelli
- Clinica Pediatrica II dell'Università e Istituti Clinici di Perfezionamento, Milano, Italy
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Abstract
BACKGROUND Calpains are cytoplasmic proteases widely distributed among eucaryotic cells. Low levels of calpain activity were found in hypertrophic hearts from hypertensive rats, but its role in hypertrophic hearts from human hypertensives is unknown. Therefore, calpain activity was investigated in erythrocytes from essential hypertensive patients in relation to their left ventricular mass. OBJECTIVE To study the role of calpain activity in the development of left ventricular hypertrophy (LVH) in human essential hypertension. METHODS A total of 115 hypertensives (72 untreated and 43 with treatment interrupted for at least 4 months) were included in the study. Calpain I activity was measured in human erythrocytes and LVH was measured as left ventricular mass index (LVMI) by M-mode echocardiography. RESULTS Values are given as mean+/-SEM. The hypertensives (97 men and 18 women) were 43.5+/-0.9 years old with mild to moderate levels of hypertension (systolic/diastolic blood pressure of 147.9+/-1.4/98.7+/-0.9 mmHg) and relatively recent LVH onset (3.5+/-0.5 years). An inverse relation between LVMI and erythrocytic calpain activity was present in all (P = 0.0023, R2 = 7.9%). This relation was still present considering only untreated hypertensives (P = 0.008; R2 = 9.7%), but was lost in the 43 previously treated hypertensives. Moreover, in the untreated hypertensives, after excluding the possible confounding effects of sex, age, body mass index, blood pressure and duration of hypertension, a stepwise regression showed that only two variables remained significantly related to LVMI: calpain (F = 6.23) and mean arterial pressure (F = 4.689). No relations were found between LVMI and calpastatin activity either in the whole population, or in treated or untreated hypertensives. CONCLUSIONS If we assume that the level of erythrocyte calpain activity mirrors the level in cardiomyocytes, these data seem to suggest that increased protein degradation by calpain may prevent the development of LVH in hypertensive patients. This effect is independent of the duration and severity of hypertension.
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Affiliation(s)
- P Stella
- Milan University, S. Raffaele Hospital, Italy
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Soldati L, Spaventa R, Vezzoli G, Zerbi S, Adamo D, Caumo A, Rivera R, Bianchi G. Characterization of voltage-dependent calcium influx in human erythrocytes by fura-2. Biochem Biophys Res Commun 1997; 236:549-54. [PMID: 9245686 DOI: 10.1006/bbrc.1997.7002] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Thus far, the methods used to determine erythrocyte Ca2+ influx have not allowed the assessment of the kinetics of ion uptake. To overcome this drawback, we studied a new method, using the fluorescent Ca2+-chelator fura-2, which directly quantifies intracellular Ca2+ changes in human erythrocytes. This method has the advantage over previous techniques that it monitors continuously cellular Ca2+ levels. The Ca2+ influx is modulated by cellular membrane potential in the presence of a transmembrane Ca2+ concentration gradient and exhibits a first slow increase of the intracellular Ca2+ concentration, followed, after the reachment of a threshold value of 125 +/- 13 nM Ca2+, by a faster increase until a plateau is reached. The influx rate is inhibited by dihydropyridines in the micromolar range. These findings support the hypothesis that erythrocyte Ca2+ influx is mediated by a carrier similar to the slow Ca2+ channels and is dependent on membrane depolarization.
