Navegando por Palavras-chave "hypercalciuria"
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- ItemSomente MetadadadosBone disease in idiopathic hypercalciuria(Lippincott Williams & Wilkins, 2006-07-01) Heilberg, Ita P. [UNIFESP]; Weisinger, Jose R.; Cent Univ Venezuela; Universidade Federal de São Paulo (UNIFESP)Purpose of reviewDecreased bone mineral density and increased prevalence of bone fractures have been found in patients with idiopathic hypercalciuria. the purpose of this review is to summarize the recent published evidence that supports a potential role of the bone, and its link to the kidney and intestine, in the pathogenesis of idiopathic hypercalciuria. the effects of hypercalciuria on bone and the implications for treatment are also reviewed.Recent findingsEvidence suggests that the incidence of a first fracture in kidney stone patients is fourfold higher than the control population. Support for the role of bone in the pathophysiology of hypercalciuria has been corroborated. New studies have detailed the effects of several cytokines increased number and sensitivity of vitamin D receptors, and increased acid production - upon the bone acting cells. Similarly, recent clinical and experimental studies have suggested that genetic factors confer a predisposition to the formation of renal calcium stones and bone demineralization.SummaryWhether hypercalciuria is the result of a primary bone disorder, a consequence of a persisting negative calcium balance or a combination of both still remains to be determined. Nevertheless, bone status must be evaluated and followed up in patients with idiopathic hypercalciuria.
- ItemSomente MetadadadosA critical appraisal of the radiological evaluation of nephrocalcinosis(Karger, 2007-01-01) Cheidde, Lara; Aron Ajzen, Sergio; Tamer Langen, Cecilia Helena; Christophalo, Dejaldo; Pfeferman Heilberg, Ita; Universidade Federal de São Paulo (UNIFESP)Background/Aim: the level of agreement concerning the diagnosis of nephrocalcinosis (NC) based on ultrasonography (US), computed tomography (CT) or kidney/ureter/bladder (KUB) X-ray was assessed. Methods: Sequences of KUB+US+CT from 62 patients, 48 with at least one exam suggesting NC and 14 with pelvicalyceal calcifications ( nephrolithiasis) were reviewed twice by 3 radiologists ( firstly randomized and secondly presenting KUB+US+CT of each patient together). Results: the intraobserver concordance varied from 76 to 90% for KUB, 77 to 85% for US and 82 to 89% for CT. There was a significant change in diagnosis between the 1st and 2nd reviews for observer 1 in KUB and CT, for observer 2 in US, but not for observer 3. Evaluating patients' exams together did not provide a better agreement. the highest sensitivity and specificity ( 92 and 89%, respectively) were only attained when 2 exams suggested NC diagnosis, being CT one of them. These enabled us to suggest that 33 out of 48 (62.5%) patients had NC ( evidenced in US+CT+KUB (81.8%), US+CT (12.1%) or KUB+CT (6.1%). Conclusion: the low level of concordance renders the radiological diagnosis of NC difficult. Nephrocalcinosis should be confirmed by CT combined with either US or KUB. Copyright (c) 2007 S. Karger AG, Basel.
- ItemSomente MetadadadosEffect of etidronate treatment on bone mass of male nephrolithiasis patients with idiopathic hypercalciuria and osteopenia(Karger, 1998-08-01) Heilberg, I. P.; Martini, L. A.; Teixeira, S. H.; Szejnfeld, V. L.; Carvalho, A. B.; Lobao, R.; Draibe, S. A.; Universidade Federal de São Paulo (UNIFESP)Osteopenia is frequently found among calcium stone forming (CSF) patients with hypercalciuria. We investigated the effect of a 2-year therapeutic course of etidronate, a bone-sparing agent, in 7 young male CSF patients. the treatment consisted of a cyclic intermittent administration of phosphate followed by sodium etidronate and calcium supplementation every 74 days. Bone mineral density (BMD) measured at 12-month intervals and bone biopsies performed at baseline and after 2 years were the primary efficacy parameters. Mean lumbar spine BMD increased significantly after the 1st year by 2.6 +/- 1.0% (mean +/- SE, p < 0.05) and nonsignificantly after the 2nd year by 5.6 +/- 2.6 %. Nonsignificant changes were observed for femoral neck mean BMD after either the 1st or the 2nd year (decrease of 2.0 +/- 1.0% and 2.0 +/- 3.0%, respectively). Mean histomorphometric parameters showed that bone volume, osteoid volume, and eroded surfaces did not differ from baseline (13.9 +/- 2.2 vs. 12.2 +/- 1.1%, 1.2 +/- 0.7 vs. 2.6 +/- 0.7%, and 20.7 +/- 6.2 vs. 13.7 +/- 1.3%, respectively). Osteoid surface was significantly lower than baseline values (9.5 +/- 5.2 vs. 18.8 +/- 5.3%, p < 0.05). These data suggest that etidronate given to young male CSF patients presenting with hypercalciuria and osteopenia led to a significant amelioration of BMD, evident only in the lumbar spine after 1 year of treatment. There was no histological evidence of long-term improvement in bone remodeling.
