Renal calcium, phosphorus, magnesium and uric acid handling: comparison between stage III chronic kidney disease patients and healthy oldest old

Introduction

It is known that chronic kidney disease (CKD) and senescence bring about a progressive reduction in glomerular filtration rate (GFR) and that in the former this is usually associated with an increase in the fractional excretion of calcium, phosphorus, magnesium, and uric acid. However, it has not yet been explained how these substances are excreted in the healthy oldest old. Thus, in the present study, we examined the renal handling of these substances in very aged people in comparison with CKD patients with similar GFR levels (stage III??CKD).

Materials and methods

Twenty volunteers were studied; 10 of them were healthy very old (VO) (??75?years old) individuals and 10 were stage III CKD patients. Exclusion criteria were as follows: presence of altered (abnormally high or low) plasma calcium, phosphorus, magnesium and uric acid, as well as previous diagnoses of diabetes mellitus and obstructive uropathy and use of drugs that could alter plasma levels of the studied substances. All volunteers were on a diet with the same content of these elements (3-day dietary register). We measured calcium, phosphorus, magnesium, uric acid, creatinine in serum plasma and morning urine, as well as serum parathyroid hormone level, in each volunteer. From these data, fractional excretion (FE) of these substances was obtained. A statistical analysis was carried out using the Wilcoxon test.

Results

Serum creatinine: 1.8?±?0.4?mg/dl (CKD) versus 0.8?±?0.2?mg/dl (VO), p?=?0.0002; serum calcium: 9.1?±?0.3?mg/dl (CKD) versus 8.7?±?0.4 (VO), p?=?0.022; serum magnesium: 2.3?±?0.2?mg/dl (CKD) versus 2.0?±?0.1 (VO), p?=?0.05; serum phosphorus: 3.9?±?0.5?mg/dl (CKD) versus 3.0?±?0.4?mg/dl (VO), p?=?0.002; serum uric acid: 6.6?±?1.5 (CKD) versus 5.2?±?1.4?mg/dl (VO), p?=?0.04; FE of calcium: 2.5?±?1?% (CKD) versus 0.8?±?0.3?% (VO), p?=?0.04; FE of magnesium: 7.2?±?4.1?% (CKD) versus 2.9?±?0.9?% (VO), p?=?0.02; FE of phosphorus: 25?±?9?% (CKD) versus 9.1?±?5.7(VO), p?=?0.001; FE of uric acid: 10?±?3?% (CKD) versus 8?±?5?% (VO), p?=?0.05.

Conclusion

Serum levels and FE of calcium, phosphorus, magnesium and uric acid were significantly higher in CKD patients compared to healthy very old people with similar GFR, except for serum magnesium and FE of uric acid, which were similar in both groups.     

Decrease in Talocrural Joint Mobility is Related to Alteration of the Arterial Blood Flow Velocity in the Lower Limb in Diabetic Women

[Purpose] The purpose of this study was to correlate the talocrural range of motion (ROM) and blood flow velocity in the lower limb arteries of diabetic women. [Subjects and Methods] Thirty women were divided into a control group (G1), consisting of 15 sedentary right-handed subjects (41.27 ± 7.24 years old) who had no history of blood system disorder, and a diabetes group (G2), consisting of 15 sedentary right-handed subjects (57.87 ± 6.20 years old) who had type 2 diabetes mellitus. Talocrural ROM was measured by using goniometry for dorsiflexion and plantar flexion movements. In addition, blood flow velocity of the dorsalis pedis, posterior tibial, and popliteal arteries was also assessed. [Results] No significant differences were found between the groups by comparing talocrural ROM and arterial blood velocity. However, a significant association was found in G2 only between the following variables: plantar flexion and blood flow velocity of the dorsalis pedis artery (rs = 0.57), plantar flexion and blood flow velocity of the popliteal artery (rs = 0.50), and dorsiflexion and blood flow velocity of the posterior tibial artery (rs = 0.57). [Conclusion] The decrease in talocrural ROM is related to a decrease in the arterial blood flow velocity in diabetic women.Key words: Diabetes mellitus, Arthrometry, Physical therapy     