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Affiliation(s)
- L Soldati
- Nephrology, Milan University, S. Raffaele Hospital, Italy
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33
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Vezzoli G, Zerbi S, Baragetti I, Soldati L, Mora S, Dell'Antonio G, Bianchi G. Nonacidotic proximal tubulopathy transmitted as autosomal dominant trait. Am J Kidney Dis 1997; 29:490-5. [PMID: 9100036 DOI: 10.1016/s0272-6386(97)90329-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The family of a patient with a nonacidotic and hypercalciuric proximal tubulopathy was studied. The proband showed glycosuria, aminoaciduria, tubular proteinuria, renal hypophosphatemia, and urate tubular hyporeabsorption without bicarbonate loss. He also presented increased urine calcium excretion, plasma 1,25-dihydroxyvitamin D, and enteral calcium absorption. Clinical consequences of the tubulopathy were osteopenia and calcium kidney stones. Fifteen of the proband's relatives were studied; six of them had renal hypophosphatemia, 10 presented hypercalciuria, and three showed both hypercalciuria and hypophosphatemia. No other reabsorption defects were observed. High plasma levels of 1,25-dihydroxyvitamin D were found in 13 family members; their values correlated positively with calcium excretion and negatively with tubular phosphate reabsorption. None produced stones or had reduced mineral bone density. Hypophosphatemia and hypercalciuria occurred in the two generations studied; their transmission was independent of gender, and male-to-male transmission occurred for both defects. Our findings suggest that a genetic alteration of proximal tubular function could cause multiple reabsorption defects in the proband or renal phosphate leakage in the proband's relatives. The genotypic alteration causing the proximal dysfunctions may be monogenic, with an autosomal dominant pattern of inheritance and variable expressivity. Increased calcium excretion may be due to the proximal tubular alteration; alternatively, it may be the result of a genetic background predisposing to idiopathic hypercalciuria. Phosphate and calcium loss could stimulate 1,25-dihydroxyvitamin D synthesis in proximal tubular cells.
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Affiliation(s)
- G Vezzoli
- Division of Nephrology, Dialysis, and Hypertension, San Raffaele Scientific Institute, Milan, Italy
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34
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Soldati L, Vezzoli G, Salardi S, Spaventa R, Barber BR, Azzani T, Bianchi G. Association between plasma membrane (Ca+Mg) ATPase and calpain/calpastatin system in rat erythrocytes. Biochem Biophys Res Commun 1996; 222:572-5. [PMID: 8670246 DOI: 10.1006/bbrc.1996.0785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
We studied the activity of plasma membrane (Ca+Mg)ATPase from erythrocytes of Milan hypertensive rat strain (MHS) and Milan low calpastatin rat strain (MLCS), that show an activity level of the specific calpain inhibitor, calpastatin, about five fold reduced in comparison with the Milan normotensive rat strain (MNS), while the protease activity level is similar. This imbalance of calpain:calpastatin ratio leads to a decrease of the erythrocyte plasma membrane (Ca+Mg)ATPase activity and to the appearance of 124 kDa fragments, which are the typical products of proteolytic calpain action on the 136 kDa (Ca+Mg)ATPase native form.
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Affiliation(s)
- L Soldati
- Department of Sciences and Biochemical Technologies, University of Milano, Italy
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35
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Vezzoli G, Reina MC, Zerbi S, Spaventa R, Soldati L, Cusi D, Bianchi G. (Ca+Mg)ATPase and calcium influx in erythrocytes of patients with idiopathic hypercalciuria. Biochem Biophys Res Commun 1995; 217:1099-104. [PMID: 8554563 DOI: 10.1006/bbrc.1995.2882] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Increased erythrocyte (Ca+Mg)ATPase activity was previously observed in idiopathic hypercalciuria. In order to verify if this alteration is a primary or a secondary event, we studied Sr influx in erythrocytes from subjects with idiopathic hypercalciuria. (Ca+Mg)ATPase activity was significantly higher in hypercalciuric than in hypercalciuric than in normocalciuric subjects whereas no difference in Sr influx was found between the two groups. (Ca+Mg)ATPase activity positively correlated with the erythrocyte Sr content found after 5 min of incubation and with urine Ca excretion. The normal Sr permeability suggests that (Ca+Mg)ATPase is primarily altered in idiopathic hypercalciuria. The primary increase of (Ca+Mg)ATPase activity may enhance passive Ca influx by reduction of cellular Ca concentration. It may induce a defect in cellular Ca metabolism that may cause idiopathic hypercalciuria by stimulating bone Ca turn-over and enteral Ca absorption.
