acid-phosphatase and Kidney-Failure--Chronic

The association between elevated serum type 5 TRACP activity and metabolic bone diseases has been recognized for many years. However, serum type 5 TRACP exists as two related isoforms: 5a and 5b. Only isoform 5b is osteoclast-derived; the origin and significance of isoform 5a has hardly been explored. We have used simultaneous immunoassays for type-5 TRACP activity and total type-5 TRACP protein in conjunction with non-denaturing gel electrophoresis and column chromatography to investigate the nature and significance of TRACP isoforms 5a and 5b in end-stage renal disease (ESRD) and rheumatoid arthritis (RA). Our studies have shown that TRACP activity and protein are elevated in approximately 50% of sera from ESRD patients, which is caused by osteoclastic isoform 5b. We have also shown that total TRACP protein, but not TRACP activity, is elevated in approximately 30% of sera from RA patients, which is caused by non-osteoclastic isoform 5a. When macrophages or dendritic cells (DC) were cultured in vitro, abundant TRACP 5a was secreted into the culture medium, whereas TRACP 5b was retained intracellularly by both cell types. This implicates macrophages and DC as potential sources of elevated TRACP 5a in RA. Because TRACP isoform expression may be disease-specific, it is important to be able to distinguish TRACP 5a from 5b. There are four criteria by which to do so: (1) TRACP 5a bears sialic acid residues while TRACP 5b does not; (2) the pH optimum for TRACP 5a is 5.2 while that for TRACP 5b is 5.8; (3) the specific activity of TRACP 5a is significantly lower than that of TRACP 5b; and (4) TRACP 5a is as an uncleaved polypeptide, whereas TRACP 5b is a proteolytically nicked disulfide-linked "heterodimer." The differences in biochemical properties and disease-specific expression of TRACP isoforms 5a and 5b suggest that they are regulated differently and perform separate functions in a tissue-specific manner.

Topics: Acid Phosphatase; Arthritis, Rheumatoid; Blotting, Western; Dendritic Cells; Epitopes; Humans; Hydrogen-Ion Concentration; Immunoassay; Isoenzymes; Kidney Failure, Chronic; Macrophages; Peptides; Protein Isoforms; Tartrate-Resistant Acid Phosphatase

Renal osteodystrophy continues to be a long-term complication associated with high rates of morbidity in patients with chronic renal failure. Although bone histomorphometry is the most reliable diagnostic method, several new biochemical markers of bone turnover have been proposed in recent years for the evaluation of bone remodelling in uremic patients. This review assesses the value and the limitations of serum markers of bone formation and resorption in the diagnosis of the major types of renal osteodystrophy. In addition, we consider the hypothetical role of serum beta2-microglobulin and of some local mediators involved in the process of bone cell activation and inhibition, such as circulating cytokines and their inhibitors and receptors.

Topics: Acid Phosphatase; Alkaline Phosphatase; beta 2-Microglobulin; Biomarkers; Bone and Bones; Bone Remodeling; Chronic Kidney Disease-Mineral and Bone Disorder; Collagen; Collagen Type I; Cytokines; Humans; Isoenzymes; Kidney Failure, Chronic; Osteocalcin; Parathyroid Hormone; Peptide Fragments; Peptides; Predictive Value of Tests; Procollagen; Tartrate-Resistant Acid Phosphatase

Topics: Acid Phosphatase; Ascites; Chyle; Drainage; Humans; Hypertension, Portal; Kidney Failure, Chronic; Lymph; Pancreatitis; Shock, Hemorrhagic; Sympathetic Nervous System; Thoracic Duct

Cinacalcet hydrochloride is a calcimimetic agent that activates the calcium-sensing receptor on the surface of parathyroid cells and inhibits parathyroid hormone (PTH) secretion. To manage secondary hyperparathyroidism, cinacalcet, which lowers PTH levels without increasing serum calcium, phosphorus and calcium-phosphorus product (Ca x P) levels, may provide a new potential therapy. To identify the optimal starting dose of cinacalcet for Japanese hemodialysis patients with secondary hyperparathyroidism, this double-blind, placebo-controlled, parallel, dose-finding study was conducted. One hundred and twenty Japanese hemodialysis patients with intact PTH levels greater than or equal to 300 pg/mL were randomized into four groups: placebo, and 12.5, 25 and 50 mg of cinacalcet. The treatment period was three weeks followed by a two-week follow-up observation period. Cinacalcet decreased serum intact PTH levels in a dose-dependent manner, and also decreased serum calcium, phosphorus, Ca x P, tartrate-resistant acid phosphatase and osteocalcin levels. The treatment with cinacalcet was generally well tolerated in this study. However, the incidence of treatment-related adverse events, such as gastrointestinal disorders and hypocalcemia, and the rate of withdrawal from the study due to treatment-related adverse events were higher in the 50 mg dose group than in the other groups. On the basis of both efficacy and safety results, 25 mg has been identified as the optimal starting dose of cinacalcet for Japanese hemodialysis patients with secondary hyperparathyroidism.

Topics: Acid Phosphatase; Aged; Asian People; Calcium; Cinacalcet; Dose-Response Relationship, Drug; Double-Blind Method; Female; Follow-Up Studies; Humans; Hyperparathyroidism, Secondary; Isoenzymes; Japan; Kidney Failure, Chronic; Male; Middle Aged; Naphthalenes; Osteocalcin; Parathyroid Hormone; Phosphorus; Renal Dialysis; Tartrate-Resistant Acid Phosphatase

Postmenopausal women with end-stage renal failure are at an increased risk of fracture because of the effects of secondary hyperparathyroidism and postmenopausal osteoporosis. In the present study, we investigated the feasibility of using raloxifene to prevent fractures in postmenopausal women with end-stage renal failure on hemodialysis.. This study was conducted using a multicenter, single-arm, prospective design. Raloxifene was administered to postmenopausal women aged ≥50 years who were on maintenance hemodialysis and met any of the following criteria after a 24-week run-in period: an alkaline phosphatase level (bone formation marker) of ≥6.18 µkat/L (≥370 U/L), a bone-specific alkaline phosphatase (BAP; bone formation marker) level of ≥0.59 µkat/L (≥35.4 U/L), or a bone-derived tartrate-resistant acid phosphatase (TRACP-5b; bone resorption marker) level of ≥4.2 U/L.. A total of 48 individuals were eligible for study inclusion. Of them, 30 individuals participated in this study. The BAP levels were significantly decreased at week 4, but returned to the baseline levels at week 24. Similarly, the TRACP-5b levels were significantly decreased at week 4, but returned to the baseline levels at week 24. The serum calcium value decreased consistently after the start of raloxifene therapy. The intact parathyroid hormone (iPTH) levels were likely increased at week 4. The ratio of BAP to iPTH levels and the ratio of TRACP-5b to iPTH levels both showed significant decreases over time. During the raloxifene therapy, no thrombosis or other drug-related adverse events developed.. The study results indicated that raloxifene can transiently reduce the levels of bone metabolism markers and might be useful for preventing fractures in postmenopausal women with end-stage renal failure, although raloxifene use over the long term may not have adequate efficacy in the absence of appropriate concomitant active vitamin D therapy.