- ItemSomente MetadadadosHematuria due to hyperuricosuria in children: 36-month follow-up(Dustri-verlag Dr Karl Feistle, 1997-11-01) Perrone, H. C.; Stapleton, F. B.; Toporovski, J.; Schor, Nestor [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); CHILDRENS HOSP & MED CTRHyperuricosuria (HU), defined as a urinary acid excretion higher than 95 percent of normal values, is an important lithogenic factor, accounting; for about 5-20% of recurrent hematuria in childhood. We prospectively studied 30 children (15 male, 15 female aged 3 to 13 years old) with previously undiagnosed isolated hematuria and HU for 6 to 36 months. The family history of nephrolithiasis was positive in 40%, Idiopathic hypercalciuria (IH), UCa >4 mg/kg/day, was not found initially, but was diagnosed after 6 to 24 months in 20% of the patients. The following treatments were utilized: restricted purine diet (13%), allopurinol (4%) and potassium citrate (1%). No specific treatment was given to 82% of the patients. Therapy normalized uricosuria with resolution of hematuria over 6-12 months. Thirteen percent and 6% of untreated patients developed urolithiasis after 6 and 12 months respectively. The data suggest that HU, like IH, is associated with hematuria. Furthermore, recognition of this association may prevent unnecessary, and in some cases, invasive diagnostic manoeuvres.
- ItemSomente MetadadadosPhyllanthus niruri normalizes elevated urinary calcium levels in calcium stone forming (CSF) patients(Springer, 2004-10-01) Nishiura, J.; Campos, A.; Boim, M.; Heilberg, I; Schor, N.; Universidade Federal de São Paulo (UNIFESP)Phyllanthus niruri is a plant used for years in Brazil to treat urinary calculi. We prospectively evaluated the effect of P. niruri intake on 24 h urinary biochemical parameters in an attempt to assess its in vivo effect in calcium stone forming (CSF) patients. A total of 69 CSF patients (39 males and 30 females, 38+/-8 years old) were randomized to take either P. niruri (n=33) (450 mg capsules, td) or placebo (n=36) for 3 months. Blood calcium, uric acid, citrate, magnesium, oxalate, sodium and potassium were determined at baseline and at the end of the study. A subset analysis was made in patients classified according to the presence of metabolic abnormalities (hypercalciuria, hyperuricosuria, hyperoxaluria, hypocitraturia and hypomagnesiuria). Overall, there were no significant differences in the mean values of urinary parameters between the urine samples before and after P. niruri intake, except for a slight reduction in mean urinary magnesium after P. niruri, which was within the normal range. However, in the subset analysis, we observed that P. niruri induced a significant reduction in the mean urinary calcium in hypercalciuric patients (4.8+/-1.0 vs 3.4+/-1.1 mg/kg/24 h, P<0.05). in this short-term follow-up, no significant differences in calculi voiding and/or pain relief between the groups taking P. niruri or the placebo were detected. Our data suggest that P. niruri intake reduces urinary calcium based on the analysis of a subset of patients presenting with hypercalciuria. Larger trials including primary hypercalciuric stone formers should be performed in order to confirm these findings and to determine the possible clinical consequences of urinary calcium reduction during P. niruri administration.
