The clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of chron... more The clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of chronic kidney disease mineral and bone disorders (CKD-BMD) in adults, of the Latin American Society of Nephrology and Hypertension (SLANH) comprise a set of recommendations developed to support the doctor in the management of these abnormalities in adult patients with stages 3-5 kidney disease. This excludes changes associated with renal transplantation. The topics covered in the guidelines are divided into four chapters: 1) Evaluation of biochemical changes, 2) Evaluation of bone changes, 3) Evaluation of vascular calcifications, and 4) Treatment of CKD-MBD. The guidelines are based on the recommendations proposed and published by the Kidney Disease: Improving Global Outcomes (KDIGO) for the prevention, diagnosis, evaluation and treatment of CKD-MBD (KDIGO Clinical practice guidelines for the diagnosis, evaluation, prevention and treatment of Chronic Kidney Disease Mineral and Bone Disorder [CKD-MBD]), adapted to the conditions of patients, institutions and resources available in Latin America, with the support of KDIGO. In some cases, the guidelines correspond to management recommendations directly defined by the working group for their implementation in our region, based on the evidence available in the literature. Each chapter contains guidelines and their rationale, supported by numerous updated references. Unfortunately, there are few controlled studies with statistically sufficient weight in Latin America to support specific recommendations for the region, and as such, most of the references used correspond to studies carried out in other regions. This highlights the need to plan research studies designed to establish the current status of mineral and bone metabolism disorders in Latin America as well as defining the best treatment options for our population.
Paracellular transport in the kidney is mediated by a family of proteins located in the tight jun... more Paracellular transport in the kidney is mediated by a family of proteins located in the tight junctions called claudins which confers its ionic selectivity. Claudin-2 is highly expressed in the proximal tubule and descending limb of Henle and mediate paracellular reabsorption of sodium and calcium cations. In the thick ascending limb of Henle (TALH) calcium is reabsorbed by a paracellular channel formed by Claudin-16 and-19. Claudin-16 mediates cationic permeability while Claudin-19 increases the cationic selectivity of Claudin-16 by blocking anionic permeability. On the other hand, Claudin 14, that is also located in TALH, inhibits the paracellular permeability of Claudin-16 to calcium. Recent wide genomic association analysis studies have detected four common synonymous variants (genetic polymorphisms of a single nucleotide, SNPs) at the locus of Claudin-14 gene that were significantly associated with the presence of renal lithiasis. Another study of wide genomic association and nephrolithiasis was carried out in the general population but including chromosome X, where claudin-2 gene is located. They detected nine SNPs that had a significant association with renal lithiasis risk. A greater knowledge of the paracellular pathway controlled by claudins and its regulation will allow us to develop future new treatments for idiopathic hypercalciuria and renal lithiasis.
Food additives containing phosphorus are increasingly being added to dietary products. Their addi... more Food additives containing phosphorus are increasingly being added to dietary products. Their addition to processed foods is due to various reasons: as preservatives, as leaving agents or as flavor enhancers. As these additives are being incorporated to dietary products that naturally contain phosphorus as well as those that do not contain it, the estimation of total phosphorus content by food tables or software programs becomes difficult, considering this addition as a hidden source of phosphate. Thus we decided to evaluate in a series of processed foods, grouping them by type of dietary product, if the label mentioned the presence of food additives containing phosphorus (as described by the Argentine Alimentary Code in its resolution MERCOSUR about additives). We analyzed the labels of 81 processed foods divided in 7 groups: 1) dairy products, 2) sausages and derivatives, 3) meat and derivatives, 4) bread and cookies, 5) cereals and derivatives, 6) drinks, and 7) others. We found a...
Introduction: Decreased bone mineral density and increased prevalence of bone fractures have been... more Introduction: Decreased bone mineral density and increased prevalence of bone fractures have been found in patients with idiopathic hypercalciuria. It is not yet clear if thiazide treatment prevent these events. Methods: We retrospectively evaluated bone mass and biochemical markers of bone turnover in response to thiazide therapy in 52 consecutive female patients with idiopathic hypercalciuria and nephrolithiasis. Patients were divided in two subgroups according to their menopausal status: 25 were pre-menopausal (Group I) and 27 were postmenopausal (Group II). Results: Osteoporosis was found in 12 patients at baseline, 9 at the lumbar spine and 6 at the femoral neck. Two were pre-menopausal and 10 were postmenopausal. Patients with osteoporosis were analyzed separately (Group III). There was a significant and persistent reduction in urinary calcium with preservation of bone mass in all the groups after a median follow-up of 51 months. Few adverse effects were found using low doses ...
