[Effect of 1-alpha-hydroxyvitamin D-3 on calcium concentration and the level of immunoreactive parathormone in the serum of patients with chronic renal failure].
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Biomedical subjects
Publications and source records attributed to J Kuska.
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In 100 patients with essential hypertension and 50 healthy subjects the relation between plasma renin activity (PRA) and plasma aldosterone level (Ald) was investigated. PRA as well as plasma aldosterone was estimated a) after a diet with normal sodium content (equals 120 mEq per day) provided for 3 days and after an 8 hrs rest ("L" value of PRA and Ald) and b) after sodium restriction (10 mEq per day) for 3 days and 3-4 hrs ambulation ("A" value of PRA and Ald). Concerning the behaviour of "L"- und "A"-PRA all patients were divided into 4 groups: a) patients with normal, b) rigid, c) low and d) high PRA. Despite differentiated values of PRA in patients of all groups a normal increase of the plasma aldosterone level was stated after sodium restriction in the diet and upright position. Even in 18% of healthy subjects with low PRA a normal increase of Ald after sodium restriction and upright position was observed. These results seem to prove that in patients with low and rigid PRA and in 18% of healthy subjects the renin-angiotensin system is not the main or only regulator of aldosterone secretion.
In 19 patients with acute renal insufficiency the plasma renin activity (PRA) and the aldosteronaemia were determined during the phase of anuria and oliguria. Significantly elevated PRA values were found while plasma aldosterone was only moderately elevated in the blood plasma. Apart from this a significantly negative correlation between the aldosterone level and the sodium and bicarbonate concentrations in the blood plasma were found. The lack of a significant positive correlation between PRA and plasma aldosterone levels suggests the participation of factors other than renin in the regulation of the aldosterone secretion in patients with acute renal insufficiency.
Serum immunoreactive parathyroid hormone (iPTH) was estimated in 30 patients with renal failure before and after haemodialysis. All patients were anuric or oliguric at the time of the investigation. Pre-dialysis iPTH values were significantly elevated (3.4 ng/ml) as compared with normal subjects (less than 0.5 ng/ml). Simultaneously, a significant hypocalcaemia (4.15 mEq/litre) was confirmed which was negatively correlated with iPTH levels. After 7-8 h of haemodialysis using a calcium concentration of 4.0 mEq/litre in the dialysate, a significant drop of iPTH level to 1.8 ng/ml was noted.
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In 15 patients with chronic renal insufficiency the influence of the haemodialysis on the level of the blood serum of immune-reactive parathormone (iPTH). In the therapy of dialysis a wash with high calcium content (= 8 mg/100 ml) was used. After a single haemodialysis a decrease of the iPTH-level was observed. After a dialysis therapy lasting several months the values of the iPTH-concentration in 7 of 8 examined patients were significantly lower than before this therapy. The results cited prove that by means of a wash with high calcium content the increased PTH-secretion may be diminished in patients with chronic renal insufficiency.
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