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The nutritional roles, requirements, and metabolism and the quantitative relationship between dietary intakes and health for a number of the minerals and trace elements have been more clearly defined in recent years, but there are still considerable deficiencies in our understanding of these issues, e.g., the significance of calcium in the etiology and treatment of osteoporosis and hypertension. Reliable information is now available on the content, and the principal factors affecting it, of most of the minerals and trace elements in human and cow's milks. However, for some of the trace elements, there is still a wide variation in reported values in the literature, which is due, at least in part, to analytical difficulties. The contribution of cow milk and milk products to the diet in Western countries is significant for sodium, potassium, chloride, calcium, phosphorus, zinc, and iodine. Iodine is the only trace element for which there has been any suggestion of excessive amounts in cow milk. However, there is evidence of a decline in milk iodine concentrations in the United States in recent years, although the situation in other countries less clear. Breast milk usually has adequate mineral and trace element contents for feeding full-term infants, with the exceptions of fluoride, for which supplementation of infants is recommended, and of selenium in some countries, such as Finland and New Zealand, where maternal intakes are low. However, breast milk selenium contents have increased in these countries in recent years due to increased maternal selenium intakes. The concentrations of minerals and trace elements in infant formulas for full-term infants are generally higher than in human milk, and all appear to be more than adequate, with the possible exception of selenium, which may need to be increased in some formulas. Considerable changes in the mineral and trace element contents of formulas have been instituted in recent years in the light of improved knowledge of infant requirements. While the chemical forms of the macrominerals and some of the trace elements (iron, zinc, copper, and manganese) in milks are fairly well defined, the forms of many of the trace elements are unknown. Sodium, potassium, chloride, and iodine are believed to be almost totally absorbed from milks and infant formulas.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Minerals and trace elements in milk. 149 49

To determine whether cardiac hypertrophy secondary to chronic renovascular hypertension is associated with altered in vivo myocardial metabolism, phosphorus-31 nuclear magnetic resonance saturation transfer techniques were used to study creatine kinase (CK) kinetics in six chronically hypertensive dogs with moderate cardiac hypertrophy and eight control dogs. The forward rate constant of CK and the flux of phosphocreatine to adenosine triphosphate were determined in both groups of dogs before and during norepinephrine administration (1 microgram/kg per min), used to increase heart rate x systolic blood pressure (rate-pressure product), cardiac output and oxygen consumption. Baseline and norepinephrine-induced changes in rate-pressure product, cardiac output and oxygen consumption were similar in both groups of dogs, as were baseline forward rate constant and flux of phosphocreatine to adenosine triphosphate. However, the norepinephrine-induced changes in forward rate constant and flux were significantly less in hypertensive than in control dogs (p less than 0.05) even though changes in hemodynamic and functional variables were similar in both groups. These data demonstrate that moderate myocardial hypertrophy is associated with altered CK kinetics, which do not appear to affect the heart's ability for global mechanical recruitment at this stage in the hypertensive process. It is possible that the changes in myocardial enzyme kinetics may contribute to diastolic dysfunction previously reported in this model and may be a precursor for ultimate development of heart failure if hypertension is maintained for prolonged periods.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Creatinine kinase kinetics studied by phosphorus-31 nuclear magnetic resonance in a canine model of chronic hypertension-induced cardiac hypertrophy. 153 Aug 55

The pathogenesis of progressive renal disease includes systemic hypertension and intrarenal factors that may be hemodynamic or metabolic in origin and involve mediators of inflammation. Most current information derives from experiments in rodents. In other species (rabbit, dog, baboon) subjected to renal mass reduction, a greater variety of pathologic changes is apparent than in rats. Clinical trials at controlling progression of renal disease are compounded by numerous factors; and it is not evident that extrapolation can safely be made from results of animal studies to human disease. The mechanism(s) of renal disease progression in humans, therefore, remain largely unknown. Current therapeutic recommendations in patients with chronic renal disease include limitation of phosphorus absorption, correction of lipid abnormalities and control of systemic blood pressure. The latter can be achieved with a variety of agents some of which, like angiotensin converting enzyme inhibitors and calcium antagonists, may be preferred because of specific intrarenal effects.
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PMID:Progression of renal disease: current concepts and therapeutic approaches. 161 70