Topics: Acid Phosphatase; Aged; Alkaline Phosphatase; Biomarkers; Bone and Bones; Bone Density Conservation Agents; Bone Resorption; Female; Humans; Isoenzymes; Kidney Failure, Chronic; Middle Aged; Osteoporosis, Postmenopausal; Osteoporotic Fractures; Parathyroid Hormone; Postmenopause; Prospective Studies; Raloxifene Hydrochloride; Renal Dialysis; Tartrate-Resistant Acid Phosphatase

Sclerostin, which is secreted exclusively by osteocytes, is a negative regulator of bone formation. The role of sclerostin in chronic kidney disease-mineral and bone disorder is not well known. In the present study, we examined the relationship between serum sclerostin levels, bone turnover markers, and bone mineral density (BMD) of the radius in maintenance hemodialysis patients.. This was a cross-sectional study that analyzed sclerostin, bone alkaline phosphatase (a bone formation marker), and tartrate-resistant acid phosphatase 5b (a bone resorption marker) in stored serum samples from 181 hemodialysis patients (age, 68 ± 11 y; 105 males and 76 females; hemodialysis duration, 6.9 ± 5.9 y). The BMD in the distal one-third of the radius and in the ultradistal radius, which are enriched with cortical and cancellous bone, respectively, was examined by dual-energy x-ray absorptiometry.. Serum sclerostin was 125 ± 53 pmol/L (mean ± SD). Serum sclerostin correlated significantly and negatively with serum bone alkaline phosphatase and tartrate-resistant acid phosphatase 5b (r = -0.265, P < .001; r = -0.218, P < .01, respectively). The BMD in the distal one-third of the radius and in the ultradistal radius both correlated significantly and positively with serum sclerostin levels (r = 0.454, P < .0001; r = 0.329, P < .0001, respectively). In multiple regression analysis, serum sclerostin was associated significantly and independently with BMD of both parts of the radius (β = 0.200, P < .001; β = 0.218, P < .05), after adjustment for age, hemodialysis duration, and bone metabolism markers.. Serum sclerostin was associated significantly, independently, and positively with BMD of both cortical and cancellous bone. Sclerostin is considered to be one of the factors associated with chronic kidney disease-mineral and bone disorder in hemodialysis patients.

Topics: Acid Phosphatase; Adaptor Proteins, Signal Transducing; Aged; Aged, 80 and over; Alkaline Phosphatase; Biomarkers; Bone and Bones; Bone Density; Bone Morphogenetic Proteins; Bone Resorption; Cross-Sectional Studies; Female; Genetic Markers; Humans; Isoenzymes; Kidney Failure, Chronic; Male; Middle Aged; Renal Dialysis; Tartrate-Resistant Acid Phosphatase

Abnormalities in PTH are implicated in the pathogenesis of bone abnormalities in chronic kidney disease (CKD)-mineral bone disorder (CKD-MBD). PTH concentrations are important in clinical decision and management. This emphasises the importance of providing an assay which measures biologically active PTH. We compared concentrations of intact PTH with biointact PTH (1-84) in CKD and end stage renal disease (ESRD) and investigated the relationship between the 2 PTH assays with bone and mineral laboratory parameters and bone mineral density (BMD) in CKD.. We assessed 140 patients (61 in ESRD and 79 with CKD stages 1-4) in this cross-sectional study. We measured biointact PTH (1-84) as well as routine biochemical parameters on all subjects. In the CKD cohort, bone turnover markers; bone alkaline phosphatase (BAP) and tartrate resistant acid phosphatase (TRACP)-5b and bone mineral density (BMD) were also determined.. In ESRD, intact PTH concentration was significantly higher compared to biointact PTH (1-84) (422 [443] v/s 266 [251] pg/mL, (p<0.001) with an average bias of 60%. In CKD, intact PTH concentration was also higher compared to biointact PTH (1-84) (79[55] v/s 68[49] pg/mL p<0.001) with an average bias of 18%. Only the biointact PTH (1-84) assay showed any significant correlation with serum calcium concentrations (r=-0.26, p<0.05) and phosphate (r=0.25, p<0.05) in CKD. Following multilinear regression analysis and adjustment for all significant co-variables, only eGFR, BAP and 25 (OH)vitamin remained significantly associated with intact PTH and biointact PTH (1-84). The strength of association was stronger between BAP and biointact PTH (1-84) (biointact PTH (1-84): p=0.007, intact PTH: p=0.01). In adjusted analyses, only biointact PTH (1-84) was significantly associated with BMD at the fore-arm (FARM) (p=0.049).. The study confirms the differences between intact PTH and biointact PTH (1-84) in ESRD. Whilst there may be similarities in the diagnostic ability of both intact and biointact PTH (1-84), our data suggest that biointact PTH (1-84) assay may better reflect bone metabolism and BMD in CKD. Further longitudinal studies are needed.

Topics: Acid Phosphatase; Aged; Aged, 80 and over; Alkaline Phosphatase; Bone Demineralization, Pathologic; Bone Density; Calcitriol; Cross-Sectional Studies; Female; Humans; Isoenzymes; Kidney Failure, Chronic; Male; Middle Aged; Parathyroid Hormone; Phosphates; Renal Dialysis; Severity of Illness Index; Tartrate-Resistant Acid Phosphatase

Increased levels of serum undercarboxylated osteocalcin, which were associated with bone metabolism markers, correlated inversely with indices of glucose metabolism (plasma glucose, hemoglobin A1C, and glycated albumin) in hemodialysis patients with abnormalities of bone metabolism.. Undercarboxylated osteocalcin (ucOC), a possible marker of bone metabolism and one of the osteoblast-specific secreted proteins, has recently been reported to be associated with glucose metabolism. We tested the hypothesis that ucOC levels are associated with indices of glucose metabolism in chronic hemodialysis patients with abnormalities of bone metabolism.. Serum ucOC, bone alkaline phosphatase (BAP, a bone formation marker), and tartrate-resistant acid phosphatase-5b (TRACP-5b, a bone resorption marker) were measured in 189 maintenance hemodialysis patients (96 diabetics and 93 non-diabetics), and their relationships with glucose metabolism were examined.. ucOC correlated positively with BAP (ρ = 0.489, p < 0.0001), TRACP-5b (ρ = 0.585, p < 0.0001) and intact parathyroid hormone (iPTH; ρ = 0.621, p < 0.0001). Serum ucOC levels in the diabetic patients were lower than those of non-diabetic patients (p < 0.001), although there were no significant differences in serum BAP or TRACP-5b between diabetic and non-diabetic patients. Serum ucOC correlated negatively with plasma glucose (ρ = -0.303, p < 0.0001), hemoglobin A1C (ρ = -0.214, p < 0.01), and glycated albumin (ρ = -0.271, p < 0.001), although serum BAP or TRACP-5b did not. In multiple linear regression analysis, log [plasma glucose], log [hemoglobin A1C], and log [glycated albumin] were associated significantly with log [ucOC] after adjustment for age, gender, hemodialysis duration, and body mass index but were not associated with log [BAP], log [TRACP-5b], or log [intact PTH].. Increased levels of serum ucOC, which were associated with bone metabolism markers, were inversely associated with indices of glucose metabolism in hemodialysis patients.

