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)

This study evaluates the use of calcium carbonate in chronic renal failure. Forty-eight patients (25 male, 23 female, mean age 54.3 years, six pre-dialysis. 12 CAPD, 30 haemodialysis) on phosphate restriction and requiring aluminum hydroxide (mean 2.4 +/- 0.8 g/day) to control serum phosphate, were converted to an equivalent dose of calcium carbonate (2.5 +/- 0.6 g/day). None received vitamin D analogues. Three months post-conversion there was a significant decrease in mean (+/- SEM) serum phosphate (1.86 +/- 0.08 versus 1.66 +/- 0.05 mmol/l P less than 0.01) and serum aluminum (28.3 +/- 5.4 versus 13.2 +/- 3.0 micrograms/l, P less than 0.0001): calcium/phosphate product was unchanged. Post-conversion there was an increase in serum bicarbonate, (20.6 +/- 0.5 versus 22.1 +/- 0.6 mmol/l, P less than 0.01) and serum calcium (2.32 +/- 0.02 versus 2.45 +/- 0.03 mmol/l, P less than 0.0001). No change in serum creatinine, alkaline phosphatase or parathormone occurred. No adverse effects were reported but nine (18%) patients became hypercalcaemic (2.7 to 2.93 mmol/l), eight of whom responded to dose reduction. Hypercalcaemia did not correlate with pre-conversion serum calcium, parathyroid hormone, alkaline phosphatase or aluminium. Calcium carbonate is an effective alternative to aluminium-based phosphate binders. It produces a beneficial increase in serum calcium and bicarbonate and a significant decrease in serum aluminium. Hypercalcaemia is unpredictable but is easily reversible in the majority of patients.
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PMID:The use of calcium carbonate to treat the hyperphosphataemia of chronic renal failure. 251 82

Serum level of osteocalcin was measured by radioimmunoassay in 52 patients with chronic renal failure and 92 control subjects. The patients were treated by usual hemodialysis over a 3-month period. The osteocalcin level of the patients was significantly higher than that of the control subjects, but the patients with diabetic nephropathy had a lower osteocalcin level than the patients with non-diabetic nephropathy. There was a significant correlation between serum osteocalcin level and alkaline phosphatase or PTH level. On the other hand, there was no relationship between serum osteocalcin level and various parameters such as bone mineral contents, and bone cortex volume measured by the microdensitometry method. Hemodialysis affected the serum osteocalcin level. The clinical value of osteocalcin as a parameter of bone formation in chronic hemodialysis patients was discussed.
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PMID:[Clinical evaluation of osteocalcin in chronic hemodialysis patients]. 261 81

Osteitis fibrosa, a frequent complication of chronic renal failure, is characterized by increased rates of bone formation and bone resorption due to increased secretion of parathyroid hormone (PTH). Effective treatment with oral calcitriol is often impossible in patients with osteitis fibrosa, because low doses may cause hypercalcemia. Because short-term infusions of intravenous calcitriol are capable of suppressing the secretion of parathyroid hormone in patients with uremia without causing hypercalcemia, we evaluated the effectiveness of long-term intermittent calcitriol infusions (1.0 to 2.5 micrograms three times weekly, during dialysis) in treating severe osteitis fibrosa in 12 consecutive patients on hemodialysis whose disease was refractory to conventional therapy. After a mean (+/- SE) treatment period of 11.5 +/- 1.4 months, the mean bone-formation rate declined from 1642 +/- 277 to 676 +/- 106 microns 2 per square millimeter per day (P less than 0.01) in the 11 patients who successfully completed the study. Similar reductions occurred in the osteoblastic osteoid (18 +/- 3 to 9 +/- 2 percent; P less than 0.01) and the degree of marrow fibrosis (6.2 +/- 1.7 to 3.5 +/- 1.3 percent; P = 0.01). Concomitant serum biochemical changes included increased calcium levels (2.55 +/- 0.03 to 2.67 +/- 0.05 mmol per liter; P less than 0.01), decreased alkaline phosphatase levels (489 +/- 77 to 184 +/- 32 U per liter; P less than 0.001), and decreased levels of PTH (amino-terminal, 172 +/- 34 to 69 +/- 16 ng per liter in five patients, P less than 0.03; and carboxy-terminal, 1468 +/- 467 to 1083 +/- 402 ml-eq per liter in six patients, P not significant). Although the majority of the patients had transient episodes of asymptomatic hypercalcemia, this complication could be quickly reversed by temporarily halting treatment or decreasing the dose of calcitriol. We conclude that long-term intermittent infusions of intravenous calcitriol are effective in ameliorating osteitis fibrosa in patients on dialysis. Patients whose osteitis fibrosa is refractory to oral calcitriol and who are candidates for parathyroidectomy should be considered first for intravenous calcitriol therapy.
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PMID:Intravenous calcitriol in the treatment of refractory osteitis fibrosa of chronic renal failure. 274 71