Recently, we reported the isolation and identification of a potent vasoconstrictor enzyme from the rat submandibular gland, a member of the rat kallikrein gene family, which we named submandibular enzymatic vasoconstrictor (SEV). We studied whether messenger RNA (mRNA) for SEV is present in the kidney and isolated glomeruli, using the polymerase chain reaction assay with primers specific to the entire rat kallikrein family that would amplify a 430-bp fragment from their mRNA. As a probe we used a phosphorus-32-labeled oligonucleotide specific for SEV mRNA. A fragment of the predicted size was obtained on Southern blot for amplified renal RNA; however, no signal was obtained with glomerular RNA. To further confirm the presence of SEV mRNA in the kidney, polymerase chain reaction was repeated using primers specific to SEV mRNA that would amplify a 372-bp fragment from SEV mRNA alone. Again, a fragment of the predicted size was obtained on Southern blot after amplification of renal RNA but not RNA from the glomeruli. Southern blot of polymerase chain reaction-amplified RNA with primers that amplified the entire kallikrein gene family, using kallikrein complementary DNA that recognizes all members of the kallikrein gene family as a probe, revealed a 430-bp fragment for both renal and glomerular RNA, indicating that glomeruli contain mRNA for a member or members of the kallikrein family other than SEV. When the Southern blots were hybridized with a 32P-labeled oligonucleotide probe specific for glandular kallikrein, a fragment of the predicted size was obtained from amplified renal RNA but not glomerular RNA.(ABSTRACT TRUNCATED AT 250 WORDS)
Hypertension 1992 Feb
PMID:Submandibular enzymatic vasoconstrictor messenger RNA in rat kidney. 173 90

The differential diagnosis of hypercalcemia has expanded to over 25 separate disease states, with primary hyperparathyroidism and malignancy accounting for 80-90% of all hypercalcemic patients. Primary hyperparathyroidism comprises the majority of hypercalcemic patients among the ambulatory population, but malignancy accounts for up to 65% of such patients in the hospital. Factors favoring primary hyperparathyroidism include a family history of hyperparathyroidism or multiple endocrine neoplasia, a history of childhood radiation to the head and neck, the postmenopausal state, a history of renal calculi or peptic ulcer, hypertension, the induction of hypercalcemia by thiazides, or an asymptomatic patient with a prolonged, stable mild hypercalcemia. The usefulness of the serum calcium, parathyroid hormone, chloride, phosphorus, serum 25-OHD, and 1,25-(OH)2D, and urinary calcium in the differential diagnosis of hypercalcemia is discussed. The pitfalls of an excessive reliance on the serum PTH in diagnosing hyperparathyroidism are stressed. The discriminant values of the serum calcium, chloride, phosphorus, and parathyroid hormone are explored, with the serum parathyroid hormone, chloride, and calcium proving most useful in separating primary hyperparathyroidism from other forms of hypercalcemia. Multivariate discriminant analysis using the serum calcium, phosphorus, and chloride and the hematocrit achieves an accuracy of 95-98% and is the most economical method of identifying hyperparathyroidism. The addition of the amino-terminal or intact PTH assay increases the accuracy to 99% and is essential in the presence of renal insufficiency.
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PMID:Differential diagnosis of hypercalcemia. 176 70