Topics: Acid Phosphatase; Aged; Aged, 80 and over; Alkaline Phosphatase; Biomarkers; Blood Glucose; Bone Diseases, Metabolic; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Female; Glycated Hemoglobin; Glycated Serum Albumin; Glycation End Products, Advanced; Humans; Isoenzymes; Kidney Failure, Chronic; Male; Middle Aged; Osteocalcin; Renal Dialysis; Serum Albumin; Tartrate-Resistant Acid Phosphatase

Vascular calcification (VC) is highly prevalent in CKD and leads to increased vascular stiffness and cardiovascular disease (CVD). Non-traditional cardiovascular risk factors include abnormal bone turnover and/or dysregulation of the calcification inhibitors, although their relative contribution remains unclear. We investigated the association between bone turnover, the calcification inhibitors (matrix gla protein; MGP and Fetuin-A), and the phosphate regulating hormone; fibroblast growth factor-23 (FGF-23) and arterial stiffness in pre-dialysis CKD patients. One hundred and forty-five patients with CKD stages 1-4 (74 M, 71 F) aged (mean [SD]) 53 [14] years were studied. Bone turnover markers (bone-specific alkaline phosphatase (BALP) and tartrate-resistant acid phosphatase (TRACP)) and MGP, Fetuin-A and FGF-23 were determined. BMD was measured at the lumbar spine (LS), femoral neck (FN), forearm (FARM) and total hip (TH). Arterial stiffness was assessed by contour analysis of digital volume pulse (SI(DVP)). There was a significant positive correlation between TRACP:BALP ratio and SI(DVP) ( r=0.19, p=0.023). Following multi-linear regression analysis, significant associations were seen between serum BALP (p=0.037), TRACP (p=0.009) and TRACP:BALP ratio (p=0.001) and SI(DVP) independently of traditional CVD risk factors. No significant relationship between SI(DVP) and MGP, Fetuin-A and FGF-23 was observed. A significant negative correlation was seen between BMD at the FARM and SI(DVP) in CKD stage 4 (r=-0.35, p=0.024). The association remained significant following correction for age, gender and cardiovascular risk factors (p=0.029). Our data suggest a link between imbalances in bone turnover and arterial stiffness in pre-dialysis CKD. Longitudinal studies are needed to evaluate the clinical usefulness of these bone turnover markers as predictors of CVD in CKD.

Topics: Acid Phosphatase; Alkaline Phosphatase; Arteries; Biomarkers; Bone Density; Bone Remodeling; Demography; Female; Fibroblast Growth Factor-23; Humans; Isoenzymes; Kidney Failure, Chronic; Male; Middle Aged; Regression Analysis; Renal Dialysis; Tartrate-Resistant Acid Phosphatase

To study the most frequent markers of mineral-bone metabolism in young hemodialysis (HD) patients in order to detect any metabolism changes that could lead to the atherosclerosis and extravascular calcification frequently observed in chronic kidney disease (CKD) patients and estimate their potential prognostic significance.. We measured serum levels of intact-PTH (iPTH), Osteoprotegerin (OPG), total soluble receptor activator of nuclear factor-κB ligand (sRANKL), tartrate-resistant acid phosphatase (TRAP-5b), osteocalcin (Oc), bone-specific alkaline phosphatase (BAP), calcium, phosphorus, 25(OH)D(3) and 1,25 (0H)(2)D(3) in young HD patients and controls. In comparison to controls, serum OPG, iPTH, BAP, phosphorus, and osteocalcin levels were higher whereas 25(OH)D(3) and 1,25(OH)(2)D(3) were lower in HD patients.. In conclusion, our results indicate that bone formation and resorption parameters are already altered in young HD subjects. These changes may lead to vascular calcifications and cardiovascular complications, given that elevated OPG levels predict cardiovascular events in HD patients. Furthermore, low levels of vitamin D metabolites have been associated with the presence of vascular calcification.

Topics: Acid Phosphatase; Adolescent; Adult; Alkaline Phosphatase; Atherosclerosis; Biomarkers; Bone and Bones; Bone Density; Calcifediol; Calcitriol; Calcium; Case-Control Studies; Humans; Isoenzymes; Kidney Failure, Chronic; Osteocalcin; Osteoprotegerin; Parathyroid Hormone; Phosphorus; Prognosis; RANK Ligand; Renal Dialysis; Tartrate-Resistant Acid Phosphatase; Young Adult

End-stage renal disease (ESRD) is often complicated by chronic inflammation and malnutrition. We tested whether serum tartrate-resistant acid phosphatase (TRACP) isoform 5a relates to other markers of inflammation in ESRD.. Predialysis serum was collected from 99 ESRD patients (51 male, 48 female) aged 55 +/- 15 years and a control group of 36 healthy subjects (8 male, 28 female) aged 43.2 +/- 10.5 years.. Serum TRACP 5a activity and protein, TRACP 5b activity and C-reactive protein (CRP) were estimated by in-house immunoassays. Commercial kits were used for serum bone-specific alkaline phosphatase, Ntelopeptides of Type I collagen, interleukin-6 (IL-6) and fetuin-A. Intact parathyroid hormone was determined by chemiluminescent assay. Albumin, cholesterol, triglycerides, ferritin and hemoglobin were compared to the hospital reference ranges. Bone mineral density (BMD) was measured at the heel in 69 patients and all control subjects and expressed as g/cm2 and age-corrected T-score.. Mean (median) levels of all serum markers were significantly elevated in ESRD except fetuin-A, which was significantly reduced. Mean BMD (g/cm2) was not different than control, but mean T-score was significantly reduced. TRACP 5a protein correlated with CRP, triglycerides and ferritin, but not with IL-6 or any other nutritional or bone markers or BMD. TRACP 5b activity correlated with all bone markers and BMD, but not with inflammation or nutritional markers.. Our findings suggest that TRACP 5a may be a useful marker to estimate the degree of inflammation in ESRD patients on chronic hemodialysis.

Topics: Acid Phosphatase; Adult; Albumins; Alkaline Phosphatase; alpha-Fetoproteins; Biomarkers; Bone Density; C-Reactive Protein; Case-Control Studies; Collagen Type I; Female; Humans; Inflammation; Interleukin-6; Isoenzymes; Kidney Failure, Chronic; Linear Models; Male; Middle Aged; Parathyroid Hormone; Protein Isoforms; Renal Dialysis; Statistics, Nonparametric; Tartrate-Resistant Acid Phosphatase

Recent studies have indicated a link between bone metabolism and cardiovascular events in patients with chronic kidney disease (CKD). CKD is a major health problem worldwide. This study evaluates the role of noninvasive markers of bone metabolism in predicting cardiovascular morbidity (coronary artery disease, peripheral vascular disease, stroke) and mortality in patients with mild to severe forms of CKD. In a prospective cohort study, 627 patients with CKD were screened. To focus on bone metabolism, traditional risk factors for cardiovascular events were excluded, and 135 patients with CKD stages 1-5 were followed for 4 yr. Glomerular filtration rate was calculated by the Modification of Diet in Renal Disease formula. PTH (measured by four different assays), vitamin D 25 and 1,25, bone-specific alkaline phosphatase (BSALP), TRACP-5b, osteocalcin, serum collagen cross-link molecules, RANKL, and osteoprotegerin were determined. Predictors of cardiovascular events were evaluated by multivariable logistic regression, Kaplan-Meier survival, and Cox regression analysis. There were a total of 45 cardiovascular events (33%). Event rates were 5.6%, 29.1%, 45.2%, and 45.0% in CKD stages 1-2, 3, 4, and 5, respectively. In logistic regression, cardiovascular events were predicted only by (1) CKD stage (independent of age or sex; p < 0.001); (2) BSALP (p = 0.03); and (3) TRACP-5b (p = 0.04). Markers of bone formation (BSALP) and resorption (TRACP-5b) can serve as predictors of cardiovascular morbidity and mortality in CKD.