A group of 72 patients with chronic renal failure (22 non-dialysed and 50 hemodialysed) were studied for the behaviour of the threshold of vibratory sensibility in upper and lower limbs at frequencies of 125 and 250 Hz. The patients dialysed were examined just before hemodialysis. All the patients were studied for the following parameters: concentration of calcium, inorganic phosphates, PTH, creatinine, uric acid in the blood serum and the activity of general alkaline phosphatase and its thermolabile fraction (osseous). The patients dialysed differed from the patients non-dialysed in higher creatinine, uricemia and the activity of alkaline phosphatase, both general and its "osseous" fraction. But they did not differ significantly in the concentration of phosphates, PTH and calcemia . Two thirds of patients with chronic renal failure, both dialysed and non-dialysed, revealed a significant increase in the threshold of vibratory sensibility, better marked in lower limbs then in upper limbs. As opposed to patients non-dialysed, patients dialysed did not show a significant correlation between the level of PTH in blood serum and the threshold of vibratory sensibility. Dialysotherapy did not influence significantly the frequency of disorders in vibratory sensibility. Considering the fact of almost identical frequency of disorders in vibratory sensibility both in patients dialysed and non-dialysed and also the lack of correlation between the level of lesion of vibratory sensibility and the concentration of PTH in blood serum, the participation of parathormone in the pathogenesis of uremic neuropathy seems to be doubtful.
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PMID:[Study of vibration sensation in the aspect of disorders of calcium-phosphate metabolism in patients with chronic renal failure]. 264 22

All patients with chronic renal failure have secondary hyperparathyroidism shown by elevated serum parathormone. Medical and surgical treatment is involves the use of phosphate binders, one alpha and increased frequency of dialysis. Surgery is indicated when medical treatment fails to control the Ca2+ PO4(2-) levels that activate renal osteodystrophy. High alkaline phosphatase and Ca2+ above 2.7 mmol/l are indications for surgery. Careful preoperative preparation and postoperative control minimise complications of haemorrhage, sepsis, tetany and cardiac arrhythmias. Long-term complications are hypoparathyroidism and recurrent hyperparathyroidism. Shortened dialysis periods may lead to increased parathyroid complications.
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PMID:Surgical treatment of secondary and tertiary hyperparathyroidism. 267 38

Itching is the dermatologic symptom more often found in patients with chronic renal failure. We have studied 80 patients with end-stage renal disease; itching was present in 56.3% of the cases. We didn't detected in this study any correlation between itching, long term hemodialysis, high calcium, phosphorus, alkaline phosphatase or phosphocalcic product levels. We have seen: 1. Those patients with itching were older than the rest. 2. Itching was important in those patients with residual diuresis less than 500 ml/day (p greater than 0.01). 3. Those men without itching had higher hematocrit levels (p greater than 0.01). 4. Histologic findings on optic and electronic microscopy were more frequent in patients who presented this symptom.
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PMID:[Pruritus in chronic kidney insufficiency]. 269 31

Six patients with progressive chronic renal failure not yet requiring dialysis and not consuming supplemental calcium or vitamin D developed hypercalcemia. Three had proven and 1 suspected tertiary hyperparathyroidism, 1 parathyroid carcinoma and 1 aplastic bone. None of the 3 patients who underwent bone biopsy had heavy bone aluminum staining. The patients with proven parathyroid-mediated hypercalcemia had marked elevation of C-terminal parathyroid hormone and alkaline phosphatase values and, when performed, radiographs consistent with osteitis fibrosa. When these findings are absent or the diagnosis is otherwise uncertain, a bone biopsy may provide a definitive diagnosis and guide management.
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PMID:Hypercalcemia in patients with advanced chronic renal failure not yet requiring dialysis. 275 79