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Affiliation(s)
- G Vezzoli
- Department of Nephrology Dialysis and Hypertension, S. Raffaele Scientific Institute, University of Milano, Italy
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36
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Molteni N, Bardella MT, Vezzoli G, Pozzoli E, Bianchi P. Intestinal calcium absorption as shown by stable strontium test in celiac disease before and after gluten-free diet. Am J Gastroenterol 1995; 90:2025-8. [PMID: 7485015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate the effect of gluten-free diet on mineral and bone metabolism in women with celiac disease and, using the strontium test, to assess intestinal calcium absorption. METHODS We studied body mass index, biochemical and bone mineral indices, strontium absorption test, and bone mineral density in 18 women (mean age 36.8 yr, range 18-68 yr) with celiac disease at diagnosis and after 12 months of gluten-free diet. RESULTS Mean strontium absorption at diagnosis was markedly decreased with respect to control values (13.84 +/- 9.03% vs 22.47 +/- 4.21%, p < 0.0001), and 11 of the 18 patients (61%, subgroup A) had low values. In all patients, mean hemoglobin, serum potassium, magnesium, plasma calcium, urinary calcium, and phosphorus were significantly abnormal at diagnosis, whereas only the subgroup A had significantly reduced body mass index, 25 OH vitamin D, and elevated alkaline phosphatase. This subgroup differed in body mass index (p < 0.003) and calciuria (p < 0.035) with respect to the other patients. Strontium absorption correlated with body mass index, calcemia, and 25 OH vitamin D. After the gluten-free diet, all biochemical variables and strontium absorption normalized (23.23 +/- 5.54%), whereas bone mineral density did not change. CONCLUSIONS At diagnosis, the patients frequently had intestinal calcium malabsorption, as demonstrated by strontium test, with an early renal compensatory mechanism. After the gluten-free diet, the normalization of calcium absorption and the decrease of mid-molecule parathyroid hormone suggested a normalization of mineral metabolism, although a positive effect on bone mineral density was not evident at that time.
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Affiliation(s)
- N Molteni
- Cattedra di Gastroenterologia, University of Milan, IRCCS Ospedale Maggiore, Italy
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37
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Vezzoli G, Corghi E, Edefonti A, Palazzi P, Dell'Antonio G, Elli A, Azzani T, Vallino F, Bianchi G. Nonacidotic kidney proximal tubulopathy with absorptive hypercalciuria. Am J Kidney Dis 1995; 25:222-7. [PMID: 7847348 DOI: 10.1016/0272-6386(95)90002-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We studied three patients with proximal tubulopathy characterized by defective reabsorption of phosphate, glucose, amino acids, urate, and low molecular weight proteins. This tubulopathy differs from Fanconi syndrome in that the patients had normal plasma bicarbonate and absorptive hypercalciuria associated with increased 1,25-dihydroxyvitamin D levels. The youngest patient was rachitic and may be classified with previously described patients, whereas the other two patients presented with nonrachitic osteopenic bone disease and their tubulopathy started during adult life. Kidney defects appeared sequentially in one of the nonrachitic patients. The two brothers of the youngest patient had similar kidney and bone disturbances. One of the other two patients had a brother with similar kidney reabsorption defects; an additional brother was probably affected and a sister presented with glycosuria, but no other reabsorption defects. The findings in these two families suggest a genetic transmission of proximal tubulopathy. The third case was sporadic. Renal histology of the three patients showed a great number of giant cells in the tubular lumen. We conclude that, at least in our adult patients, tubulopathy may represent a new entity among the proximal tubular dysfunction cases described to date. The features of this proximal defect suggest that it may be caused by a selective alteration of luminal cell membrane transport of phosphate, glucose, amino acids, urate, and proteins in the presence of a normal sodium gradient across the tubular cell membrane.
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Affiliation(s)
- G Vezzoli
- Division of Nephrology, Dialysis and Hypertension, San Raffaele Hospital, University of Milan, Italy
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38
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Vezzoli G, Reina MC, Cusi D, Casirati P, Soldati L, Azzani T, Muirhead R, Bianchi G. Erythrocyte membrane calcium transport in patients with primary hyperparathyroidism. Biochem Biophys Res Commun 1994; 202:1505-10. [PMID: 8060333 DOI: 10.1006/bbrc.1994.2101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The chronic effect of PTH on erythrocyte membrane Ca transport was examined. (Ca+Mg)ATPase activity and passive Sr influx were measured to assess the rate of passive Ca influx (total and inhibited by dihydropyridines [DHPs]), in erythrocytes from patients with primary hyperparathyroidism and normal controls. Erythrocyte Sr influx was lower in patients, due to a decreased DHP-sensitive Sr influx. Conversely, efflux activity of (Ca+Mg)ATPase was not different in patients and controls. We hypothesize that in primary hyperparathyroidism chronic PTH stimulation may induce a downregulation of the erythrocyte Ca influx mediated by DHP-sensitive Ca carrier.