Topics: Acid Phosphatase; Adult; Aged; Aged, 80 and over; Alkaline Phosphatase; Biomarkers; Bone and Bones; Cardiovascular Diseases; Demography; Female; Humans; Isoenzymes; Kidney Failure, Chronic; Male; Middle Aged; Organ Specificity; Prognosis; Proportional Hazards Models; Regression Analysis; Survival Analysis; Tartrate-Resistant Acid Phosphatase

The processes involved in bone remodeling are under the control of a multitude of systemic and local factors. Receptor activator of nuclear factor-kappaB ligand (RANKL)/osteoprotegerin (OPG) complex seems to be one of the major modulators of bone remodeling. In chronic renal failure, the cytokine systems involved in the regulation of bone turnover may be influenced, and are therefore likely to contribute to the pathogenesis of renal bone disease. The aim of the present study was the evaluation of RANKL/OPG complex in concert with other biochemical parameters in hemodialysis (HD) patients and the investigation of possible correlations between the serum levels of its components and several clinical parameters of these patients.. We measured serum levels of intact PTH (iPTH), total serum RANKL (sRANKL), osteoprotegerin (OPG), alkaline phosphatase, osteocalcin (OC), and tartrate-resistant acid phosphatase (TRAP) in 104 HD patients and in 40 healthy controls.. The average serum OPG level was significantly higher, whereas the average serum concentration of RANKL was nonsignificantly lower in patients on HD therapy than in age-matched healthy controls. Consequently, the mean sRANKL/OPG ratio was significantly lower in patients. Among HD patients, serum level of OPG increased significantly with aging and with a longer duration of hemodialysis. RANKL levels were inversely correlated with age nonsignificantly in the whole group of patients and significantly in the female subgroup (r=-0.322, p=0.035), whereas RANKL/OPG ratio declined significantly with age in the entire cohort of patients (r=-0.259, p=0.008). In addition, iPTH, OC, TRAP were significantly higher in female, whereas RANKL/OPG ratio was significantly higher in male than female patients.. Lower values of sRANKL/OPG ratio in HD patients, as well as the age and duration of HD dependent increase of serum OPG and the age-dependent decrease of sRANKL concentration especially in women cannot be explained by the elimination of renal clearance only. Alterations in sRANKL/OPG ratio might reflect a compensatory mechanism to modulate bone remodeling in these patients.

Topics: Acid Phosphatase; Adult; Age Factors; Aged; Aged, 80 and over; Alkaline Phosphatase; Biomarkers; Bone Remodeling; Case-Control Studies; Cohort Studies; Female; Humans; Isoenzymes; Kidney Failure, Chronic; Male; Middle Aged; Osteocalcin; Osteoprotegerin; RANK Ligand; Renal Dialysis; Sex Factors; Tartrate-Resistant Acid Phosphatase

The derangements in bone metabolism in patients with chronic renal failure (CRF) are summarized as uremic bone disease (UBD). In this study, we planned to determine the serum prolidase to compare it with the other biochemical markers. This study was performed on 44 patients (19 females, 25 males, mean age = 56.8 +/- 15.6 years) with endstage renal disease (ESRD). The patients were divided into three groups according to serum bone alkaline phosphatase (bAP) levels. The patients whose bAP was > or =77 U/L were accepted as having high-turnover UBD (n=18), the patients whose bAP was < or =50 U/L were accepted as having low-turnover UBD (n=14), and the patients whose bAP levels were between these two values were accepted as having bone disease with normal turnover (n=12). The serum prolidase levels did not increase in patients with ESRD. There were no significant differences between the serum prolidase levels of patients according to types of the UBD (p > 0.05). Kidney is the most prolidase-rich tissue of the human body. The serum prolidase activity is low in all patients with ESRD, irrespective of the type of UBD. Therefore, we concluded that prolidase had no value in the diagnosis of UBD.

Topics: Acid Phosphatase; Adult; Aged; Aged, 80 and over; Alkaline Phosphatase; Biomarkers; Bone Diseases; Dipeptidases; Female; Humans; Isoenzymes; Kidney Failure, Chronic; Male; Middle Aged; Statistics as Topic; Statistics, Nonparametric; Tartrate-Resistant Acid Phosphatase

The receptor activator of nuclear factor kappaB ligand (RANKL), produced by osteoblasts/stromal cells, is a member of the RANK/RANKL/OPG system, which regulates bone resorption by osteoclasts. Since RANKL and osteoprotegerin (OPG) production in bone is influenced by parathyroid hormone (PTH), we measured serum RANKL and OPG concentrations in haemodialysis (HD) patients, who commonly hypersecrete PTH. We aimed to determine if clinically demonstrated PTH-enhanced bone resorption is a consequence of increased RANKL synthesis.. RANKL, OPG, osteocalcin, intact PTH, bone-specific alkaline phosphatase, tartrate-resistant acid phosphatase 5b and beta-CrossLaps (CTx) were measured in blood samples from 80 HD patients and 50 age-matched controls. HD patients were stratified to tertiles according to their serum PTH levels: 29.3-103.0, 109.7-263.0 and 262.0-1700.0 pg/ml in the first, second and third tertiles, respectively.. Mean serum RANKL levels were 1.6 times higher in HD patients than in age-matched controls (1.36+/-0.39 vs 0.83+/-0.70 pmol/l; P<0.001). All the measured bone markers significantly differed between patients and controls (P<0.001). Spearman's tests of correlation showed a statistically significant association of RANKL with PTH, osteocalcin and CTx (r=0.322, P=0.004; r=0.231, P=0.039; and r=0.230, P=0.040, respectively). Mean serum RANKL levels were significantly different between PTH tertiles (P = 0.003), but serum OPG levels were not (P=0.144). The highest RANKL levels were measured in the upper PTH tertile (1.54+/-0.39 pmol/l) and were significantly higher than in the middle or lower tertiles (1.27+/-0.42 and 1.23+/-0.26 pmol/l, respectively; P=0.003). Both of the measured bone-resorption markers, tartarate-resistant acid phosphatase 5b and CTx, as well as both bone formation markers, osteocalcin and bone-specific alkaline phosphatase were also significantly higher in the upper tertile, indicating that whole-bone remodelling is activated at high PTH and RANKL levels.. Serum RANKL levels were significantly higher in HD patients than in healthy age-matched controls. Moreover, RANKL levels were significantly higher in the upper PTH tertile, indicating enhanced RANKL synthesis in a PTH-dependent fashion. Thus, our clinical findings clearly support published in vitro studies that demonstrated a stimulating effect of PTH on RANKL synthesis. Therefore, the hypothesis that PTH increases bone resorption in HD patients through RANKL appears valid.

Topics: Acid Phosphatase; Adult; Aged; Alkaline Phosphatase; Bone Resorption; Carrier Proteins; Case-Control Studies; Collagen; Female; Glycoproteins; Humans; Isoenzymes; Kidney Failure, Chronic; Male; Membrane Glycoproteins; Middle Aged; Osteocalcin; Osteoprotegerin; Parathyroid Hormone; Peptide Fragments; RANK Ligand; Receptor Activator of Nuclear Factor-kappa B; Receptors, Cytoplasmic and Nuclear; Receptors, Tumor Necrosis Factor; Renal Dialysis; Tartrate-Resistant Acid Phosphatase

Our purpose was to develop a specific immunoassay for tartrate-resistant acid phosphatase (TRACP) 5b using naphthol ASBI phosphate (N-ASBI-P) as a selective substrate for isoform 5b and heparin as a selective inhibitor of isoform 5a.. Serum TRACP 5a and 5b and recombinant TRACP 5a were used to optimize and standardize the immunoassay for specificity, linearity, analytical recovery, sensitivity and reproducibility. Serum N-telopeptide cross-links (NTX) and bone alkaline phosphatase (bone ALP) were also measured. The clinical sensitivity and specificity were assessed in healthy control subjects and patients with osteoarthritis (OA), rheumatoid arthritis (RA) and endstage renal disease (ESRD).. TRACP 5b specificity was achieved at pH 6.3 with 2.5 mmol/l substrate and 25 U/ml heparin. Isoform 5b specificity was increased over our original immunoassay using 4-nitrophenyl phosphate (4-NPP) without heparin. The alternative immunoassay was linear with 110% analytical recovery and no serum matrix effects. The average intra-assay error was 10.65%; the average inter-assay error was 10.11% for values of 1-3 U/l and 6.5% for values of 7-11 U/l. Mean serum TRACP 5b in OA and RA were not significantly different from control using either immunoassay. Mean serum TRACP 5b was significantly increased in ESRD with both immunoassays. Serum TRACP 5b levels correlated significantly with NTX and bone ALP in the disease groups, but not always in the control group.. This alternative immunoassay for TRACP 5b activity is highly specific. It should have applications in evaluating patients with bone disease and will improve our understanding of the biological significance of TRACP 5b expression in health and disease.