A review of current and novel therapies for idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) is a progressively fibrotic interstitial lung disease that is associated with a median survival of 2-3 years from initial diagnosis. To date, there is no treatment approved for IPF in the United States, and only one pharmacological agent has been approved outside of the United States. Nevertheless, research over the past 10 years has provided us with a wealth of information on its histopathology, diagnostic work-up, and a greater understanding of its pathophysiology. Specifically, IPF is no longer thought to be a predominantly pro-inflammatory disorder. Rather, the fibrosis in IPF is increasingly understood to be the result of a fibroproliferative and aberrant wound healing cascade. The development of therapeutic targets has shifted in accord with this paradigm change. This review highlights the current understanding of IPF, and the recent as well as novel therapeutics being explored in clinical trials for the treatment of this devastating disease.KEY WORDS : Idiopathic pulmonary fibrosis/drug therapy, idiopathic pulmonary fibrosis/pathology, molecular targeted therapy, clinical trials     

Conservative management of perforation, dehiscence, and uterine rupture

Of 237 cases that suffered a perforation, dehiscence or uterine rupture, the conservative treatment was carried out in 71.3% of all cases. 155 which were conservatively handled, were followed. 55 corresponded to perforation, 89 to dehiscence and 11 to rupture. Out of 155 patients 82 (52.9%) became pregnant again, some thereof even on five occasions, thus reaching a total of 117 gestations. 13.6% ended in abortion, 23.8% has a vaginal birth. A cesarean section was applied in 47% of the cases and 5.1% a cesarean hysterectomy. Only in 2 cases (1.7%), the disunion occurred again. A hysterographical control was exerted. 41% of the hysterograms were normal. 26.2% showed the "habitual post surgical isthmic defect" and only in 32.7% of the cases, there were abnormal patterns in isthmic and cavity. The absolute post natal morbility was 6.5% and the noncorrected perinatal mortality was 5.4%. Based on these results, we recommended that, whenever it is possible, one should apply a conservative therapy, in cases of these accidents.     

Abdominoplasty: Technical refinement and analysis of 130 cases in 8 years' follow-up

The author describes surgical details and improvements on his personal technique. He establishes a relationship between the method and the natural phenomenon that occurs on the umbilical region of the newborn child. The author suggests reimplanting the umbilicus 1 cm below its natural projection on the abdominal flap. He presents two new instruments, one to facilitate the incisions and the other to help the marking of the umbilical area. He describes 8 years' follow-up of 130 patients.     

Fat suction versus abdominoplasty

The author describes his fat-suction technique for the treatment of abdominal adiposity. He stresses the importance of the proper selection of patients prior to surgery and the indications for such surgery, analyzing especially the accumulation of subcutaneous adiposity and muscular flaccidity. He divides surgical techniques into four separate groups: isolated fat suction; fat suction associated with infraumbilical cutaneous resection; fat suction associated with conventional abdominoplasty; and, conventional abdominoplasty. The criteria of indications for each separate procedure are strongly emphasized.     

Full-thickness eye-wall biopsy: long-term results in 9 patients.

Nine patients who had an eye-wall biopsy were evaluated for long-term results. The follow-up time ranged from 2 1/2 months to 7 years. Six patients were followed up for more than 2 years. Few operative and postoperative complications were observed. Except for 1 patient with reticulum cell sarcoma, all eyes retained preoperative visual acuity. Tractional retinal detachment occurred only in 1 patient, who had vitreous bands around the biopsy site and did not undergo a simultaneous vitrectomy during the biopsy operation.     

Abdominoplasty combined with lipoplasty without panniculus undermining: abdominolipoplasty--a safe technique

This article discusses the author's technique of abdominoplasty that combines the excision of excess skin with lipoplasty without panniculus undermining and resection.