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Affiliation(s)
- G Vezzoli
- Department of Nephrology Dialysis and Hypertension, University of Milan, Italy
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39
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Milano S, Maroldi R, Vezzoli G, Bozzola G, Battaglia G, Mombelloni G. Chylothorax after blunt chest trauma: an unusual case with a long latent period. Thorac Cardiovasc Surg 1994; 42:187-90. [PMID: 7940492 DOI: 10.1055/s-2007-1016485] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report on a case of closed chest trauma with an unusual latent period of 11 weeks in a woman 26 years old. The patient had a dual thoracic duct with a dual lesion and was evaluated using lymphography and CT. We discuss the pathogenetic mechanism and the unusual radiological appearance with discontinuity of the duct, and an increase in back pressure which promotes dilatation of lymphatic vessels and nodes. The dual duct had two separate traumatic consequences: a chyloma on the right and leakage in the pleura on the left. Pleuroperitoneal shunting was effective after failure of conservative treatment. Two years after discharge the patient is asymptomatic with normal chest X-ray image. She is near term in a normal pregnancy and without signs of silent malignancy.
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Affiliation(s)
- S Milano
- Department of Thoracic and Cardiovascular Surgery, Civili Hospital, Brescia, Italy
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40
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Cusi D, Fossali E, Piazza A, Tripodi G, Barlassina C, Pozzoli E, Vezzoli G, Stella P, Soldati L, Bianchi G. Heritability estimate of erythrocyte Na-K-Cl cotransport in normotensive and hypertensive families. Am J Hypertens 1991; 4:725-34. [PMID: 1930857 DOI: 10.1093/ajh/4.9.725] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Na-K-Cl cotransport was measured in 209 essential hypertensive patients (EH) and in 114 normotensive controls (NT). The distribution of Na-K-Cl cotransport was bimodal in EH and unimodal in NT. The EH with higher Na-K-Cl cotransport values had increased passive permeability to Na in fresh erythrocytes and increased Li-Na countertransport compared to NT. Li-Na countertransport was significantly increased in the EH as a whole, but the increase was accounted for by some EH individuals with elevated Na-K-Cl cotransport values. A simple biometric analysis of the Na-K-Cl cotransport was performed for 287 individuals of 86 families with different prevalence of hypertension (neither parent hypertensive, 39 families; one, 31 families; or both, 16 families). Na-K-Cl cotransport was not correlated between spouses, but was correlated highly significantly between the average value of the two parents (mid-parent) and offspring. The polygenic additive heritability (h2) was about 50% for all families considered together. It increased slightly for the hypertensive families analyzed alone (no significant correlation was found, and hence genetic heritability, in the normotensive families). Finally, after applying arbitrary cut-off points to the Na-K-Cl cotransport values, segregation analysis showed that some major gene, recessive for the high allele, also contributes to the phenotypic value of Na-K-Cl cotransport.