Topics: Acid Phosphatase; Adult; Aged; Aged, 80 and over; Anticoagulants; Arthritis, Rheumatoid; Biomarkers; Bone and Bones; Chromatography, Ion Exchange; Enzyme Inhibitors; Female; Fluorescent Dyes; Heparin; Humans; Hydrolysis; Immunoassay; Indicators and Reagents; Isoenzymes; Kidney Failure, Chronic; Male; Middle Aged; Neuraminidase; Organophosphorus Compounds; Osteoarthritis; Recombinant Proteins; Tartrate-Resistant Acid Phosphatase; Trypsin

Tartrate-resistant acid phosphatase (AcP) 5b is a marker of osteoclastic activity and bone resorption. Immunoassays for serum TRAcP may lack sensitivity and specificity because of the presence of non-bone isoform 5a. The purpose of this study was to isolate the serum isoforms, quantify their disease-related expressions, and test an improved immunoassay for TRAcP 5b.. We separated TRAcP isoforms chromatographically from pooled sera of healthy, rheumatoid arthritis (RA) and endstage renal disease (ESRD) subjects. TRAcP isoforms were identified by electrophoresis and quantified by biochemical and immunochemical assays. Serum TRAcP activity in healthy, RA, and ESRD cohorts was assessed at pH 5.5 and 6.1, and compared with bone alkaline phosphatase (BAP) and N-telopeptides of type I collagen (NTx).. TRAcP isoforms 5a and 5b were present in all sera; 5b was identical to osteoclastic TRAcP. In serum from healthy subjects, 5a accounted for 87% of the enzyme protein but only 55% of the activity. In RA, both isoforms were increased two- to threefold in protein, but their specific activities were subnormal. In ESRD, only 5b was abnormal, being increased fivefold in protein and threefold in activity. In RA sera, TRAcP activity did not correlate with either BAP or NTx. In ESRD sera, TRAcP activity correlated with BAP and NTx only when measured at pH 6.1.. All sera contained both TRAcP isoforms 5a and 5b, but only 5b was present in bone. TRAcP isoform expression was variable in different diseases. Measurement of TRAcP activity at pH 6.1 improves the specificity of immunoassay for isoform 5b.

Topics: Acid Phosphatase; Arthritis, Rheumatoid; Biomarkers; Humans; Immunoassay; Isoenzymes; Kidney Failure, Chronic; Osteoclasts; Reference Values; Sensitivity and Specificity; Tartrate-Resistant Acid Phosphatase

Tartrate-resistant acid phosphatase (TRAP) isoform 5b is a potential serum marker for osteoclastic activity. Biochemical assays for serum TRAP activity with para-nitrophenylphosphate (pNPP) have low specificity for bone because of hydrolysis by unrelated nontype 5 TRAPs of blood cells and by related isoform 5a. Our purpose was to increase the specificity of TRAP assay for osteoclastic activity by using naphthol-ASBI phosphate (N-ASBI-P) as a substrate for serum type 5 TRAP activity and heparin as an inhibitor of isoform 5a. TRAP activity in individual and pooled sera of normal subjects and patients with endstage renal disease (ESRD) and rheumatologic diseases was quantitated using pNPP and N-ASBI-P as substrate at pH 5.5 and 6.1. For some experiments, heparin (23U/ml) was added as a specific inhibitor of isoform 5a activity. Isoforms 5a and 5b were separated from serum pools by cation exchange chromatography and identified by nondenaturing polyacrylamide gel electrophoresis (PAGE). N-ASBI-P was selectively hydrolyzed by TRAP isoform 5b. TRAP assays with pNPP and N-ASBI-P correlated only in ESRD sera, which contained primarily isoform 5b. The two assays did not correlate in normal or rheumatic sera with significant amounts of 5a. Heparin inhibited isoform 5a activity approximately 50% but had little effect on isoform 5b activity. Biochemical assay of serum TRAP activity can be made specific for isoform 5b by using N-ASBI-P and heparin. This method can be adapted to simple microplate biochemical or immunochemical assays. This simplified method for assessment of osteoclastic TRAP 5b activity warrants a detailed investigation in diseases of bone metabolism.

Topics: Acid Phosphatase; Aniline Compounds; Arthritis, Rheumatoid; Biomarkers; Bone Remodeling; Chromatography, Ion Exchange; Clinical Enzyme Tests; Electrophoresis, Polyacrylamide Gel; Enzyme Inhibitors; Heparin; Humans; Hydrogen-Ion Concentration; Hydrolysis; Isoenzymes; Kidney Failure, Chronic; Organophosphorus Compounds; Osteoclasts; Osteolysis; Sensitivity and Specificity; Substrate Specificity; Tartrate-Resistant Acid Phosphatase

Linear growth is reduced in prepubertal children with adynamic renal osteodystrophy, suggesting that the proliferation and/or differentiation of epiphyseal growth plate chondrocytes is abnormal in this disorder. To examine this issue, in situ hybridization and histochemistry were used to measure selected markers of endochondral bone formation and bone resorption in the proximal tibia of subtotally nephrectomized rats fed a high calcium diet to induce biochemical changes consistent with adynamic osteodystrophy. Blood ionized calcium concentrations were higher and serum PTH levels were lower in nephrectomized, calcium-supplemented rats than in either intact or nephrectomized control animals. Linear growth and tibial length were reduced, but messenger RNA levels for type II collagen, type X collagen, and the PTH/PTHrP receptor did not differ from control values in nephrectomized rats given supplemental calcium. In contrast, both the width of epiphyseal cartilage and the height of the zone of hypertrophic chondrocytes were greater in calcium-supplemented nephrectomized rats. These morphological changes were associated with decreases in histochemical staining for tartrate-resistant acid phosphatase and lower levels of messenger RNA expression for the matrix metalloproteinase MMP-9/gelatinase B immediately adjacent to the epiphyseal growth plate. Diminished chondroclastic/osteoclastic activity alters growth plate morphology and adversely affects linear bone growth in calcium-supplemented, nephrectomized rats.

Topics: Acid Phosphatase; Animals; Biomarkers; Calcium; Growth Plate; Isoenzymes; Kidney Failure, Chronic; Male; Matrix Metalloproteinase 9; Nephrectomy; Osteoclasts; Osteogenesis; Parathyroid Hormone; Rats; Rats, Sprague-Dawley; RNA, Messenger; Tartrate-Resistant Acid Phosphatase; Tibia; Time Factors

The objective of this study was to identify the isoform, type-5a or type-5b, responsible for increased tartrate-resistant acid phosphatase (TRAP) activity in endstage renal disease (ESRD) and TRAP protein in rheumatoid arthritis (RA). We studied 24 sera each from healthy, ESRD and RA subjects. Type-5 TRAP activity and protein were quantitated by immunoassays. Isoform expression was determined by computerized imaging of non-denaturing polyacrylamide gels (PAGE) stained for TRAP activity. Other biochemical markers included: intact parathyroid hormone (iPTH), total and bone-specific alkaline phosphatase (TAP, BAP), N-telopeptides of type-I collagen (NTx), and free pyridinoline (Pyd). Isoform 5a was normal in both ESRD and RA. Isoform 5b was elevated in ESRD only. Serum TRAP activity correlated with both isoforms 5a and 5b in RA, but only with 5b in ESRD. TRAP protein assays did not correlate with PAGE assays for 5a or 5b. TRAP activity, but not protein, correlated with BAP and NTx in RA sera. Both TRAP activity and protein correlated with iPTH, TAP and Pyd in ESRD sera. Increased TRAP activity in ESRD was due to increased osteoclastic isoform 5b and related to bone turnover. Increased TRAP protein in RA was suspected, but not proven, to be isoform 5a and not related to bone turnover. Heterogeneity of serum TRAP and preferential expression of isoforms has clinical significance in different diseases including ESRD and RA.