As vitamin D insufficiency is very common world-wide, vitamin D supplementation has generated muc... more As vitamin D insufficiency is very common world-wide, vitamin D supplementation has generated much debate and subsequent research not only in the general population but also in patients with chronic kidney disease (CKD). Several observational and mechanistic studies have suggested that vitamin D’s actions may be more broad and significant than originally appreciated, far exceeding bone and mineral metabolism. This is probably due to the fact that most tissues in the body express vitamin D receptors. As patients with kidney disease cannot convert 25-hydroxyvitamin D [25(OH)D] to its more active form, 1,25-dihydroxy vitamin D [1,25(OH)2D] because of reduced activity of the enzyme 1α-hydroxylase in the kidneys to produce classic bone and mineral effects, nephrologists have traditionally replaced patients with kidney disease with active vitamin D, 1,25-dihydroxvitamin D, or related analogs. Multiple observational studies in patients with CKD have shown that they not only have low levels of 1,25(OH)2D, but also low 25(OH)D levels. The fact that there is also extrarenal conversion of 25(OH) vitamin D to 1,25(OH)2 vitamin D in CKD in multiple tissues leading to autocrine effects, has led to the speculation that CKD patients should also need to be supplemented with nutritional vitamin D. This chapter outlines the available evidence on the controversy about which vitamin D is better for patients with kidney disease: Active vitamin D, nutritional or both.
Background and Aims Sarcopenia is the loss of skeletal muscle mass and function that occurs with ... more Background and Aims Sarcopenia is the loss of skeletal muscle mass and function that occurs with aging. These modifications lead to greater morbidity and mortality as a result of falls, hospitalization, depression and dependence among others. Chronic Kidney disease (CKD) and hemodialysis (HD) produce a favorable environment for the development of sarcopenia. Objective: to study the prevalence of sarcopenia and its different components (muscle mass, strength and physical performance) using EWGSOP 2018 proposed criteria. Method cross-sectional study evaluating 100 adult HD patients. We evaluated: Grip strength (GS) with Jamar Hydraulic Hand Dynamometer (three determinations in the arm without fistula); Appendicular lean mass (ALM) by DXA (GE LUNAR Prodigy Advance) and physical performance: Gait-speed (Time needed to perform a 4-meter walk on a flat surface) and the sit-stand test Results 58 males (M) and 42 females (F). Mean age for M was 54.3 years and 58 years for F. The prevalence ...
Introduction: 25(OH) vitamin D deficiency is a prevailing alteration in patients with chronic kid... more Introduction: 25(OH) vitamin D deficiency is a prevailing alteration in patients with chronic kidney disease (CKD); however, in our environment, it is not routinely measured and, therefore, vitamin replacement is unusual. Objective: Our purpose was assessing the prevalence of and the factors related to 25 (OH) vitamin D deficiency in patients with CKD in hemodialysis (HD), especially the relation to function and muscle mass. Methods: We conducted a prospective, multicenter study in adult patients on chronic HD who were not receiving any vitamin D derivative. Blood levels of 25(OH) D, Hemoglobin, CRP, Albumin, Ca, P, ALP and PTHi were measured. The handgrip strength was measured with a dynamometer and the sitting-rising test was carried out. A bioimpedance analysis (BCM, Fresenius Medical Care) was conducted in the patients who had no contraindications. Results: 138 patients were included. The levels of 25(OH) vitamin D were 20.43±10.5 ng/ml; the insufficiency/deficiency had 87% prevalence (and 37% prevalence with less than 15 ng/ml). Vitamin D concentrations/deficiency showed a significant correlation with/relation to age, diabetes, hemoglobin and albumin levels, muscle strength and mass, and functional class (p<0.05). Conclusions: High prevalence of hypovitaminosis D in patients on hemodialysis, particularly in the elderly and in patients with diabetes. This should be related to undernutrition, anemia, the functional class and the muscle strength/mass of patients, the latter two being unreported factors until now. All these factors should be considered when vitamin replacement is conducted and when its effectiveness is assessed.
