Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.1.3.1 (alkaline phosphatase)
 47,916 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During the hemodialysis treatment of 543 uremic patients for 10 years, significant complications concerning metabolic calcium disturbances, subperiosteal resorption, calcification of soft tissue or peripheral vessels, and fractures were noted. Significant elevation of alkaline phosphatase was induced for 5 years under hemodialysis using 5.0--6.0 mg/dl dialysate calcium, but not under 7.5 mg/dl dialysate calcium. Plasma immunoreactive parathyroid hormone (iPTH) values were abnormally high with a few exceptions, without relationship to serum calcium levels. Among the patients with chronic renal failure on dietary control, osteomalacic changes were predominant, but their iPTH values were not always elevated. When the patients were treated for a long time with hemodialysis, the mixed type of osteomalacia and osteites fibrosa appeared. Administration of dihydrotachysterol and 1 alpha-hydroxycholecalciferol to the patients on hemodialysis changed the mixed type of osteomalacia and osteitis fibrosa to the osteomalacic type with the marked reduction of osteoid seam thickness.
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PMID:Azotemic renal osteodystrophy; clinical features and bone pathology. 46 54

77 epileptics receiving a combination of anticonvulsants have been studied. 25(OH)D3 levels were diminished in 38% of the patients, markedly so in 25%. iPTH levels were elevated in 13%. Total, as well as ionized, serum calcium levels were significantly lower in the epileptic patients, as compared with a control population. Serum P, Mg, and plasma total CO2 levels remained unaltered. Alkaline phosphatase levels were increased, as well as gamma-GT levels. A transiliac bone biopsy was performed in 15 patients and histomorphometric studies were achieved on decalcified and undecalcified sections. Osteomalacia was present in 4 out of the 15 cases, hyperosteoidosis in one. Three biological features distinguished the cases with osteomalacia : iPTH levels and alkaline phosphatase values were significantly higher, and serum P levels were significantly lower (all were below 2,4 mg/dl) as compared with the non-osteomalacic patients. In an epileptic population, the serum Ca value is lower than in a control population by 0,5 mg/dl. When in addition the serum P is low (which was a feature of male patients), the danger exists for osteomalacia to develop. The former abnormality is connected with low 25(OH)D3 levels, the primary event, while the latter is probably related to high (secondary) iPTH levels.
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PMID:[Metabolic investigation of a population of institutionalized epileptics (author's transl)]. 47 9

The effects of synthetic salmon CT, administered subcutaneously and intermittently (1 MRC U/kg/day for 15 days/month over 6 months) were investigated in 15 uremic patients on regular dialysis treatment (RDT), all presenting various degrees of osteodystrophy. Clinically, osteoarticular pain disappeared in 8 out of 10 cases; 1 patient with rib fractures had a rapid calcification of the bone fracture repair tissue. No significant changes were found in serum calcium and PTH levels. Phosphotemia showed a significant decrease within the first 20 days. The varying individual hypophosphatemic response proved to be related to the initial level of phosphatemia. The alkaline phosphatase, when increased, showed a decrease to the normal range. A significant decrease in osteoclastic hyperactivity (active resorption surface, osteoclast index) and a slight increase in osteoblastic pool (active osteoid surface) were documented. No change was noted when osteomalacia predominated. Side effects included: anorexia, nausea, vomiting, face flushing. Our data suggest that salmon CT may be usefully employed in chronic uremic patients on RDT, when secondary hyperparathyroidism predominates.
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PMID:Effect of calcitonin on bone lesions in chronic dialysis patients. 49 16

Altogether 15 partially independent measurements of bone mass in 100 women with clinical and roentgenological signs of osteoporosis were correlated to the alkaline phosphatase activities of the same individuals. There was a slight but significant negative correlation indicating an increasing alkaline phosphatase activity with decreasing bone mass. This correlation was not caused by interaction of age. There was no correlation or morphological signs of osteomalacia. The changes could not be explained by fractures. It is suggested that a slight increase in the alkaline phosphatase activity in women with a more severe osteoporosis is related to bone resorption.
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PMID:Alkaline phosphatase in women with osteoporosis. 49 27

In 100 epileptic patients under treatment with long-term anti-convulsants, radiographs of the hands and feet, and estimations of serum 25-hydroxycholecalciferol, parathormone, alkaline phosphatase, calcium, and inorganic phosphate were done to detect a medication-induced osteomalacia. The correlation between the individual parameters was investigated. It was shown that the serum 25-hydroxycholecalciferol level and the skeletal radiograph were the most valuable in the early detection of osteomalacia. One of these investigations in addition to routine serum chemistry is recommended for the future at the yearly follow-up examinations of adult epileptics so that early and adequate treatment with vitamin D can be started.
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PMID:[Diagnosis of anticonvulsant osteomalacia in adults (author's transl)]. 59 89