Topics: Acid Phosphatase; Arthritis, Rheumatoid; Bone and Bones; Electrophoresis, Polyacrylamide Gel; Humans; Isoenzymes; Kidney Failure, Chronic; Tartrate-Resistant Acid Phosphatase

Tartrate-resistant acid phosphatase (TRAP; EC 3.1.3.2) is a product of osteoclasts and a biochemical marker of bone resorption rate. However, erythrocytes and platelets contribute to total TRAP activity in serum, reducing the specificity of direct biochemical assays in serum. Osteoclast TRAP is also known as type-5 TRAP and is antigenically unique. Immunoassays are sought to improve the specificity and sensitivity of TRAP as a bone marker.. We developed two colorimetric microplate assays for type-5 TRAP: an enzyme capture immunoassay to measure antibody-bound enzymatic activity, and a two-site immunoassay to measure bound enzyme protein. Both use the same monoclonal antibody (14G6) to capture type-5 TRAP, which permits determination of specific activity of serum TRAP in health and disease.. Both TRAP assays were linear from one-tenth to fivefold the mean value in 18 healthy subjects. In these subjects, the mean (SD) TRAP activity was 3.2 (0.54) U/L for the enzyme capture assay and 37 (13) microg/L for the two-site assay. Mean TRAP activity was not significantly increased in 64 patients with endstage renal disease requiring hemodialysis (HD) or 99 unselected patients with rheumatic diseases. By contrast, TRAP protein was increased in both the HD and rheumatic disease groups. The specific activity of TRAP in the 17 of 64 HD sera that had increased TRAP activity (0.088 U/microg) was similar to that in healthy subjects (0.091 U/microg). By contrast, the specific activity of TRAP in the 31 of 99 rheumatic sera with increased TRAP protein (0.035 U/microg) was significantly decreased.. Wide sample distributions for TRAP activity in HD patients and TRAP protein in rheumatic disease patients suggest the presence of subpopulations of HD patients with increased TRAP activity and of rheumatic patients with increased TRAP protein. Each assay for TRAP activity and protein may have its own biological significance and clinical applications in specific groups of patients.

Topics: Acid Phosphatase; Adult; Antibody Specificity; Bone Resorption; Female; Horseradish Peroxidase; Humans; Immunoassay; Isoenzymes; Kidney Failure, Chronic; Male; Renal Dialysis; Rheumatic Diseases; Sensitivity and Specificity; Tartrate-Resistant Acid Phosphatase

Collagen type 1 represents more than 90% of bone matrix. Therefore, quantitation of collagen crosslinks, such as deoxypyridinoline, can provide information on bone resorption degree. An evaluation was made of deoxypyridinoline as well as other bone markets, such as alkaline phosphatase, tartrate resistant acid phosphatase, and hydroxyproline in patients with the diagnosis of osteoporosis. Paget's disease, hyperthyroidism, and chronic renal failure on haemodialysis or not. Deoxypyridinoline levels were significantly increased in patients with osteoporosis, Paget's disease, and hyperthyroidism. Hydroxyproline levels were increased in patients with Paget's disease, and tartrate resistant acid phosphatase was increased in all the entities studied. Deoxypyridinoline can be a more sensitive marker than hydroxyproline, with some advantages, such as its quantitation in a urine specimen and its high bone specificity. In patients with renal failure, tartrate resistant acid phosphatase was the only biochemical marker of bone resorption with increased levels.

Topics: Acid Phosphatase; Adult; Alkaline Phosphatase; Amino Acids; Biomarkers; Bone Resorption; Female; Humans; Hydroxyproline; Hyperthyroidism; Kidney Failure, Chronic; Male; Middle Aged; Osteitis Deformans; Osteoporosis; Sensitivity and Specificity

Serum levels of the carboxy-terminal pyridinoline cross-linked telopeptide of type I collagen (ICTP) and the carboxy-terminal propeptide of type I procollagen (PICP) were measured in 95 patients with renal hyperparathyroidism who had undergone a total parathyroidectomy and autotransplantation of a small portion of the resected gland. The results were compared with the serum levels of other bone metabolic markers and bone mineral densities in the distal radius (R-BMD) and lumbar vertebrae (L-BMD), which were measured by dual energy x-ray absorptiometry and converted to the percentage of the mean value of sex- and age-matched healthy controls. The preoperative mean values of ICTP and PICP were 142.4 ng/ml and 187.8 ng/ml, respectively. Although the serum levels of PICP levels exceeded the normal range in 42.1% of the patients, those of ICTP exceeded it in all of them. The serum levels of ICTP correlated positively not only with those of tartrate-resistant acid phosphatase (TRACP), total alkaline phosphatase (ALP), and osteocalcin but also negatively with the values of %R-BMD and %L-BMD and seemed to manifest specifically the disturbance of bone metabolism. On the other hand, the serum levels of PICP correlated with those of ALP and TRACP but not with values of %BMDs. After surgery, the serum levels of ICTP decreased gradually, but those of PICP increased immediately up to peak values at 7 days and then decreased gradually after 14 days, reaching the normal range at 3 months. These changes in the bone metabolic markers seemed to reflect the change in bone metabolism that was converting from bone resorption to bone formation. The percent change in the PICP/ICTP ratio at 7 days correlated significantly with the percent change in R-BMD at 12 months, and it was suggested that postoperative bone gain might be predicted using a combination of postoperative changes in PICP and ICTP.

Topics: Absorptiometry, Photon; Acid Phosphatase; Alkaline Phosphatase; Biomarkers; Bone and Bones; Bone Density; Bone Resorption; Case-Control Studies; Collagen; Collagen Type I; Female; Forecasting; Humans; Hyperparathyroidism, Secondary; Isoenzymes; Kidney Failure, Chronic; Lumbar Vertebrae; Male; Middle Aged; Osteocalcin; Osteogenesis; Parathyroid Glands; Parathyroidectomy; Peptide Fragments; Peptides; Procollagen; Radius; Tartrate-Resistant Acid Phosphatase; Transplantation, Autologous

We have prospectively studied the evolution of serum levels of the prostatic-specific antigen and prostatic acid phosphatase in 14 male hemodialyzed patients, receiving a cycle of nandrolone decanoate (200 mg intramuscularly, once a week, for six months) as treatment for anemia. Androgen administration did not produce significant increases in serum concentrations of both tumor markers (basal: 0.9 +/- 0.5 and 0.7 +/- 0.3 ng/ml; at six months: 1.3 +/- 1.1 and 0.8 +/- 0.7 ng/ml respectively). Only one patient had a value of prostatic-specific antigen over the normal range: 4.2 ng/mol at the sixth month period, with a rapid decrease after the withdrawal of androgens. All the remaining values of both markers were within the normal range. In another six patients undergoing a prolonged treatment with androgens (between 9 to 24 months), the serum levels of prostatic-specific antigen and prostatic acid phosphatase were within the normal range in all of them. Nandrolone decanoate administration does not induce increases in prostate tumor markers when it is used as treatment for anemia in hemodialyzed patients.