The aim of designing this consensus document was to collaborate with nephrologists in the managem... more The aim of designing this consensus document was to collaborate with nephrologists in the management of mineral metabolism in patients with chronic kidney disease. To do this, we formulated questions requiring answers for the clinical management of our patients and consulted bibliographic sources and international guidelines with the aim of adapting them to the Argentine situation. The new definitions and the more integrated classification system recently proposed by the Kidney Disease Improving Global Outcomes (KDIGO) Foundation have been taken into account. Chapter VI on vascular calcifications in chronic kidney disease is presented, with an appendix on the diagnosis of vascular calcifications.
Citrate is a powerful inhibitor of the crystallization of calcium salts. Hypocitraturia is a bioc... more Citrate is a powerful inhibitor of the crystallization of calcium salts. Hypocitraturia is a biochemical common alteration in calcium stone formation in adults and especially in children. The acid pH (systemic, tubular and intracellular) is the main determinant of citrate excretion in the urine. While the etiology of hypocitraturia is idiopathic in most patients with kidney stones, there are a number of causes for this abnormality including distal renal tubular acidosis, hypokalemia, diets rich in animal protein and / or diets low in alkali and certain drugs, such as acetazolamide, topiramate, ACE inhibitors and thiazides. Dietary modifications that benefit these patients include high intake of fluids and fruits, especially citrus, sodium and protein restriction, with normal calcium intake. Treatment with potassium citrate is effective in patients with primary or secondary hypocitraturia and acidification disorders, which cause unduly acidic urine pH persistently. Adverse effects ar...
Introduction: Parathyroidectomy (PTx) is the selecte treatment for patients with severe secondary... more Introduction: Parathyroidectomy (PTx) is the selecte treatment for patients with severe secondary hyperparathyroidism, refractory to medical treatment. There is not enough information about this procedure in Argentina, that is the reason why we performed this study. Methods: 255 patients with PTx were included from the year 2003 to 2007 on a voluntary register. Studies of pre-surgical localization, phosphocalcic metabolism laboratories before and after surgery were evaluated, and the type of surgical technique used. The persistence and recurrence of post-surgical hyperparathyroidism was analyzed. Results: The PTx rate was 2,7/1000 patients year. 83% of the patients had neck echography and 59% Sestamibi scans with Tc 99. There was a positive correlation (p<0,001) between the number of detected glands by echography and Sestamibi. The parathyroidectomy performed was: subtotal in 77%, total with self-implant in 14% and total without self-implant in 9%. There were significant falls of Ca and P, Alkaline Phosphatase and PTH (1744±788 pg/ml to 247±450 pg/ml; p<0.0001) post-surgical. 2.4 ±2,5 months after the PTx, 72% of patients had PTH <2 50 pg/ml, 19,8% had persistence and 8,3% had recurrence. According to the type of surgery, the persistence and recurrence were for subtotal PTx 22% and 8,3%, total PTx with implant 11% and 11%, and total PTx without selfimplant 13% and 4% respectively. The performance of the Sestamibi scan did not affect the PTx results. No noticeable differences were observed among the centers for persistence and recurrence. Conclusions: The PTx rate was very low, echography was the preferred method of pre-surgical localization, and subtotal PTx was the most used surgical technique. PTx was successful in most of the patients, and persistence and recurrence were not related to the technique.
Citrate is a powerful inhibitor of the crystallization of calcium salts. Hypocitraturia is a bioc... more Citrate is a powerful inhibitor of the crystallization of calcium salts. Hypocitraturia is a biochemical common alteration in calcium stone formation in adults and especially in children. The acid pH (systemic, tubular and intracellular) is the main determinant of citrate excretion in the urine. While the etiology of hypocitraturia is idiopathic in most patients with kidney stones, there are a number of causes for this abnormality including distal renal tubular acidosis, hypokalemia, diets rich in animal protein and / or diets low in alkali and certain drugs, such as acetazolamide, topiramate, ACE inhibitors and thiazides. Dietary modifications that benefit these patients include high intake of fluids and fruits, especially citrus, sodium and protein restriction, with normal calcium intake. Treatment with potassium citrate is effective in patients with primary or secondary hypocitraturia and acidification disorders, which cause unduly acidic urine pH persistently. Adverse effects ar...