The influence of a small amount of 1 alpha (OH)D3 on patients with chronic renal failure at the predialytic stage (CRFPS patients) receiving CaCO3 was investigated. 7 patients given CaCO3 (3 g/day) were administered 1 alpha (OH)D3 (0.25 micrograms/day) over a period of 12 weeks. 2 patients were eliminated from the study because of obvious deterioration of renal function. The others revealed no significant changes in levels of serum creatinine, adjusted calcium, phosphate, calcium x phosphate product, alkaline phosphatase, C-terminal parathyroid hormone, pH and bicarbonate. Our results indicated that even 0.25 micrograms/day 1 alpha (OH)D3 should not be prescribed to CRFPS patients given 3 g/day CaCO3. We recommend a little sole use of CaCO3 in CRFPS patients, paying attention to any exacerbation of renal function due to a rise in serum calcium concentration, when therapy for secondary hyperparathyroidism is required.
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PMID:Influence of 1 alpha-hydroxy vitamin D3 (0.25 micrograms/day) and calcium carbonate on patients with chronic renal failure at the predialytic stage. 279 95

32 patients with slowly evolving predialysis chronic renal failure, who were not exposed to aluminum-containing antacids, were studied. A low aluminum intake was considered a useful condition to examine the bone deposition of the element as dependent variable, not interfering with PTH secretion and bone metabolism. Iliac bone biopsies for bone aluminum content and histomorphometric and histodynamic evaluations were taken. Serum aluminum, creatinine, calcium, phosphate, iPTH, osteocalcin (BGP), alkaline phosphatase (AP), 25-OHD3 and 1,25(OH)2D3 were also measured. 16 of the patients were on long-term treatment with 1,25(OH)2D3 (0.25 micrograms daily) for prevention and treatment of secondary hyperparathyroidism. Bone aluminum content of all patients showed a strong positive correlation with BGP and iPTH (p less than 0.001) while the correlation with serum creatinine was not significant. Multiregression analysis has singled out BGP as the most predictive variable of bone aluminum content (r2 = 0.419). The patients receiving 1,25(OH)2D3 had lower iPTH (p less than 0.01), lower bone aluminum content (p less than 0.05) and increased mineral apposition rate (p less than 0.05) compared to the untreated group. The results suggest that treatment with 1,25(OH)2D3 for long-term suppression of secondary hyperparathyroidism does not enhance aluminum accumulation in bone. The finding of lower bone aluminum together with increased mineral apposition rate, seems to indicate that 1,25(OH)2D3 is able to induce an osteoid mineralization process more selective against aluminum incorporation in bone than in case of more severe hyperparathyroidism and 1,25(OH)2D3 deficiency. At least in the present condition of low aluminum intake, 1,25(OH)2D3 may be considered to have protective effects on bone from aluminum deposition.
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PMID:Bone aluminum content in predialysis chronic renal failure and its relation with secondary hyperparathyroidism and 1,25(OH)2D3 treatment. 281 88

Three haemodialyzed chronic renal failure patients with histologically proven osteomalacia due to aluminium toxicity were treated with repeated injections of desferrioxamine, a potent chelator of aluminium. The drug, in doses of 3 or 6 g, was administered intravenously once a week for 5 to 11 months, at the end of a dialysis session. Treatment was well tolerated. Dramatic clinical improvement was observed, with rapid regression of pain and functional impairment. There was a 65% increase in alkaline phosphatase and a rise of immunoreactive parathyroid hormone (terminal C fragment). Healing of fractures was confirmed by radiology, and a second bone biopsy in the 3 patients after double tetracycline labelling showed regression of morphological and dynamic signs of osteomalacia, considerable reduction in stainable aluminium deposits and strong increase in bone remodelling compatible with the development of hyperparathyroidism. It is concluded that a moderate dose of desferrioxamine administered once a week is effective against osteomalacia due to aluminium toxicity.
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PMID:[Desferrioxamine treatment of osteomalacia caused by aluminum poisoning]. 293 57


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