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Affiliation(s)
- D Cusi
- Postgraduate School of Nephrology, University of Milano, Italy
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41
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Betti A, Vittori O, Vezzoli G. [Diagnostic imaging of Budd-Chiari syndrome in adults and children]. Radiol Med 1990; 79:70-6. [PMID: 2180005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Budd-Chiari syndrome is caused by the obstruction of the hepatic veins or of the inferior vena cava. It is characterized by the classic symptomatological triad: ascites, hepatomegaly, and abdominal pain. In 2/3 cases its etiology remains unknown. Budd-Chiari syndrome may be associated with polycythemia vera, neoplasms, chronic leukemia, congenital abnormalities, hypercoagulation conditions, pregnancy, oral contraceptives, and constrictive pericarditis. Even though its clinical diagnosis is difficult, radiology plays a decisive role with US, CT, MR imaging and, above all, angiography; the latter, together with liver biopsy, generally provides with an unquestionable diagnosis. Through the definition of stage of the disease, of level (intrahepatic, venous, caval, cardiac), of type (intrinsic or extrinsic), and degree of both obstruction and consequent development of collateral channels, radiology determines which patients should undergo a medical or a surgical treatment. In some case, percutaneous angioplasty can be performed. Four cases of Budd-Chiari syndrome, including two children, were investigated with US, CT, angiography, and liver biopsy; MR imaging was also employed in one case. The underlying cause was identified in 3 patients: constrictive pericarditis of probable congenital origin and web occlusion of the inferior vena cava near the right atrium in the 2 children; hepatic vein thrombosis due to essential thrombocythemia in the third case. In the fourth patient, thrombosis of the inferior vena cava and hepatic veins was unexplained. The diagnosis was established by means of liver biopsy and phlebography of the hepatic veins. Good diagnostic information was also supplied by non-invasive techniques, such as US, CT, and MR imaging.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- A Betti
- Servizio di Radiologia I, Spedali Civili, Brescia
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42
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Cusi D, Alberghini E, Pati P, Tripodi G, Barlassina C, Colombo R, Cova T, Niutta E, Vezzoli G, Bianchi G. Pathogenetic mechanisms in essential hypertension. Analogies between a rat model and the human disease. Int J Cardiol 1989; 25 Suppl 1:S29-36. [PMID: 2695468 DOI: 10.1016/0167-5273(89)90090-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Essential hypertension is a genetic disease. Its phenotypic expression depends on the interaction between genetic and environmental factors. In prehypertensive rats of the Milan hypertensive strain (MHS) a genetically inherited increase of tubular reabsorption was found, which causes the increase of blood pressure. Studies of ion transport systems in these rats have shown that the Na-K cotransport activity is increased both in erythrocytes and in tubular cells of MHS rats compared with their normotensive controls (MNS) and that this alteration is genetically linked to the transmission of high blood pressure levels. Also, in young human normotensives prone to develop essential hypertension there is an abnormal pattern of renal function which could be in agreement with a primitive increase in tubular reabsorption. Studies of erythrocyte ion transport systems in these subjects suggest that at least in a subgroup of humans predisposed to develop essential hypertension a pathogenetic mechanism similar to the one proposed for the MHS rat can be at work.
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Affiliation(s)
- D Cusi
- Institute of Medical Sciences, Postgraduate School of Nephrology, University of Milano, Italy
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43
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Bianchi G, Vezzoli G, Cusi D, Cova T, Elli A, Soldati L, Tripodi G, Surian M, Ottaviano E, Rigatti P. Abnormal red-cell calcium pump in patients with idiopathic hypercalciuria. N Engl J Med 1988; 319:897-901. [PMID: 2971139 DOI: 10.1056/nejm198810063191402] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Idiopathic hypercalciuria is a common disorder whose inheritance suggests an enzyme abnormality in calcium transport. We measured calcium-magnesium-ATPase activity in erythrocytes from 38 patients (mean age [+/- SEM], 40 +/- 2.1 years) with idiopathic hypercalciuria (24-hour urinary calcium excretion greater than or equal to 0.1 mmol per kilogram of body weight) and a history of multiple calcium oxalate kidney stones. As compared with 41 healthy controls, the patients with hypercalciuria had increased erythrocyte-membrane calcium-magnesium-ATPase activity (64.2 +/- 2.19 vs. 51.6 +/- 1.91 nmol of ATP split per milligram per minute; P less than 0.01) and increased sodium-potassium pump activity (6866 +/- 233 vs. 6096 +/- 228 mumol of sodium per liter of red cells per hour; P less than 0.05). No significant difference between the two groups was found in erythrocyte sodium-potassium cotransport, sodium-lithium countertransport, or potassium content. In 66 patients with kidney stones (38 with hypercalciuria and 28 with normal calcium excretion), 24-hour urinary calcium excretion correlated with calcium-magnesium-ATPase activity (r = 0.46, P less than 0.001). Erythrocyte calcium-magnesium-ATPase activity remained unchanged in eight subjects studied after four months on a low-calcium diet. A study of 30 healthy families found significant correlations between mean values in parents and those in offspring for calcium-magnesium-ATPase (r = 0.68, P less than 0.001) and urinary calcium excretion (r = 0.45, P less than 0.02), with no significant correlations between parents with respect to these measures (r = 0.27 and r = 0.08, respectively). We conclude that abnormalities in erythrocyte calcium-magnesium-ATPase activity may represent an inherited defect in calcium transport related to the cause of idiopathic hypercalciuria.