Introduction: Parathyroidectomy (PTx) is the selecte treatment for patients with severe secondary... more Introduction: Parathyroidectomy (PTx) is the selecte treatment for patients with severe secondary hyperparathyroidism, refractory to medical treatment. There is not enough information about this procedure in Argentina, that is the reason why we performed this study. Methods: 255 patients with PTx were included from the year 2003 to 2007 on a voluntary register. Studies of pre-surgical localization, phosphocalcic metabolism laboratories before and after surgery were evaluated, and the type of surgical technique used. The persistence and recurrence of post-surgical hyperparathyroidism was analyzed. Results: The PTx rate was 2,7/1000 patients year. 83% of the patients had neck echography and 59% Sestamibi scans with Tc 99. There was a positive correlation (p<0,001) between the number of detected glands by echography and Sestamibi. The parathyroidectomy performed was: subtotal in 77%, total with self-implant in 14% and total without self-implant in 9%. There were significant falls of Ca and P, Alkaline Phosphatase and PTH (1744±788 pg/ml to 247±450 pg/ml; p<0.0001) post-surgical. 2.4 ±2,5 months after the PTx, 72% of patients had PTH <2 50 pg/ml, 19,8% had persistence and 8,3% had recurrence. According to the type of surgery, the persistence and recurrence were for subtotal PTx 22% and 8,3%, total PTx with implant 11% and 11%, and total PTx without selfimplant 13% and 4% respectively. The performance of the Sestamibi scan did not affect the PTx results. No noticeable differences were observed among the centers for persistence and recurrence. Conclusions: The PTx rate was very low, echography was the preferred method of pre-surgical localization, and subtotal PTx was the most used surgical technique. PTx was successful in most of the patients, and persistence and recurrence were not related to the technique.
The clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of chron... more The clinical practice guidelines for the prevention, diagnosis, evaluation and treatment of chronic kidney disease mineral and bone disorders (CKD-BMD) in adults, of the Latin American Society of Nephrology and Hypertension (SLANH) comprise a set of recommendations developed to support the doctor in the management of these abnormalities in adult patients with stages 3-5 kidney disease. This excludes changes associated with renal transplantation. The topics covered in the guidelines are divided into four chapters: 1) Evaluation of biochemical changes, 2) Evaluation of bone changes, 3) Evaluation of vascular calcifications, and 4) Treatment of CKD-MBD. The guidelines are based on the recommendations proposed and published by the Kidney Disease: Improving Global Outcomes (KDIGO) for the prevention, diagnosis, evaluation and treatment of CKD-MBD (KDIGO Clinical practice guidelines for the diagnosis, evaluation, prevention and treatment of Chronic Kidney Disease Mineral and Bone Disorder [CKD-MBD]), adapted to the conditions of patients, institutions and resources available in Latin America, with the support of KDIGO. In some cases, the guidelines correspond to management recommendations directly defined by the working group for their implementation in our region, based on the evidence available in the literature. Each chapter contains guidelines and their rationale, supported by numerous updated references. Unfortunately, there are few controlled studies with statistically sufficient weight in Latin America to support specific recommendations for the region, and as such, most of the references used correspond to studies carried out in other regions. This highlights the need to plan research studies designed to establish the current status of mineral and bone metabolism disorders in Latin America as well as defining the best treatment options for our population.