Patients with severe symptomatic renal osteodystrophy were treated with either 1,25(OH)2D3 or 1 alpha(OH)D3. In 39 instances, there was either reversal of symptoms and/or a marked fall in plasma alkaline phosphatase. Bone biopsies showed improvement of either osteomalacia or osteitis fibrosa, and serum iPTH often fell. In thirteen patients, no improvement occurred. In seven patients, bone biopsy disclosed osteomalacia, and serum iPTH was normal or only slightly elevated. Thus, there was a defect in mineralisation. apparently unrelated to the lack of 1,25(OH)2D3 and in the absence of evidence of phosphate depletion. The other 'treatment failure' group showed osteitis fibrosa on biopsy and iPTH levels were markedly elevated. They are presumed to have marked secondary hyperparathyroidism. These 'treatment failure' groups had higher pre-treatment levels of serum Ca and Mg than in those showing a favourable response; also, hypercalcaemia developed rapidly during 1,25(OH)2D3 treatment. Thus, 1,25(OH)2D3 is efficacious in treating symptomatic osteodystrophy in many uraemic patients, and in other patients, it may help identify bone disease of other, as yet unknown, pathogenesis.
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PMID:Use of 1,25(OH)2-vitamin D3 to separate 'types' on renal osteodystrophy. 60 Sep 61

(1) The bone histology of 233 non-dialysed and 276 haemodialysed patients with chronic renal failure is reviewed. In non-dialysed patients osteitis fibrosa occurred in 83.7% and osteomalacia in 23.6% of patients. Osteomalacia was not found in the absence of osteitis fibrosa. In haemodialysed patients there was a more variable bone histology, sometimes resembling non-dialysed bone disease, but in general with a greater incidence of osteomalacia, especially with increasing time on dialysis. In some patients there was a predominance of osteomalacia accompanied by no or only mild osteitis fibrosa and the serum alkaline phosphatase was normal. (2) The results of treating twenty-six haemodialysed patients with 1alpha-hydroxyvitamin D3 (1alpha-OHD3) are described. Patients with osteomalacia and minimal or no osteitis fibrosa and a normal serum alkaline phosphatase (Group I) in general failed to respond and it is suggested that 1,25-dihydroxyvitamin D3 deficiency is not the sole factor responsible for the osteomalacia in these patients. In contrast, 1alpha-OHD3 therapy was effective in improving osteitis fibrosa and osteomalacia in some patients with moderate to severe degrees of osteitis fibrosa and osteomalacia (Group IIa) and in improving osteitis fibrosa where this occurred alone (Group IIb).
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PMID:Histopathology of renal osteodystrophy with particular reference to the effects of 1alpha-hydroxyvitamin D3 in patients treated by long-term haemodialysis. 60 22

Twenty-three patients with bone disease and chronic renal failure were treated for periods of 4--28 months with 1alpha-hydroxyvitamin D3 (1alpha-OHD3). Improvements in bone histology were consistently seen in patients with features both of osteitis fibrosa and osteomalacia but were not invariably observed in patients with osteitis fibrosa or osteomalacia alone (37 and 50% improved respectively). Several factors influencing the outcome of treatment were assessed on the basis of histological responses in bone. A low level of plasma calcium before treatment, rather than the dose of 1alpha-OHD3 tolerated, was the major detectable factor which favourably affected the histological outcome. Other factors examined, including initial plasma concentrations of phosphate, immunoreactive parathyroid hormone and alkaline phosphatase, and treatment with haemodialysis or dietary supplements of calcium did not apparently influence the response.
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PMID:Factors influencing the response to 1alpha-hydroxyvitamin D3 in patients with renal bone disease. 60 25

Six patients with chronic renal disease and variable degrees of renal osteodystrophy were treated for three weeks with either 1alpha,25-dihydroxyvitamin D3 (1alpha25(OH)D3) or 1alpha,hydroxyvitamin D3 (1alpha(OH)D3) and both the biochemical and osseous responses measured. The most consistent changes seen were an increase in serum calcium concentration to normal, a decrease in immunoreactive parathyroid hormone toward normal, an increase in the extent of the calcification front and a decrease in the extent of fibrous dysplasia in the marrow cavity. Two important parameters which did not change significantly were serum alkaline phosphatase activity and the osteoid volume. These data, in conjunction with that from previous studies, indicate that therapy with 1alpha,25(OH)2D3 or 1alpha(OH)D3 does not heal the osteomalacia of renal osteodystrophy, but that it does suppress the secondary hyperparathyroidism, and ameliorate the osteitis fibrosa seen in patients with chronic renal disease. They raise the likelihood that additional factors, such as metabolites of vitamin D other than 1alpha,25(OH)2D3, play a role in regulating bone formation and/or mineralization.
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PMID:The effect of 1alpha(OH)D3 and 1alpha,25(OH)2D3 on the bone in patients with renal osteodystrophy. 62 25

Osteomalacia may be a contributory factor in some patients in the development of fractures of the femoral neck and complicate the subsequent management. The level of serum alkaline phosphatase is often valuable in the diagnosis of metabolic bone disease but rises after any uncomplicated fracture, and since such a rise may limit the diagnostic usefulness of this measurement in detecting osteomalacia its extent was assessed in 106 patients. In the majority serum levels were normal on admission, rising after seven to nine days to reach a maximum within a month after fracture. Elevated levels on admission were found in patients with osteomalacia, liver damage or where there had been a delay of several weeks between injury and admission. In a small number of patients normal levels on admission subsequently reached very high values, usually in association with comminution or instability of the fracture. Elevated levels persisted for six to twelve weeks after fracture, the major influence upon the level at this time being the maximum value achieved rather than the presence of osteomalacia. If patients are to be screened for osteomalacia, the alkaline phosphatase must be measured within the first week after a fracture to avoid the distorting influences of the fracture itself.
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PMID:Changes in serum alkaline phosphatase after femoral fractures. 62 81


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