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Biomedical subjects

S Ljunghall

Publications and source records attributed to S Ljunghall.

At least 343 records · Page 19Linked to original sources
PubMed1982

Renal handling of urate in patients with calcium stone disease.

The renal handling of urate was investigated in 28 recurrent calcium stone formers and 12 healthy controls. 12 patients were hyperuricosuric and 16 patients had incomplete proximal or distal acidification defects. Measurements of the glomerular filtration and the tubular reabsorption of filtered urate were made through the pyrazinamide (PZA)-suppression test of urate secretion. Hyperuricosuria could not be explained by defects in the renal handling of urate. Patients with proximal acidification defects had a higher tubular reabsorption of filtered urate than the other subjects. Tubular reabsorption of filtered urate was inversely correlated, and filtered urate escaping reabsorption positively correlated to the 24-hour excretion of urate. In contrast, the PZA-suppressible fraction of urate excretion, which is the net effect of tubular secretion and post-secretory reabsorption and thought to be the main regulator of urate excretion, was not correlated to the 24-hour excretion of urate. It is concluded that the renal handling of urate is basically normal in calcium stone disease, whereas minor deviations may co-exist with renal tubular acidification dysfunction.

Calcium↗
PubMed1982

Urate metabolism in primary hyperparathyroidism.

Urate metabolism was studied in 40 patients with primary hyperparathyroidism (HPT), 20 of them had a history of renal stones. Preoperatively they had, compared to controls, a reduction of the clearance of urate and a rise of the serum urate concentrations. These disturbances were normalized postoperatively. HPT patients, in particular those with a history of stones, had a high urinary calcium excretion probably as a result of both increased bone resorption and intestinal calcium uptake. There was a close relationship between the urinary urate and calcium excretions preoperatively but not after surgery. There were no consistent differences with regard to urate metabolism in the stone-forming individuals with HPT as compared to those who had never formed a renal stone and thus it seems unlikely that disturbances of urate handling are of any particular importance for the well-known propensity to form stones in primary HPT.

Adult↗
PubMed1982

Treatment with cimetidine in patients with primary hyperparathyroidism.

Treatment with cimetidine (1000 mg daily in four divided doses) was given for 3--30 weeks to 10 patients with primary hyperparathyroidism (HPT). All patients had hypercalcaemia and raised serum concentrations of parathyroid hormone (PTH). During treatment no consistent effects were noted on neither serum calcium or PTH and normalization did not occur in any case. Hypergastrinaemia was demonstrated in 6 patients and was also unaffected by therapy while in the 4 patients with normal pre-treatment gastrin values a slight increase was seen. This study does not support the view that cimetidine can be of use for the treatment of primary HPT.

Adult↗
PubMed1982

Regulation of parathyroid hormone release in primary and secondary hyperparathyroidism - studies in vivo and in vitro.

The effects of calcium on parathyroid hormone (PTH) release were studied in vivo and in vitro in primary hyperparathyroidism (HPT) and in vitro in secondary HPT. In vivo the serum PTH was clearly reduced by intravenous calcium infusion in all the examined patients with primary HPT caused by adenoma. In vitro the release of PTH from dispersed parathyroid cells was likewise suppressed by raising the calcium concentrations in the incubation media, though in all cases a basal release of PTH still persisted even at high calcium concentrations. The degree of suppressibility in vitro varied, but in both primary HPT with adenoma and in secondary HPT it was inversely related to the patients' serum calcium values. These results suggest that the secretion of PTH in patients with primary and secondary HPT is not autonomous either in vivo or in vitro. Furthermore, the non-suppressible basal release of PTH indicates that a major cause for the increased secretion of PTH is the increased number of parenchymal cells. However, the degree of suppressibility of the individual cells rather than the absolute number of cells, seems to be of great importance for the individual serum calcium values in HPT.

Adenoma↗
PubMed1982

Evaluation of parathyroid function in patients with hypergastrinaemia and pernicious anaemia.

In order to evaluate the possible causal relationship between raised serum gastrin levels and the development of primary hyperparathyroidism (HPT) which is suggested from experimental studies we evaluated parathyroid function in a group of 32 patients with hypergastrinaemia and pernicious anaemia. The values for serum calcium and parathyroid hormone were determined as well as the fasting urinary excretions of cyclic AMP and calcium. There was no relationship between the serum gastrin levels and any of the other studied parameters and there was no consistent pattern suggesting parathyroid hyperfunction. A retrospective analysis of hospital records from 441 patients operated for primary HPT showed a prevalence of pernicious anaemia of 1.8%. This figure is higher than that found in the unselected age-matched population (0.31%). However, taken together this study does not support the hypothesis that hypergastrinaemia is of particular importance for the pathogenesis of primary HPT.