Paracellular transport in the kidney is mediated by a family of proteins located in the tight jun... more Paracellular transport in the kidney is mediated by a family of proteins located in the tight junctions called claudins which confers its ionic selectivity. Claudin-2 is highly expressed in the proximal tubule and descending limb of Henle and mediate paracellular reabsorption of sodium and calcium cations. In the thick ascending limb of Henle (TALH) calcium is reabsorbed by a paracellular channel formed by Claudin-16 and-19. Claudin-16 mediates cationic permeability while Claudin-19 increases the cationic selectivity of Claudin-16 by blocking anionic permeability. On the other hand, Claudin 14, that is also located in TALH, inhibits the paracellular permeability of Claudin-16 to calcium. Recent wide genomic association analysis studies have detected four common synonymous variants (genetic polymorphisms of a single nucleotide, SNPs) at the locus of Claudin-14 gene that were significantly associated with the presence of renal lithiasis. Another study of wide genomic association and nephrolithiasis was carried out in the general population but including chromosome X, where claudin-2 gene is located. They detected nine SNPs that had a significant association with renal lithiasis risk. A greater knowledge of the paracellular pathway controlled by claudins and its regulation will allow us to develop future new treatments for idiopathic hypercalciuria and renal lithiasis.
Food additives containing phosphorus are increasingly being added to dietary products. Their addi... more Food additives containing phosphorus are increasingly being added to dietary products. Their addition to processed foods is due to various reasons: as preservatives, as leaving agents or as flavor enhancers. As these additives are being incorporated to dietary products that naturally contain phosphorus as well as those that do not contain it, the estimation of total phosphorus content by food tables or software programs becomes difficult, considering this addition as a hidden source of phosphate. Thus we decided to evaluate in a series of processed foods, grouping them by type of dietary product, if the label mentioned the presence of food additives containing phosphorus (as described by the Argentine Alimentary Code in its resolution MERCOSUR about additives). We analyzed the labels of 81 processed foods divided in 7 groups: 1) dairy products, 2) sausages and derivatives, 3) meat and derivatives, 4) bread and cookies, 5) cereals and derivatives, 6) drinks, and 7) others. We found a...
Introduction: Decreased bone mineral density and increased prevalence of bone fractures have been... more Introduction: Decreased bone mineral density and increased prevalence of bone fractures have been found in patients with idiopathic hypercalciuria. It is not yet clear if thiazide treatment prevent these events. Methods: We retrospectively evaluated bone mass and biochemical markers of bone turnover in response to thiazide therapy in 52 consecutive female patients with idiopathic hypercalciuria and nephrolithiasis. Patients were divided in two subgroups according to their menopausal status: 25 were pre-menopausal (Group I) and 27 were postmenopausal (Group II). Results: Osteoporosis was found in 12 patients at baseline, 9 at the lumbar spine and 6 at the femoral neck. Two were pre-menopausal and 10 were postmenopausal. Patients with osteoporosis were analyzed separately (Group III). There was a significant and persistent reduction in urinary calcium with preservation of bone mass in all the groups after a median follow-up of 51 months. Few adverse effects were found using low doses ...
As vitamin D insufficiency is very common world-wide, vitamin D supplementation has generated muc... more As vitamin D insufficiency is very common world-wide, vitamin D supplementation has generated much debate and subsequent research not only in the general population but also in patients with chronic kidney disease (CKD). Several observational and mechanistic studies have suggested that vitamin D’s actions may be more broad and significant than originally appreciated, far exceeding bone and mineral metabolism. This is probably due to the fact that most tissues in the body express vitamin D receptors. As patients with kidney disease cannot convert 25-hydroxyvitamin D [25(OH)D] to its more active form, 1,25-dihydroxy vitamin D [1,25(OH)2D] because of reduced activity of the enzyme 1α-hydroxylase in the kidneys to produce classic bone and mineral effects, nephrologists have traditionally replaced patients with kidney disease with active vitamin D, 1,25-dihydroxvitamin D, or related analogs. Multiple observational studies in patients with CKD have shown that they not only have low levels of 1,25(OH)2D, but also low 25(OH)D levels. The fact that there is also extrarenal conversion of 25(OH) vitamin D to 1,25(OH)2 vitamin D in CKD in multiple tissues leading to autocrine effects, has led to the speculation that CKD patients should also need to be supplemented with nutritional vitamin D. This chapter outlines the available evidence on the controversy about which vitamin D is better for patients with kidney disease: Active vitamin D, nutritional or both.