- ItemSomente MetadadadosRecurrent vesical calculi, hypercalciuria, and biochemical evidence of increased bone resorption in an adult male with paraplegia due to spinal cord injury: is there a role for intermittent oral disodium etidronate therapy for prevention of calcium phosphate bladder stones?(Nature Publishing Group, 2005-05-01) Vaidyanathan, S.; Watson, I. D.; Jonsson, O.; Buczynski, A. Z.; Grases, F.; Heilberg, Ita Pfeferman [UNIFESP]; Yasui, T.; Wyndaele, J. J.; Tozawa, K.; Kohri, K.; Schurch, B.; Hughes, P. L.; Singh, G.; Soni, B. M.; Sett, P.; Fraser, W. D.; Dist Gen Hosp; Sahlgrenska Univ Hosp; Metropolitan Rehabil Ctr; Univ Balearic Isl; Universidade Federal de São Paulo (UNIFESP); Nagoya City Univ; Univ Ziekenhuis Antwerpen; Univ Hosp Balgrist; Royal Liverpool & Broadgreen Univ HospStudy design: Clinical case report with comments by colleagues from Sweden, Poland, Spain, Brazil, Japan, Belgium and Switzerland.Objectives: To discuss the role of disodium etidronate therapy for prevention of calcium phosphate vesical calculi in persons with spinal cord injury, who have hypercalciuria and biochemical evidence of increased bone resorption.Setting: Regional Spinal Injuries Centre, Southport, UK.Methods: A 21-year-old male sustained paraplegia (T-10; ASIA scale: A) in a road traffic accident in June 2001. He had an indwelling urethral catheter until the end of August 2001, when he started self-catheterisation. He developed bladder stones and electrohydraulic lithotripsy (EHL) was performed in May 2002. All stone fragments were removed. Recurrence of vesical calculi was noted in October 2002. These stones were fragmented by lithoclast lithotripsy in two sessions, in December 2002 and February 2003; all stone fragments were removed at the end of the second session. This patient reverted to indwelling catheter drainage when vesical calculi recurred. in September 2003, X-ray of the abdomen showed recurrence of vesical calculi. By February 2004, the stones had increased in size and number. EHL of vesical calculi was again performed in April 2004. Complete clearance was achieved.Results: A 24-h urinalysis detected hypercalciuria - 18.7 mmol/day ( reference range: 2.5 - 7.5). Biochemical analysis of vesical calculus revealed calcium phosphate (85%) and magnesium ammonium phosphate (15%). Plasma C-terminal telopeptide (CTX) was increased - 1.06 ng/ml ( reference range: 0.1 - 0.5 ng/ml). Free deoxypyridinoline/creatinine ratio (fDPD/Cr) in urine was also increased - 20.2 ( reference range: 2.3 - 5.4). in April 2004, this patient was prescribed disodium etidronate 400 mg day. Nearly 3 months after commencing therapy with etidronate, plasma CTX decreased to 0.87 ng/ml. fDPD/Cr in urine also decreased to 12.4. After 4 months of etidronate therapy, 24- h urinary calcium excretion had decreased to 6.1 mmol/day.Conclusion: Etidronate ( 400 mg daily) is a very effective inhibitor of calcium phosphate crystallisation. Etidronate decreased urinary excretion of calcium, an important factor in prevention of calcium phosphate bladder stones. Etidronate therapy is not a substitute for other well-established methods for prevention of vesical calculi in spinal cord injury patients, for example, large fluid intake, avoiding long-term catheter drainage. Intermittent therapy with etidronate may be considered in selected patients, in whom hypercalciuria persists after instituting nonpharmacological therapy for an adequate period, for example, early mobilisation, weight-bearing exercises, and functional electrical stimulation. However, possible side effects of etidronate, and the fact that etidronate is not licensed in United Kingdom for prevention of urolithiasis, should be borne in mind.