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Affiliation(s)
- G Bianchi
- Institute of Medical Sciences, Postgraduate School of Nephrology, University of Milan, Italy
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44
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Bergonzini R, Vezzoli G, Rossi G, Arrighini MC, Saldi G, Chiodera PL. [Malignant lymphomas with thoracic localization. Problems of semeiology and radiological staging]. Radiol Med 1988; 76:56-63. [PMID: 3399709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A series of 234 malignant lymphomas (121 Hodgkin lymphomas and 113 non-Hodgkin lymphomas) observed at the Brescia City Hospital between 1981 and 1987 has been reviewed. This paper is aimed at assessing: 1) in which sectors of the staging radiology is indicated; 2) which radiological techniques are needed for the staging of chest lymphomas; 3) which impact they have on the therapeutic program. All patients underwent chest X-ray, which was integrated by conventional tomography in 80% of cases. Only 76 patients underwent CT: 35 times for staging, and 69 times for restaging (overall figure: 104). The two techniques were compared: in untreated patients CT gave supplementary information in 19 out of 35 cases (54.3%). In 7 patients (20%) the findings were such as to determine a change in the previous staging; only in a case (2.8%) was the management affected; in treated patients CT proved to be superior to conventional radiology in 28 out of 69 cases (40.56%) and allowed the possibility of a recurrence (which was suggested by clinical and radiological findings) to be ruled out in 23 patients (33.3%). In our opinion, CT should not be used as a routine investigation in the staging of malignant thoracic lymphomas; on the contrary, it should be limited to selected cases, when a radical radiotherapy is to be performed, or when clinics and plain radiographs proved unable to assess the nature of a pathologic thoracic condition.
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Affiliation(s)
- R Bergonzini
- Servizio di Radiologia I, Spedali Civili, Brescia
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45
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Bianchi G, Cusi D, Vezzoli G. Role of cellular sodium and calcium metabolism in the pathogenesis of essential hypertension. Semin Nephrol 1988; 8:110-9. [PMID: 3293135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The differences observed among rat strains in both basal [Na+]i and the several cation transport systems seem to be due to the different genetic background as clearly shown in F2 populations or after bone marrow transplantation in MHS. The same may be true for humans. In spite of all the caution taken in interpreting the data, because of the great possibility of methodological errors, it is likely that the differences observed in many laboratories are due to uneven genetic or ethnic composition of the samples studied, as shown by Dagher and Canessa. One intriguing observation is that most reports of "low Na-K cotransport" values in hypertensive patients are from Mediterranean countries (Italy, France, and Spain), whereas most reports of "high," or "not low Na-K cotransport," or very high values of countertransport came from populations originating from North Europe (Denmark, USA, South African whites). We are not aware of any study on erythrocyte Na-K cotransport performed in Great Britain (the greatest source of American immigrants). Indeed the difference in cotransport values between North and South European hypertensives might be due to different environmental factors, but if this is so, the difference does not depend on the salt consumption or plasma lipids that are similar in our high and low Na-K cotransport hypertensives (Cusi D et al, submitted). The picture seems relatively less confusing for calcium. The most consistent alterations in different models of hypertension is a decreased Ca-pump in SHR, MHS, and DOCA rats, reduced calcium binding in SHR and MHS, and reduced microsomal ATP dependent calcium uptake in SHR and DOCA rats. [Ca++]i, which is increased in established hypertension in man and rats, is normal in young prehypertensive rats and humans, and returns to normal values after pharmacological treatment of hypertension. This pattern of changes suggests that genetic control of these transport systems is weaker, and probably much influenced by different environmental conditions. However, because of the pivotal role of calcium in vascular smooth muscle cell concentration, its intracellular increase may be the common pathway of the different forms of hypertension. What remains unclear is the relation, if any, between calcium and sodium. Blaustein tried to find a link between them, but his hypotheses have yet to be confirmed.