Background and Aims Sarcopenia is the loss of skeletal muscle mass and function that occurs with ... more Background and Aims Sarcopenia is the loss of skeletal muscle mass and function that occurs with aging. These modifications lead to greater morbidity and mortality as a result of falls, hospitalization, depression and dependence among others. Chronic Kidney disease (CKD) and hemodialysis (HD) produce a favorable environment for the development of sarcopenia. Objective: to study the prevalence of sarcopenia and its different components (muscle mass, strength and physical performance) using EWGSOP 2018 proposed criteria. Method cross-sectional study evaluating 100 adult HD patients. We evaluated: Grip strength (GS) with Jamar Hydraulic Hand Dynamometer (three determinations in the arm without fistula); Appendicular lean mass (ALM) by DXA (GE LUNAR Prodigy Advance) and physical performance: Gait-speed (Time needed to perform a 4-meter walk on a flat surface) and the sit-stand test Results 58 males (M) and 42 females (F). Mean age for M was 54.3 years and 58 years for F. The prevalence ...
Introduction: 25(OH) vitamin D deficiency is a prevailing alteration in patients with chronic kid... more Introduction: 25(OH) vitamin D deficiency is a prevailing alteration in patients with chronic kidney disease (CKD); however, in our environment, it is not routinely measured and, therefore, vitamin replacement is unusual. Objective: Our purpose was assessing the prevalence of and the factors related to 25 (OH) vitamin D deficiency in patients with CKD in hemodialysis (HD), especially the relation to function and muscle mass. Methods: We conducted a prospective, multicenter study in adult patients on chronic HD who were not receiving any vitamin D derivative. Blood levels of 25(OH) D, Hemoglobin, CRP, Albumin, Ca, P, ALP and PTHi were measured. The handgrip strength was measured with a dynamometer and the sitting-rising test was carried out. A bioimpedance analysis (BCM, Fresenius Medical Care) was conducted in the patients who had no contraindications. Results: 138 patients were included. The levels of 25(OH) vitamin D were 20.43±10.5 ng/ml; the insufficiency/deficiency had 87% prevalence (and 37% prevalence with less than 15 ng/ml). Vitamin D concentrations/deficiency showed a significant correlation with/relation to age, diabetes, hemoglobin and albumin levels, muscle strength and mass, and functional class (p<0.05). Conclusions: High prevalence of hypovitaminosis D in patients on hemodialysis, particularly in the elderly and in patients with diabetes. This should be related to undernutrition, anemia, the functional class and the muscle strength/mass of patients, the latter two being unreported factors until now. All these factors should be considered when vitamin replacement is conducted and when its effectiveness is assessed.
The aim of designing this consensus document was to collaborate with nephrologists in the managem... more The aim of designing this consensus document was to collaborate with nephrologists in the management of mineral metabolism in patients with chronic kidney disease. To do this, we formulated questions requiring answers for the clinical management of our patients and consulted bibliographic sources and international guidelines with the aim of adapting them to the Argentine situation. The new definitions and the more integrated classification system recently proposed by the Kidney Disease Improving Global Outcomes (KDIGO) Foundation have been taken into account. Chapter VI on vascular calcifications in chronic kidney disease is presented, with an appendix on the diagnosis of vascular calcifications.
Citrate is a powerful inhibitor of the crystallization of calcium salts. Hypocitraturia is a bioc... more Citrate is a powerful inhibitor of the crystallization of calcium salts. Hypocitraturia is a biochemical common alteration in calcium stone formation in adults and especially in children. The acid pH (systemic, tubular and intracellular) is the main determinant of citrate excretion in the urine. While the etiology of hypocitraturia is idiopathic in most patients with kidney stones, there are a number of causes for this abnormality including distal renal tubular acidosis, hypokalemia, diets rich in animal protein and / or diets low in alkali and certain drugs, such as acetazolamide, topiramate, ACE inhibitors and thiazides. Dietary modifications that benefit these patients include high intake of fluids and fruits, especially citrus, sodium and protein restriction, with normal calcium intake. Treatment with potassium citrate is effective in patients with primary or secondary hypocitraturia and acidification disorders, which cause unduly acidic urine pH persistently. Adverse effects ar...
