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Target Concepts:
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Query: UMLS:C0018799 (
heart disease
)
34,133
document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)
The complications of chronic kidney disease (CKD) are dyslipidaemia, hyperkalaemia, metabolic acidosis, anaemia, and bone and mineraldisorders. Dyslipidaemia may be treated with low-density lipoprotein-lowering agents. Statins are ineffective in stages 4 and 5 CKD, but areindicated for preventing the progression of disease in the earlier stages. Chronic acidosis has recently been shown to be a risk factor in theprogression of CKD renal dysfunction. Therefore, treatment is mandatory. Practically, this should consist of 1 - 2 heaped teaspoons of sodiumbicarbonate 2 - 3 times per day, which is an inexpensive and safe therapy that does not raise the blood pressure in spite of the increased sodiumlevel. Target levels of haemoglobin, according to international guidelines, are between 10 g/dL and 12 g/dL. The serum phosphate level is raisedin stage 4 CKD, and especially in stage 5 CKD, which is associated with coronary carotid and other vascular calcifications and may result inischaemic
heart disease
, myocardial infarction and stroke. A raised parathyroid hormone level (secondary
hyperparathyroidism
) is also a majorrisk factor for cardiovascular disease and is associated with increased hypertension and resistance to the treatment of CKD-associated anaemia.
...
PMID:Important complications of chronic kidney disease. 2629 89
Secondary hyperparathyroidism almost universally accompanies end-stage renal disease (ESRD). In some, but not all studies, elevated serum parathyroid hormone (PTH) concentrations are associated with increased fracture rates, cardiovascular disease, and mortality in ESRD. The serum concentration of PTH required for optimal bone health and reduced cardiovascular risk in such patients remains elusive. Recent clinical trials have failed to show substantial changes in morbidity and mortality following reductions of elevated serum PTH concentrations. In this review, we will assess some of the difficulties in evaluating elevated serum PTH concentrations, and their association with skeletal fractures and mortality in ESRD patients. We are of the opinion that in the context of ESRD, elevated PTH concentrations occur in conjunction with other comorbid conditions such as diabetes mellitus, malnutrition, hypertension, volume excess, preexisting
heart disease
, all of which have prevented establishing a precise association between elevated serum PTH concentrations and global or skeletal outcomes. Age, gender, and racial variability among groups make interpretation exceptionally difficult. Analysis of prevalent ESRD populations with secondary
hyperparathyroidism
should take all these factors into account. We suggest that future clinical trials which examine the usefulness of reductions in serum PTH concentrations be conducted in age, sex, and racially balanced groups, without or with minimal coexisting confounding disease. Furthermore, trials in such populations should have as their primary outcome a reduction in fractures rather than an alteration in mortality.
...
PMID:Serum Parathyroid Hormone Concentrations and Clinical Outcomes in ESRD: A Call for Targeted Clinical Trials. 2667 10
Inward rectifier K
+
channels are important for maintaining normal electrical function in many cell types. The proper function of these channels requires the presence of membrane phosphoinositide 4,5-bisphosphate (PIP
2
). Stimulation of the Ca
2+
-sensing receptor CaR, a pleiotropic G protein-coupled receptor, activates both G
q/11
, which decreases PIP
2
, and phosphatidylinositol 4-kinase (PI-4-K), which, conversely, increases PIP
2
. How membrane PIP
2
levels are regulated by CaR activation and whether these changes modulate inward rectifier K
+
are unknown. In this study, we found that activation of CaR by the allosteric agonist, NPSR568, increased inward rectifier K
+
current (I
K1
) in guinea pig ventricular myocytes and currents mediated by Kir2.1 channels exogenously expressed in HEK293T cells with a similar sensitivity. Moreover, using the fluorescent PIP
2
reporter tubby-R332H-cYFP to monitor PIP
2
levels, we found that CaR activation in HEK293T cells increased membrane PIP
2
concentrations. Pharmacological studies showed that both phospholipase C (PLC) and PI-4-K are activated by CaR stimulation with the latter played a dominant role in regulating membrane PIP
2
and, thus, Kir currents. These results provide the first direct evidence that CaR activation upregulates currents through inward rectifier K
+
channels by accelerating PIP
2
synthesis. The regulation of I
K1
plays a critical role in the stability of the electrical properties of many excitable cells, including cardiac myocytes and neurons. Further, synthetic allosteric modulators that increase CaR activity have been used to treat
hyperparathyroidism
, and negative CaR modulators are of potential importance in the treatment of osteoporosis. Thus, our results provide further insight into the roles played by CaR in the cardiovascular system and are potentially valuable for
heart disease
treatment and drug safety.
...
PMID:Activation of the Ca
2+
-sensing receptors increases currents through inward rectifier K
+
channels via activation of phosphatidylinositol 4-kinase. 2783 49
Metastatic pulmonary calcification is a metabolic lung disease that occurs due to a prolonged hypercalcemic state where calcium salts precipitate into numerous foci or nodules of fluffy calcifications in the lung apices, usually bilaterally. Calcifications can also occur in other organs such as in the stomach and the kidneys. It is often underdiagnosed and is usually associated with end stage renal failure and resultant secondary
hyperparathyroidism
. Nevertheless, it is rarely reported in the postcardiac surgery status and cardiac transplant patients. We present a case of a 15-year-old male patient with a recent history of cardiac transplant due to a complex congenital
heart disease
where findings of extensive metastatic pulmonary calcifications were seen a routine follow-up chest radiograph. Clinical manifestations of metastatic pulmonary calcifications can range from having no symptoms or mild dyspnea on exertion to fulminant respiratory failure. Therefore, early recognition of imaging features and initiation of proper management is crucial to the patient's outcome.
...
PMID:Metastatic pulmonary calcifications postcardiac transplant in a 15-year-old patient: A case report and review of literature. 3287 95
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