Adult↗
PubMed1982

Parathyroid surgery in chronic renal insufficiency. Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation to the forearm.

During the period 1970 to 1980 48 parathyroidectomies were performed in 46 patients with chronic renal insufficiency. Thirty patients underwent 31 subtotal parathyroidectomies and 17 patients underwent total parathyroidectomy with parathyroid autotransplantation to the forearm. Ten patients were on conservative renal treatment, 26 were on chronic haemodialysis and 12 had functioning kidney transplants at the time of parathyroid surgery. The indication for parathyroidectomy were clinical symptoms such as pruritus, bone and joint pain, neuromuscular disorders and radiological skeletal abnormalities pointing to hyperparathyroidism (HPT). Hypercalcaemia was present in 38 patients. The clinical symptoms and radiological findings were favourably affected by parathyroid surgery but vascular calcification was not affected by the operation in any of the patients. Normocalcaemia was achieved after surgery in all patients except one, who had residual parathyroid tissue in the neck. Vitamin D substitution was required in about 30% of the patients regardless of the type of operation that was performed. Recurrent HPT occurred in 9% with similar rates after both types of surgery. However, recurrence was more easily managed after a total parathyroidectomy with autotransplantation to the forearm than after a subtotal parathyroidectomy.

Adolescent↗
PubMed1981

Calcium and magnesium metabolism during long-term treatment with thiazides.

The effects of treatment with bendroflumethiazide (2.5 mg twice daily with potassium supplements) on mineral metabolism were evaluated in 111 patients followed for a minimum period of one year. The urinary calcium decreased with approximately 30% irrespective of the pretreatment levels and remained on this lower level during follow-up. This reduction of urinary calcium was associated with a reduction of the intestinal calcium absorption. The serum calcium increased slightly in most of the patients and in 10% of them hypercalcaemia could be demonstrated at some time. In most of these cases the hypercalcaemia was slight and temporary and when sustained rapidly reversed upon withdrawal of therapy. Initially the urinary magnesium excretion increased but after two years' treatment the values were no longer raised. The serum magnesium levels showed a continued decrease during follow-up but in muscle biopsies, performed after three years treatment, no magnesium deficiency was evident. During treatment also the fasting urinary calcium was reduced, suggesting reduced bone resorption, but urinary hydroxyproline was unchanged. The serum PTH levels appeared unchanged during follow-up. Thiazides appear to cause a persisting reduction of calcium excretion, which is compensated by reduced intestinal uptake, whereas parathyroid function is unaffected. Although there was a gradual decline of serum magnesium, magnesium deficiency was not demonstrated.

Adult↗
PubMed1981

Phosphate metabolism in renal stone formers. (II): Relation to renal tubular functions and calcium metabolism.

Patients with idiopathic recurrent calcium nephrolithiasis (n = 57) and controls (n = 16) were investigated regarding the relationship between renal phosphate handling, other renal tubular functions and calcium metabolism. Incomplete renal tubular acidosis (RTA) was disclosed in 13 patients. RTA patients together with stone formers with normal renal acidification capacity (SF) exhibited low values for serum phosphate and renal threshold phosphate concentration (TmP/GFR) compared with controls. TmP/GFR was lower in RTA patients than in stone formers with normal renal acidification. Hypercalciuria of the absorptive type with normal serum PTH and urinary cAMP concentrations was a common finding in both stone patient groups, whereas no patient displayed unequivocal evidence of parathyroid hyperfunction. Fractional excretion of sodium was raised in both SF and RTA patients compared with controls. There was a positive relationship between the fractional excretion of phosphate and sodium in all subjects as a group. TmP/GFR was negatively correlated to fractional excretion of sodium. Twenty-three percent of RTA patients and 8% of SF displayed tubular proteinuria which often was associated with low TmP/GFR levels and enhanced natriuresis. It is concluded that a defective renal tubular phosphate handling is common in calcium stone formers and often associated with signs of other tubular dysfunctions. The altered phosphate handling seems to be unrelated to hypercalciuria.

Adolescent↗
PubMed1981

Phosphate metabolism in renal stone formers. (I): Indices of phosphate handling in calcium stone patients and healthy subjects.