Examination of the effects of dietary manipulation on progression of chronic renal failure (CRF) has been of interest for two reasons: dietary protein restriction is an effective method of ameliorating uremic symptoms and studies of changes in serum creatinine (and later, creatinine clearance or glomerular filtration rate, showed that the course of renal insufficiency is predictable. Results from studies of patients and animals with CRF suggested that a low-protein, phosphorus-restricted diet could slow the rate of loss of renal function. Animal studies have identified several mechanisms for progressive renal damage. These include glomerular hypertension causing capillary damage, glomerular damage from hypertrophic stimuli or hypermetabolism, calcium-phosphorus deposition and nephrotoxicity of the diet. The scientific basis for these different mechanisms will be discussed and each mechanism will be analyzed in terms of experimental studies in patients with CRF.
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PMID:Dietary manipulation and progression of chronic renal failure. 177 91

One common nutrient postulated to be protective against osteoporosis, hypertension, and colon cancer is dietary calcium. We report here nutrient patterns by calcium intake in older adult residents of a geographically defined community in Southern California. The analysis included all 426 men and 531 women aged 50-79 y with complete 24-h diet data. Nutrient-density-adjusted calcium intake was divided into tertiles: low intake (less than 284 mg/1000 kcal), mid intake (284-440 mg/1000 kcal), and high intake (greater than 440 mg/1000 kcal). The distribution of the reported 24-h nutrient density of protein, fat, fiber, caffeine, trace minerals, vitamin D, and vitamin C was examined in relation to the calcium-intake tertiles. In both men and women, the adjusted intakes of protein, saturated fatty acids, vitamin D, magnesium, and phosphorus were significantly higher in the high-calcium-intake group than in the low- and mid-calcium-intake groups. In both men and women, alcohol intake was significantly lower in the high-calcium-intake group. Studies postulating a protective role for calcium will need to consider the multicolinearity in the Western diet.
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PMID:Calcium intake: covariates and confounders. 184 36

Changes in renal function induced by protein intake are thought to reflect evolutionary adaptation of the kidney. Excess dietary proteins over long periods may increase normal blood flow and glomerular filtration rate, requiring the continuous use of outer cortex's reserve glomeruli. According to the hyperfiltration theory, pressures and flows in outer cortical glomeruli contribute to continuous intrarenal capillary hypertension and predispose healthy people to progressive glomerular sclerosis and deterioration of renal function. Pressures and flows associated with the response to renal disease in turn may accelerate the development of sclerosis, leading to even more rapid loss of renal function. Restriction of dietary protein (less than or equal to 0.6 g/kg per day) and/or phosphorus seems to slow the rate of loss of renal function in patients with chronic renal insufficiency. Evidence for the role of lipids in the progression of renal disease is not clear. All of these dietary factors possibly play a role in the progression of renal disease; the relative importance of each factor varies, depending on the pathogenesis, stage, and mechanism of progression of the disease. Findings indicate that nutrition therapy can decrease rate of deterioration of renal function in patients with chronic renal diseases.
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PMID:Effect of diet on progression of chronic renal disease. 191 49

The data regarding the value of manipulating electrolytes in hypertension are controversial. It appears there are subsets of hypertensive patients who respond with lowering of blood pressure in conjunction with changes in intake of sodium, potassium, and calcium. The information regarding phosphorus and magnesium is less convincing. This paper examines current reports regarding these electrolytes and their role in the pathophysiology and treatment of essential hypertension.
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PMID:Electrolytes in the epidemiology, pathophysiology, and treatment of hypertension. 194 87

We describe two twin sisters in whom calcification of different arteries was detected in the first weeks of life. Transient renal insufficiency, arterial hypertension, and skeletal abnormalities were also observed. One child had anasarca and heart decompensation at birth. Prenatal infarction of one kidney had occurred in the same infant. A kidney biopsy showed calcium deposits in all the layers of the arteries. Most findings in these patients are compatible with idiopathic arterial calcification of infancy (IACI). Investigation of calcium and phosphorus metabolism revealed spontaneously receding hypercalciuria, increased intraerythrocytic calcium levels, and transient X-ray abnormalities of the long bones. Treatment initially consisted of biphosphonate and later, the calcium antagonist flunarizin. A progressive diminution of the arterial calcification was observed in the course of both treatments.
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PMID:Idiopathic arterial calcification of infancy. 200 22


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