Introduction: Parathyroidectomy (PTx) is the selecte treatment for patients with severe secondary... more Introduction: Parathyroidectomy (PTx) is the selecte treatment for patients with severe secondary hyperparathyroidism, refractory to medical treatment. There is not enough information about this procedure in Argentina, that is the reason why we performed this study. Methods: 255 patients with PTx were included from the year 2003 to 2007 on a voluntary register. Studies of pre-surgical localization, phosphocalcic metabolism laboratories before and after surgery were evaluated, and the type of surgical technique used. The persistence and recurrence of post-surgical hyperparathyroidism was analyzed. Results: The PTx rate was 2,7/1000 patients year. 83% of the patients had neck echography and 59% Sestamibi scans with Tc 99. There was a positive correlation (p<0,001) between the number of detected glands by echography and Sestamibi. The parathyroidectomy performed was: subtotal in 77%, total with self-implant in 14% and total without self-implant in 9%. There were significant falls of Ca and P, Alkaline Phosphatase and PTH (1744±788 pg/ml to 247±450 pg/ml; p<0.0001) post-surgical. 2.4 ±2,5 months after the PTx, 72% of patients had PTH <2 50 pg/ml, 19,8% had persistence and 8,3% had recurrence. According to the type of surgery, the persistence and recurrence were for subtotal PTx 22% and 8,3%, total PTx with implant 11% and 11%, and total PTx without selfimplant 13% and 4% respectively. The performance of the Sestamibi scan did not affect the PTx results. No noticeable differences were observed among the centers for persistence and recurrence. Conclusions: The PTx rate was very low, echography was the preferred method of pre-surgical localization, and subtotal PTx was the most used surgical technique. PTx was successful in most of the patients, and persistence and recurrence were not related to the technique.
Citrate is a powerful inhibitor of the crystallization of calcium salts. Hypocitraturia is a bioc... more Citrate is a powerful inhibitor of the crystallization of calcium salts. Hypocitraturia is a biochemical common alteration in calcium stone formation in adults and especially in children. The acid pH (systemic, tubular and intracellular) is the main determinant of citrate excretion in the urine. While the etiology of hypocitraturia is idiopathic in most patients with kidney stones, there are a number of causes for this abnormality including distal renal tubular acidosis, hypokalemia, diets rich in animal protein and / or diets low in alkali and certain drugs, such as acetazolamide, topiramate, ACE inhibitors and thiazides. Dietary modifications that benefit these patients include high intake of fluids and fruits, especially citrus, sodium and protein restriction, with normal calcium intake. Treatment with potassium citrate is effective in patients with primary or secondary hypocitraturia and acidification disorders, which cause unduly acidic urine pH persistently. Adverse effects ar...
Introduction: Parathyroidectomy (PTx) is the selecte treatment for patients with severe secondary... more Introduction: Parathyroidectomy (PTx) is the selecte treatment for patients with severe secondary hyperparathyroidism, refractory to medical treatment. There is not enough information about this procedure in Argentina, that is the reason why we performed this study. Methods: 255 patients with PTx were included from the year 2003 to 2007 on a voluntary register. Studies of pre-surgical localization, phosphocalcic metabolism laboratories before and after surgery were evaluated, and the type of surgical technique used. The persistence and recurrence of post-surgical hyperparathyroidism was analyzed. Results: The PTx rate was 2,7/1000 patients year. 83% of the patients had neck echography and 59% Sestamibi scans with Tc 99. There was a positive correlation (p<0,001) between the number of detected glands by echography and Sestamibi. The parathyroidectomy performed was: subtotal in 77%, total with self-implant in 14% and total without self-implant in 9%. There were significant falls of Ca and P, Alkaline Phosphatase and PTH (1744±788 pg/ml to 247±450 pg/ml; p<0.0001) post-surgical. 2.4 ±2,5 months after the PTx, 72% of patients had PTH <2 50 pg/ml, 19,8% had persistence and 8,3% had recurrence. According to the type of surgery, the persistence and recurrence were for subtotal PTx 22% and 8,3%, total PTx with implant 11% and 11%, and total PTx without selfimplant 13% and 4% respectively. The performance of the Sestamibi scan did not affect the PTx results. No noticeable differences were observed among the centers for persistence and recurrence. Conclusions: The PTx rate was very low, echography was the preferred method of pre-surgical localization, and subtotal PTx was the most used surgical technique. PTx was successful in most of the patients, and persistence and recurrence were not related to the technique.
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