- ItemSomente MetadadadosSensitivity to calcium intake in calcium stone forming patients(Karger, 1996-06-01) Heilberg, Ita Pfeferman [UNIFESP]; Martini, Ligia Araujo [UNIFESP]; Draibe, Sergio Antonio [UNIFESP]; Ajzen, Horacio [UNIFESP]; Ramos, Oswaldo Luiz [UNIFESP]; Schor, Nestor [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The absorptive or renal origin of hypercalciuria can be discriminated using an acute oral calcium load test (ACLT). Of 86 patients with calcium oxalate kidney stones, 28 (23%) were found to be hypercalciuric (HCa) and 58 (67%) normocalciuric (NCa) on their customary free diet, containing 542 +/- 29 mg/day (mean +/- SE) of calcium. Since the apparently normal 24-hour calcium excretion of many calcium stone formers (CSF) may be due to a combination of high calcium absorption with moderately low calcium intake, all patients were investigated by ACLT. Of 28 HCa patients, 13 (46%) were classified as absorptive (AH) and 15 (54%) as renal hypercalciuria (RH). Of the 58 NCa patients, 38 (65%) presented features of intestinal hyperabsorption and were therefore designated as AH-like, and 20 (35%) as RH-like. To further elucidate the role of dietary calcium in these CSF, a chronic calcium load test (CCLT), consisting of 1 g/day of oral Ca for 7 days, was designed. A positive response to the CCLT was considered to occur when urinary calcium (uCa) was greater than or equal to 4 mg/kg/24 h on the 7th day. Among NCa patients, 29% of AH-like subjects responded to the CCLT and 71% did not; 50% of RH-like subjects also responded and 50% did not. In HCa patients, 85% of AH and 67% of RH subjects maintained uCa greater than or equal to 4 mg/kg/24 h after the CCLT and 15% of AH and 23% of RH subjects did not. However, a significant additional increase in mean uCa was not observed among HCa patients. All patients were submitted to a second evaluation of fasting calciuria (Ca/Cr). A modification of this parameter was noticed in 89% of RH-like and 78% of RH patients, In conclusion, these data suggest the presence of subpopulations of patients sensitive or not to calcium intake, regardless of whether the acute response to a calcium overload test suggested AH or RH. The CCLT disclosed dietary hypercalciuria in 21/58 (36%) of previously NCa patients. In these NCa patients, the ACLT may be replaced by the CCLT. The distinction between AH and RH initially evidenced by the ACLT was not further confirmed. These data suggest that either fasting Ca/Cr is not adequate for subclassification of HCa or that AH and RH represent a different spectrum of the same disease, and that a primary resorptive component should also be considered.
- ItemSomente MetadadadosVitamin D receptor gene polymorphism and bone mineral density in hypercalciuric calcium-stone-forming patients(Karger, 2002-01-01) Heilberg, I. P.; Teixeira, S. H.; Martini, L. A.; Boim, M. A.; Universidade Federal de São Paulo (UNIFESP)Reduced bone mineral density (BMD) and an increased risk of vertebral fracture have been reported in calcium-stone-forming (CSF) patients presenting with idiopathic hypercalciuria. We investigated the association between Bsml vitamin D receptor (VDR) polymorphism and BMD in 68 hypercalciuric CSF patients (35 males and 33 premenopausal females, mean age +/- SD = 39 +/- 10 years). BMD was measured at lumbar spine (L-2-L-4) and femur neck sites using dual energy X-ray absorptiometry. A 72-hour dietary record and a 24-hour urine sample were obtained from each patient to determine calcium intake and excretion. the allelic frequency found for the sample as a whole was 16% BB, 44% Bb and 40% bb. Mean BMD values did not significantly differ among BB, Bb and bb patients at L2-L4 (1.162 +/- 0.10, 1.133 +/- 0.11 and 1.194 +/- 0.19 g/cm(2), mean SD, respectively) or at neck sites (0.920 +/- 0.11, 0.931 +/- 0.15 and 0.982 +/- 0.15 g/cm(2), respectively). Calcium intake and excretion were also not significantly different among the three genotypes. Patients were then divided into two groups, normal BMD, T-score greater than or equal to -1 (n = 34) and low BMD, T-score <-1 (n = 34), to further evaluate the allele influence on previous bone loss. Despite a trend for a higher mean BMD at spine or neck sites for patients with one or two b alleles when compared to BB patients, the difference did not reach statistical significance. the distribution of BB, Bb and bb genotypes in the low-bone-mass group (15, 47 and 38%, respectively) was similar to that in the normal-bone-mass group (18, 41 and 14%, respectively). These data suggest that Bsml VDR polymorphism does not play an important role in the bone loss seen in hypercalciuric CSF patients. Copyright (C) 2002 S. Karger AG, Basel.