Topics: Acid Phosphatase; Aged; Aged, 80 and over; Anabolic Agents; Anemia; Dose-Response Relationship, Drug; Drug Administration Schedule; Hematocrit; Hemoglobinometry; Humans; Injections, Intramuscular; Kidney Failure, Chronic; Male; Middle Aged; Nandrolone; Nandrolone Decanoate; Prospective Studies; Prostate; Prostate-Specific Antigen; Renal Dialysis

We have studied the levels of the biochemical markers of bone formation total serum alkaline phosphatase, osteocalcin (BGP) and carboxyterminal propeptide of type I procollagen (PICP), the levels of the biochemical marker of bone resorption serum tartrate-resistant acid phosphatase (TRAP) and those of intact immunoreactive PTH (iPTH) in 30 patients at different stages of chronic renal failure (CRF), all of them without verifiable hepatopathy, and in 9 patients in hemodialysis with hepatopathy measured by the Knodell index. Sixteen control subjects were also studied. In the group of patients with CRF with or without hepatopathy, the levels of biochemical markers of bone turnover were significantly elevated with respect to those of control patients. We did not find any significant difference in the levels of these parameters between the groups with and without liver damage, in spite of the fact that TRAP and PICP are cleared mainly by the liver. Levels of TRAP and PICP correlated significantly with the other biochemical markers of bone turnover studied. The good relation observed between PICP, TRAP and the biochemical indexes of bone activity and iPTH levels suggests the clinical value of these markers in the follow-up of bone involvement in patients with CRF. On the other hand, the frequent hepatopathy found in patients with CRF does not seem to affect to a significant extent the diagnostic value of PICP and TRAP in this pathology.

Topics: Acid Phosphatase; Adult; Aged; Alkaline Phosphatase; Biomarkers; Bone and Bones; Bone Development; Bone Resorption; Case-Control Studies; Female; Humans; Isoenzymes; Kidney Failure, Chronic; Liver Diseases; Male; Middle Aged; Osteocalcin; Parathyroid Hormone; Peptide Fragments; Procollagen; Renal Dialysis; Tartrate-Resistant Acid Phosphatase

Serum concentrations of prostatic acid phosphatase (PAP), gamma-seminoprotein (gamma-Sm) and prostatic specific antigen (PSA) were measured in 31 hemodialysis patients without clinical signs of malignant disease. PAP, gamma-Sm and PSA levels in serum were not significantly different between control and hemodialysis groups. A significant reduction in these tumor markers was not found after dialysis treatment. This indicates that the measurement of PAP, gamma-Sm and PSA in serum is useful for the detection of prostatic cancer in patients undergoing hemodialysis.

Topics: Acid Phosphatase; Antigens, Neoplasm; Biomarkers, Tumor; Humans; Immunoenzyme Techniques; Kidney Failure, Chronic; Male; Middle Aged; Prostate-Specific Antigen; Prostatic Neoplasms; Prostatic Secretory Proteins; Proteins; Radioimmunoassay; Renal Dialysis; Seminal Plasma Proteins

The effects of internal treatment were compared with those of surgical procedures on secondary hyperparathyroidism as a complication of chronic renal failure patients in order to study their applications and problems. Maintenance hemodialysis patients complicated with 2HPT were selected as test subjects. The following internal treatment was administered. 1) Elcitonine to 6 cases and 2) Ipriflavon to 5 cases respectively and applied 3) pulse therapy of 1.25(OH)2D3 to 12 cases. On the other hand, total parathyroidectomy and autotransplantation were carried out as surgical procedures. The results of the treatment were evaluated by comparing serological data including tartrate resistant acid phosphatase (TAP) measured with the passage of time, bone scintigram findings, and change of bone mineral content (BMC) measured by single photon absorptiometry and dual photon absorptiometry. In the pulse therapy group, an oral tolerance test of 6 micrograms of 1.25(OH)2D3 was carried out to investigate its relation to long term prognosis. Furthermore, in both the pulse therapy group and PTX group, serum aluminum (A1) and delta A1 calculated by Defferoxamine (DFO) tolerance test were measured. The results are as follows. 1) In Elcitonine and Ipriflavon administration groups, increase of ALP and PTH and decrease of BMC (p less than 0.05) were recognized. 2) In the pulse therapy group, although the patients with PTH-C less than 30 ng/ml showed decrease in PTH both in short and long terms, cases with PTH-C more than 30 ng/ml kept the same level in PTH. Regardless of the change of PTH and ALP, there was no significant change observed in BMC. 3) In the PTX group, ALP/TAP ratio rose by 900% temporarily and BMC increased (p less than 0.01) in all regions measured. 4) Serum A1 and delta A1 were decreased (p less than 0.01) in PTX cases and in the pulse therapy cases in which ALP was decreased. In recent years, internal treatments on 2HPT patients have become diversified. However, exacerbation of 2HPT considered as an escape phenomenon caused the decrease in BMC after exclusive calcitonine preparatives administration. Pulse therapy, which is regarded at present as most effective in reducing PTH, ALP, did not work to increase BMC efficiently. In other word, in order to attain efficient BMC increase action, it is necessary to transfer from bone resorption phase to formative phase rapidly with drastic decrease of PTH and TAP observed in PTX.(ABSTRACT TRUNCATED AT 400 WORDS)

Topics: Acid Phosphatase; Alkaline Phosphatase; Aluminum; Bone Density; Calcitonin; Calcitriol; Drug Administration Schedule; Drug Evaluation; Humans; Hyperparathyroidism, Secondary; Isoflavones; Kidney Failure, Chronic; Parathyroid Hormone

In the diagnosis of renal osteodystrophy (ROD) and the monitoring of its clinical course, several biochemical parameters have been appreciated as a useful indicators. The present investigations were designed to evaluate the clinical value of serum tartrate resistant acid phosphatase (TRACP) as an additional parameter of osteoclastic activity in ROD based upon the concept that TRACP was marker enzyme specific for osteoclast. Serum TRACP was assayed in 72 patients on long term hemodialysis and compared with conventional parameters of ROD such as ALP, Osteocalcin, Hydroxyproline. Bone change was analyzed according to Jensen's method and categorized into 4 stages. Serum TRACP was exclusively elevated and revealed a evident correlations with each parameters as follows: TRACP v. PTH-C, r = 0.501 p less than 0.01. Hydroxyproline, r = 0.429 p less than 0.05., ALP, r = 0.001., Osteocalcin, r = 0.540 p less than 0.01. In addition, TRACP value in the patients with high stage significantly higher than that in those low stage ROD. These results suggest that measurement of TRACP would be of clinical importance and useful for diagnosis of ROD in chronic maintenance hemodialized patients.

Topics: Acid Phosphatase; Adult; Aged; Chronic Kidney Disease-Mineral and Bone Disorder; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Monitoring, Physiologic; Renal Dialysis; Tartrates

Acid phosphatase, beta-D-Glucuronidase and N-acetyl-beta-D-glucosaminidase were assessed cytochemically in peritoneal macrophages obtained from 50 patients with end-stage renal failure treated by intermittent peritoneal dialysis and from 30 control subjects with normal renal function. A statistically significant increase in beta-D-glucuronidase activity accompanied by a decrease in acid phosphatase activity were observed in peritoneal macrophages of dialysed patients, as compared with the control group. In patients with dialysis-associated peritonitis, the activity of N-acetyl-beta-D-glucosaminidase was significantly higher than that observed in the same patients during the complication-free period of the treatment.

Topics: Acetylglucosaminidase; Acid Phosphatase; Adult; Glucuronidase; Humans; Kidney Failure, Chronic; Lysosomes; Macrophages; Peritoneal Dialysis; Peritonitis; Reference Values

Acid phoshatase (AcP), beta-glucuronidase (GR) and N-acetyl-beta-D-glucosaminidase (NAG) activity in neutrophils obtained from the peritoneal fluid of 50 patients with terminal renal failure treated by intermittent peritoneal dialysis, and of 30 control subjects with normal renal function was semiquantitatively scored using a cytochemical method. This study was repeated in 22 dialyzed patients during the course of bacterial peritonitis. A significant decrease in the AcP score and an increase in the GR score were found in the neutrophils from dialyzed patients. In dialyzed patients with peritonitis, the GR and NAG scores were higher that in those without this complication.