Healthy subjects (n = 112) and patients with recurrent idiopathic calcium nephrolithiasis (n = 44) were evaluated regarding various indices of phosphate handling: serum phosphate concentration, renal tubular reabsorption of phosphate, index of phosphate excretion and renal threshold concentration for phosphate (TmP/GFR). The 24 hour and fasting 2 hour urinary phosphate excretions were similar in the two groups and the index of phosphate excretion was higher in stone formers, but for all the other variables lower mean values were found in the group of stone formers than in the group of normal subjects. The renal tubular capacity for reabsorption of phosphate (as evaluated by the different indices) appeared to decrease with advancing age concomitant with a reduction of the serum phosphate concentration. When age- and sex-matched subjects from the two groups were compared with regard to the phosphate variables lower values were still found in the group of stone forming subjects. This study gives support to earlier observations that renal stone formers tend to waste phosphate by and altered renal handling.

Absorption↗
PubMed1981

A double-blind comparison of the effects of haloperidol and cis(Z)-clopenthixol in senile dementia.

The therapeutic effects in senile dementia of haloperidol and cis(Z)-clopenthixol were compared in a double-blind, double-dummy clinical 8-week study in 47 demented patients after wash-out periods of 3 weeks or less. Forty patients, most of whom received 0.5 mg haloperidol or 5 mg cis(Z)-clopenthixol, completed the study in which assessments with the geriatric rating scales of Gottfries-Cronholm and Crichton in addition to CGI were done at weeks--3, 0, 1, 2, 4, and 8. With the Gottfries-Cronholm Scale few significant changes from week 0 were seen in the two groups of patients. Significant deteriorations at weeks 1 and 8 in the haloperidol group were, however, registered. The only significant difference between the two groups of patients regarded motor activity which was most positively influenced by cis(Z)-clopenthixol. Accordingly, most results suggesting a difference between the two test drugs were in the favour of cis(Z)-clopenthixol. With the Crichton and the CGi scales changes in the over-all impression of the patients were very few. Side effects were mild and transient.

Aged↗
PubMed1980

Biochemical and clinical effects of the prophylactic treatment of renal calcium stones with magnesium hydroxide.

Prophylactic treatment with magnesium hydroxide ws instituted in 56 consecutive cases with renal calcium stones. The patients had been investigated previously with regard to the magnesium metabolism. The urinary magnesium excretion increased promptly and remained on a higher level during treatment. No changes were observed in the serum or urinary calcium concentrations. Most patients have undergone treatment for at least 2 years and 45 have been free of recurrences of formations of new stones. The mean stone episode rate during treatment was 0.03 stones per year compared to 0.8 stones per year before treatment was instituted. The natural history of stone disease also was followed in 34 patients with stones who had received no prophylactic therapy and 15 have experienced recurrences after 2 years. Therefore, in comparison, treatment with magnesium hydroxide appeared to reduce the recurrence rate. Apart from minor gastrointestinal discomfort no adverse effects were observed during treatment.

Adult↗
PubMed1980

Treatment of recurrent calcium stone formation with cellulose phosphate.

Sodium cellulose phosphate was given to 35 patients for recurrent formation of calcium-containing stones. During therapy urinary calcium decreased by 40% in the first month and remained at this lower level. In addition, urinary magnesium excretion was reduced and the urinary magnesium/calcium ratio remained unaffected. In these patients, who mostly had had calcium oxalate stones, the prophylactic effects of sodium cellulose phosphate was poor, with a 47% recurrence rate after 2 years. This lack of prevention, despite the significant reduction of the urinary calcium, is assumed to be owing to the effects of treatment on magnesium and oxalate metabolism. Side effects were common, mainly consisting of moderate gastrointestinal discomfort, and caused withdrawal of treatment in 8 patients. This fact contributes further to our opinion that sodium cellulose phosphate is not the drug of choice in cases of calcium oxalate stone formation.

Adult↗
PubMed1980

Incidence and clinical importance of renal tubular defects in recurrent renal stone formers.

Renal tubular function was studied in 318 consecutive recurrent renal stone formers. Impaired acidification capacity was found in 19% of the patients, and tubular proteinuria in 13% of the patients. Most of the patients with defective acidification of the urine had the incomplete form of renal tubular acidosis (RTA), rpoximal and distal defects being equally common. The incidence of impaired acidification was much higher in the female (38%) than in the male (13%) stone formers. A further analysis of the clinical picture in patients with acidification defects revealed a more severe stone disease than among other stone formers. Characteristic findings were an early onset, multiple recurrences were an increased need for surgery. Stone analyses showed a high frequency of calcium phosphate stones. Investigations of renal tubular functions appear to be a valuable adjunct in the evaluation of recurrent renal stone disease.

Acid-Base Equilibrium↗