[Fanconi's syndrome: anomalous renal tubular reabsorption with aminoaciduria and osteomalacia].
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Vitamin-D deficiency is associated with secondary hyperparathyroidism, hypophosphatemia, generalized aminoaciduria, phosphaturia and, late in its course, hypocalcemia. The tubulopathy has been attributed to the elevated levels of circulating parathyroid hormone. To further delineate the mechanisms responsible for aminoaciduria, vitamin-D deficiency and/or phosphate depletion were induced by placing weanling Sprague-Dawley rats on one of the following diets for 5 weeks: (1) control = 0.7% P, 5.5 micrograms % vitamin D; (2) D-P- = 0.1% P, 0 microgram % vitamin D; (3) D+P- = 0.1% P, 5.5 micrograms % vitamin D; (4) D-P+ = 0.3% P, 0 microgram % vitamin D, and (5) D-P++ = 0.7% P, 0 microgram % vitamin D. Short-term P depletion was produced in a group of animals fed D-P++ for 4 weeks, then fed D-P- for another week. To study the effects of acute supplementation with a pharmacological dose of calcitriol on the transport of amino acids by renal brush border membrane vesicles, the latter experimental group received 500 pmol of calcitriol (and is known as the SUPP group), or an equal amount of the vehicle (and is referred to as the ETH group). The uptake of taurine and proline by renal brush border membrane vesicles was blunted by 50 +/- 3 and 40 +/- 5%, respectively, at the peak of the overshoot, in all diets except D-P++. No changes were observed in vesicle size or Vmax.(ABSTRACT TRUNCATED AT 250 WORDS)
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Calcium, phosphorus and vitamin D metabolism were examined in 21 male and 13 female subjects with renal tubular dysfunction in the cadmium-polluted Jinzu River basin in Toyama prefecture, Japan. Multiple proximal renal tubular dysfunction was detected in all subjects showing increased FE beta 2-m and FFua, generalized aminoaciduria and renal glucosuria. Reduced ability of tubular reabsorption of phosphate resulted in hypophosphatemia in 31% of the women. Despite decreased tubular reabsorption of calcium, the level of serum calcium remained normal in all subjects. Serum 1,25-dihydroxyvitamin-D [1,25(OH)2D], which is produced in the proximal tubules through 1 alpha-hydroxylation from 25-hydroxyvitamin-D [25OHD], was normal or increased to more than 60pg/ml. The serum level of 1,25(OH)2D was inversely related to creatinine clearance in both the men (p < 0.05) and women (p < 0.01). Serum iPTH was slightly increased to more than 0.9 mg/ml, whereas the levels of other hormones, including 25OHD, calcitonin, thyroxine (T4) and triiodothyronine (T3) were normal. The serum alkaline phosphatase activity and serum osteocalcin concentration were significantly increased compared to those of controls in both sexes. Bone loss detected by the measurement of bone density was prominent in female subjects. These results support the hypothesis that the serum phosphate concentration is more important than the serum concentration of 1,25(OH)2D for abnormalities of bone metabolism in cadmium-induced renal tubular dysfunction.
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A six month old boy under observation for over two years developed an ichthyosiform erythroderma with alopecia, which was diagnosed as Netherton syndrome. Histologic examination of the hair roots showed trichorrhexis invaginata (bamboo hair), trichorrhexis invaginata torta and pili torti. Prolinuria was detected. Local therapy with corticosteroids was without any effect. These symptoms can be attributed to aminoaciduria (prolinuria).
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