Topics: Acetylglucosaminidase; Acid Phosphatase; Adolescent; Adult; Female; Glucuronidase; Hexosaminidases; Humans; Kidney Failure, Chronic; Male; Middle Aged; Neutrophils; Peritoneal Cavity; Peritoneal Dialysis; Time Factors

Activity of acid phosphatase (AP), beta-glucuronidase (GR), N-acetyl-beta-D-glucosaminidase (GZ), and peroxidase (P) was assessed using a semiquantitative cytochemical method in peritoneal macrophages of 30 patients with end-stage renal failure treated by intermittent peritoneal dialysis and of 30 control patients with normal renal function. The dialysed patients showed a significantly higher activity of GR and P at the beginning of the treatment as compared with the respective activities observed in the control group and a further significant rise of these activities after 4 months of dialysis. Activity of AP at the beginning of the treatment was insignificantly lower than in the control group and the difference became significant at the end of the investigated period. There was no significant difference between the dialysed patients and the control group in the activity of GZ assessed at the beginning of the dialytic treatment and after 4 months of dialysis. A significant decrease in that activity was, however, observed in the course of dialysis.

Topics: Acetylglucosaminidase; Acid Phosphatase; Adult; Female; Glucuronidase; Humans; Kidney Failure, Chronic; Macrophages; Male; Peritoneal Cavity; Peritoneal Dialysis; Peroxidase

Topics: Acetylglucosaminidase; Acid Phosphatase; Adolescent; Adult; Female; Glucuronidase; Humans; Kidney Failure, Chronic; Macrophages; Male; Middle Aged; Peritoneal Cavity; Peroxidases

Topics: Acetylglucosaminidase; Acid Phosphatase; Ascitic Fluid; Glucuronidase; Humans; Kidney Failure, Chronic; Leukocytes; Macrophages; Peritoneal Dialysis

In 46 patients with primary hyperparathyroidism, in 21 non-dialysed patients with advanced renal failure, and in 52 patients on hemodialysis, a significant positive correlation was found between bone isoenzyme of serum alkaline phosphatase and plasma tartrate resistant acid phosphatase. In primary hyperparathyroidism, a significant positive correlation was found between the radiological degree of osteodystrophy and the biochemical parameters of bone remodelling. After removal of the parathyroid adenoma, only the tartrate-resistant acid phosphatase decreased to normal limits. Plasma tartrate resistant acid phosphatase was most significantly influenced by serum immunoreactive parathyroid hormone levels. In chronic renal failure, bone isoenzyme of serum alkaline phosphatase was most significantly influenced by serum immunoreactive parathyroid hormone levels, by hypocalcemia and by duration of hemodialysis. The results confirm that in hyperparathyroidism the extent of the whole-body rates of bone resorption and formation are approximately equal. The biochemical parameters can be used for serial assessment of the course of the disease but are not specific for diagnosis.

Topics: Acid Phosphatase; Alkaline Phosphatase; Bone and Bones; Humans; Hyperparathyroidism; Isoenzymes; Kidney Failure, Chronic; Renal Dialysis; Tartrates

Topics: Acid Phosphatase; Adolescent; Child; Child, Preschool; Hexosaminidases; Humans; Isoenzymes; Kidney; Kidney Failure, Chronic

It was found that neutrophils in untreated uraemic patients as well as in subjects on regular dialysis treatment displayed higher activity of acid phosphatase, alkaline phosphatase and peroxidase. Spontaneous reduction of nitro blue tetrazolium (NBT) by granulocytes was also higher in both groups in comparison to controls. Stimulation with latex particles gave similar results of NBT reduction in investigated patients and controls. Lymphocytes also showed an increase in acid phosphatase activity if compared to healthy persons. It seems possible that granulocytes which take part in unspecific defense mechanisms are more active in uraemic patients due perhaps to subclinical infections.

Topics: Acid Phosphatase; Adolescent; Adult; Alkaline Phosphatase; Female; Granulocytes; Humans; Kidney Failure, Chronic; Lymphocytes; Male; Middle Aged; Neutrophils; Nitroblue Tetrazolium; Peroxidases; Renal Dialysis; Tetrazolium Salts

Topics: Acid Phosphatase; Adolescent; Adult; Alanine Transaminase; Alcohol Oxidoreductases; Alkaline Phosphatase; Aspartate Aminotransferases; Enzymes; Female; Fructose-Bisphosphate Aldolase; gamma-Glutamyltransferase; Glutamate Dehydrogenase; Heparin; Humans; Hydroxybutyrate Dehydrogenase; Kidney Failure, Chronic; Leucyl Aminopeptidase; Male; Middle Aged; Renal Dialysis; Time Factors

Topics: Acid Phosphatase; Adolescent; Adult; Aged; Binding Sites; Erythrocytes; Female; Glyceraldehyde-3-Phosphate Dehydrogenases; Glycolysis; Hematocrit; Humans; Kidney Failure, Chronic; Male; Middle Aged; Phenotype; Phosphofructokinase-1; Phosphorus; Renal Dialysis; Urea; Uremia

Topics: Acid Phosphatase; Adenosine Triphosphatases; Adolescent; Adult; Aged; Glomerulonephritis; Humans; Kidney Failure, Chronic; Middle Aged; Nephrosis; Proteinuria

Topics: Acid Phosphatase; Acid-Base Equilibrium; Alkaline Phosphatase; Blood Coagulation Tests; Blood Proteins; Creatinine; Hematocrit; Hepatitis B Antigens; Humans; Kidney Failure, Chronic; Lipids; Renal Dialysis; Time Factors; Transaminases

Topics: Acid Phosphatase; Acute Kidney Injury; Alkaline Phosphatase; Animals; Chromates; Chromatography, Gel; Erythrocytes; Glomerulonephritis; Humans; Kidney; Kidney Failure, Chronic; Liver Cirrhosis; Nephrectomy; Nephrotic Syndrome; Rabbits; Renal Dialysis

Topics: Acid Phosphatase; Acute Kidney Injury; Adolescent; Adult; Aged; Alanine Transaminase; Alkaline Phosphatase; Aminohydrolases; Amylases; Aspartate Aminotransferases; Child; Enzymes; Female; Humans; Hydroxybutyrate Dehydrogenase; Kidney Failure, Chronic; Male; Middle Aged; Molecular Weight; Peritoneal Dialysis; Phosphoric Monoester Hydrolases; Water-Electrolyte Balance

Topics: Acid Phosphatase; Chromatography; Humans; Kidney Failure, Chronic; Male; Prostate; Prostatic Hyperplasia; Prostatic Neoplasms

Topics: Acid Phosphatase; Acute Kidney Injury; Alkaline Phosphatase; Amylases; Humans; Kidney Failure, Chronic; Molecular Weight; Oxidoreductases; Peritoneal Dialysis; Renal Dialysis; Transaminases

Topics: Acid Phosphatase; Humans; Intestinal Mucosa; Intestine, Small; Kidney Failure, Chronic

Topics: Acid Phosphatase; Blood Platelets; Breast Neoplasms; Buffers; Citrates; Cystic Fibrosis; Female; Heart Failure; Humans; Hydrogen-Ion Concentration; Kidney Failure, Chronic; Male; Phosphates; Prostate; Prostatic Diseases; Prostatic Neoplasms; Spectrophotometry; Stomach Neoplasms