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Affiliation(s)
- G Bianchi
- Institute of Medical Sciences, Postgraduate School of Nephrology, University of Milano, Italy
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Vezzoli G, Vittori O, Tenchini P, Ferrari VD, Bergonzini R. [Focal nodular hyperplasia of the liver. A rare pedunculated form]. Radiol Med 1986; 72:969-72. [PMID: 3797721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Bianchi G, Ferrari P, Cusi D, Barber BR, Salardi S, Torielli L, Tripodi MG, Niutta E, Vezzoli G, Barlassina C. Membrane abnormalities in essential hypertension: physiologic and genetic links. Ann N Y Acad Sci 1986; 488:266-75. [PMID: 3555253 DOI: 10.1111/j.1749-6632.1986.tb46564.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Bianchi G, Ferrari P, Cusi D, Guidi E, Salardi S, Torielli L, Tripodi MG, Niutta E, Elli A, Vezzoli G. Cell membrane abnormalities and genetic hypertension. J Clin Hypertens 1986; 2:114-9. [PMID: 3531412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Evidence indicates that an alteration in kidney function has a causal role in the pathogenesis of hypertension in the Milan hypertensive strain (MHS) rat. At the prehypertensive stage, these animals have increased glomerular filtration rate and 24-hour urinary output, whereas plasma renin activity and urinary kallikrein are lower. After transplantation, the MHS kidney increases the blood pressure of a normotensive recipient. Micropuncture experiments, where single nephron filtration rate, tubuloglomerular feedback, proximal tubular reabsorption, micro-pressures in tubuli, and interstitium and interstitial oncotic pressure were measured, suggest that the intrinsic ability of MHS proximal tubular epithelium to reabsorb solute and water is greater in prehypertensive MHS rats than in Milan normotensive strain (MNS) rats. Also rheogenic Na transport across the brush-border vesicles isolated from proximal tubular cells is faster. When erythrocytes and proximal tubular cells of MHS rats are compared to those of MNS rats, the former have smaller volume and Na content, whereas the Na transport is faster and the Ca ATPase at Vmax is lower. This indicates that the genetic cellular abnormality responsible for the renal functional abnormality and hypertension is also present in erythrocytes. Moreover, MHS erythrocyte abnormalities are genetically determined within the stem cells and are genetically associated with hypertension. Because a correlation was also found in human hypertension between erythrocyte Na transport abnormality and renal function, it is proposed that the erythrocyte may be used for studying the genetic molecular mechanisms of hypertension.
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Abstract
Results concerning kidney and red blood cell (RBC) function of Milan hypertensive rats (MHS), and of their age- and body weight-matched normotensive controls (MNS), are summarized. Our data suggest a biochemical and physiological link between RBC abnormalities and the renal mechanisms causing hypertension in MHS, and therefore the possibility of using the former as a tool for studying the genetic biochemical mechanisms of hypertension. In particular, the following results are discussed: a positive correlation between blood pressure and RBC Na+-K+ cotransport found in the F2 generation, obtained by crossing F1 (MHS X MNS) hybrids; bone marrow transplantation from MHS and MNS into F1 hybrids, causing a parallel change in recipient RBC characteristics; and similarities between erythrocytes and renal tubular cells in Na+ content, cell volume, and Na+ transport. Ca2+ ATPase or Ca2+ pump at Vmax are lower in MHS renal tubular cells and MHS erythrocytes than in MNS cells. Moreover, isolated kidneys of MHS and MNS, perfused in vitro with media at different Ca2+ concentrations, showed that the function of MNS kidney remained stable over a range of Ca2+ from 0.75 to 1.25 mM, while the function of MS kidney deteriorated at a Ca2+ concentration of 1.25 mM.
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Vezzoli G, Elli A, Niutta E, Quarto di Palo F, Bianchi G, Carafoli E. Ca-ATPase in erythrocyte membrane ghost cells of MHS rats. Am J Nephrol 1986; 6 Suppl 1:63-5. [PMID: 2950756 DOI: 10.1159/000167221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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