vitamin-d-2 and Phosphorus-Metabolism-Disorders

Topics: Biomarkers; Chromatography, High Pressure Liquid; Diagnosis, Differential; Ergocalciferols; Humans; Hypercalcemia; Hypocalcemia; Osteomalacia; Phosphorus Metabolism Disorders; Reference Values; Rickets; Specimen Handling; Vitamin D

To evaluate the efficacy and safety of alfacalcidol and paracalcitol used to correct impaired phosphorus-calcium metabolism (PCM) in patients with predialysis chronic kidney disease (CKD).. Examinations were made in 128 patients with Stages III-V CKD, including 89 (69.5%) patients with chronic glomerulonephritis, 30 (23.4%) with chronic tubulointerstitial nephritis, and 9 (7.1%) with hypertensive nephrosclerosis. Impaired PCM was detected in 90 (70.3%) of the examined patients. According to the pattern of the previous therapy, all the 90 CKD patients with PCM disorders were divided into 3 groups: 1) 32 patients with Stages IIIB-V CKD who had taken oral alfacalcidol 0.25 microg/day; 2) 28 patients with Stages IIIB-V CKD who had used oral paricalcitol 1 microg/day; 3) 30 patients with Stages IIIB-V CKD who had not received, as self- motivated, active vitamin D metabolites at the predialysis stage.. Alfacalcidol and paricalcitol were quite satisfactorily tolerated by the patients. After 3 months of initiation of the use of these agents, Groups 1 and 2 patients with predialysis CKD and baseline elevated blood intact parathyroid hormone (iPTH) levels could not only achieve, but also maintain target blood iPTH levels. In the patients taking paricalcitol, the urinary protein level decreased more promptly; moreover, by the end of month 6 the reduction in blood pressure (BP) was more significant than in those using alfacalcidol (p < 0.05). Comparison of the effects of angiotensin-converting enzyme inhibitors in combination with alfacalcidol or paricalcitol on BP changes and left ventricular mass index indicated that the most pronounced positive changes occurred when angiotensin-converting enzyme inhibitors were used in combination with paricalcitol.. The use of paricalcitol in predialysis CKD with PTH hyperproduction results in not only normalization of the levels of both PTH and osseous isoenzyme of alkaline phosphatase, but also in significantly reduced daily proteinuria and regression of left ventricular hypertrophy and chronic heart failure.

Topics: Adolescent; Adult; Aged; Bone Density Conservation Agents; Calcium Metabolism Disorders; Comorbidity; Ergocalciferols; Female; Humans; Hydroxycholecalciferols; Male; Middle Aged; Phosphorus Metabolism Disorders; Renal Insufficiency, Chronic; Severity of Illness Index; Treatment Outcome; Young Adult

The efficacy of the vitamin D analog paricalcitol has mainly been shown in short-term studies. There are limited data regarding long-term treatment with this agent. This purpose of this study was to determine long-term effects of paricalcitol therapy on parathyroid hormone (PTH) suppression and serum levels of calcium, phosphorus and calcium-phosphorus product (Ca x P).. Patients who received paricalcitol for > or = 3 months had the following data collected: demographics, drug dosage, serum PTH, corrected serum calcium concentration, serum phosphorus concentrations and serum Ca x P values.. Sixteen patients received paricalcitol for a mean of 18 months. The mean +/- SD dose of paricalcitol was 0.13 +/- 0.12 mcg/kg. The mean +/- SD pre-paricalcitol serum PTH concentration was 705 +/- 423 pg/mL. PTH concentration did not change significantly over the duration of treatment (mean +/- SD: 821 +/- 480 pg/mL). The number of patients who had at least one corrected serum calcium concentration > or = 11.5 mg/dL, one serum phosphorus concentration > or = 6.5 mg/dL, or one Ca x P level > or = 70 were 75%, 94% and 82%, respectively. Hypercalcemia and elevated Ca x P value resulted in a mean of 17% of doses being withheld during therapy.. During the study, PTH was not adequately suppressed by paricalcitol. This was primarily attributed to withholding paricalcitol doses due to elevated serum calcium and Ca x P levels.

Topics: Adult; Calcium; Ergocalciferols; Female; Humans; Hypercalcemia; Hyperparathyroidism, Secondary; Kidney Failure, Chronic; Male; Middle Aged; Parathyroid Hormone; Phosphorus; Phosphorus Metabolism Disorders; Renal Dialysis

Topics: Calcium Metabolism Disorders; Cholecalciferol; Chronic Kidney Disease-Mineral and Bone Disorder; Ergocalciferols; Humans; Hypoparathyroidism; Osteomalacia; Osteoporosis; Phosphorus Metabolism Disorders; Renal Dialysis; Vitamin D

A phosphate depletion syndrome developed in a steroid-dependent asthmatic patient. Initially, the clinical picture was confused with steroid-associated myopathy rather than the phosphate depletion syndrome which has similar symptoms. The classic biochemical findings led to the correct diagnosis. Cessation of phosphate-binding antacids and phosphorus repletion rapidly corrected the biochemical findings and led to the patient's clinical improvement. Platelet phosphate metabolism was evaluated; it was found to correlate with the phosphorus-depleted state and clinical recovery with phosphate repletion. Attention is drawn to the clinical entity of phosphate depletion which may mimic steroid-induced side effects, both of which may occur in patients receiving steroids and antacids.

Topics: Antacids; Asthma; Calcium Gluconate; Diagnosis, Differential; Ergocalciferols; Humans; Male; Methylprednisolone; Middle Aged; Osteoporosis; Phosphates; Phosphorus Metabolism Disorders; Prednisolone

Topics: Aged; Alkaline Phosphatase; Calcium; Ergocalciferols; Female; Fractures, Spontaneous; Humans; Phosphorus; Phosphorus Metabolism Disorders; Rickets

Topics: Adolescent; Amino Acid Metabolism, Inborn Errors; Chronic Kidney Disease-Mineral and Bone Disorder; Dipeptides; Ergocalciferols; Glycine; Glycosuria; Glycosuria, Renal; Humans; Hydroxyproline; Kidney Function Tests; Osteomalacia; Osteoporosis; Phosphates; Phosphorus; Phosphorus Metabolism Disorders; Radiography; Renal Aminoacidurias; Renal Tubular Transport, Inborn Errors; Rickets; Rickets, Hypophosphatemic; Urine

Topics: Blood Protein Disorders; Calcium Metabolism Disorders; Ergocalciferols; Fractures, Spontaneous; Gastroenterology; Humans; Kidney Diseases; Kidney Glomerulus; Liver Cirrhosis; Osteomalacia; Osteoporosis; Phosphorus Metabolism Disorders; Rib Fractures; Vitamin D Deficiency

Topics: Adrenal Cortex Hormones; Asthma; Calcium Metabolism Disorders; Cortisone; Ergocalciferols; Fractures, Spontaneous; Geriatrics; Humans; Osteoporosis; Phosphorus Metabolism Disorders; Spinal Diseases; Toxicology