Urinary Calcium Excretion Pattern in Preeclampsia

Aim: This study aimed to evaluate the urinary calcium excretion pattern in preeclampsia and to establish the relation between severity of preeclampsia and urinary calcium excretionMethods: This was a case-control study conducted at Paropakar Maternity and Women’s Hospital, Kathmandu from January to June 2015. There were 88 patients equally divided in each group. 24 hours urine calcium was analyzed by ortho-cresophthalin-complexone method (OCPC) and urinary proteinuria was analyzed bedside by sulphosalicylic acid. Results were analyzed using SPSS 17. P value of < 0.05 was considered as significant.Results: Preeclampsia was found to occur commonly among the nulliparous patients (59%). The patients with MAP with ≥ 110mmHg excreted less calcium in their urine in comparison to the patient with MAP < 110mmHg (73.55mg/24 hrs VS 92.79 mg/24 hr). Daily calciuria was decreased with the increase in proteinuria (91.43 mg, 76.19mg and 54.02mg in 1+, 2+ and 3+ respectively). The 24 hours urine calcium excretion in term preeclamptic patient was significantly reduced in compared to the normotensive term pregnant women (77.92 mg ± 48.61mg VS 117.66mg ±69.21 mg, p <0.001).Conclusion: Preeclamptic patients excrete significantly lower amounts of calcium in urine and it may be a marker of the severity of preeclampsia.

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Urinary calcium indices in primary hyperparathyroidism (PHPT) and familial hypocalciuric hypercalcaemia (FHH): which test performs best?

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2020-137718 ◽

2020 ◽

pp. postgradmedj-2020-137718

Author(s):

Muhammad Fahad Arshad ◽

James McAllister ◽

Azhar Merchant ◽

Edmund Rab ◽

Jacqueline Cook ◽

...

Keyword(s):

Primary Hyperparathyroidism ◽

International Workshop ◽

Significant Proportion ◽

Urinary Calcium ◽

Calcium Excretion ◽

Clearance Ratio ◽

Urine Calcium ◽

Genetic Studies ◽

Urine Calcium Excretion ◽

Control Study

AimPrimary hyperparathyroidism (PHPT) is much more common than familial hypocalciuric hypercalcaemia (FHH), but there is considerable overlap in biochemical features. Urine calcium indices help with the differential diagnosis, but their reliability in making this distinction is not clear. The aim of this study was to compare urinary calcium values in patients with PHPT and FHH.MethodsThis was a case–control study of patients with PHPT who had successful surgery and genetically proven FHH between 2011 and 2016. Due to low FHH numbers, patients from neighbouring hospitals and outside study period (2017–2019) were allowed to improve power. Data on demographics and urinary calcium were obtained from electronic records and compared between the two groups.ResultsDuring the study period, 250 patients underwent successful PHPT surgery, while in the FHH arm, 19 genetically proven cases were included. The median (IQR) 24-hour urine calcium excretion (UCE) in the PHPT group was 8.3 (5.6–11.2) mmol/24 hours compared with 3.2 (2.1–6.1) mmol/24 hour in the FHH group (p<0.001). Median (IQR) calcium to creatinine clearance ratio (CCCR) in the PHPT and FHH groups was 0.020 (0.013–0.026) and 0.01 (0.002–0.02), respectively (p=0.001). The sensitivity of urinary tests for PHPT was 96% for UCE (cut-off ≥2.5 mmol/24 hour) and 47% for CCCR (cut-off >0.02). The specificity of the urinary tests for FHH was 29.4% for UCE (cut-off <2.5 mmol/24 hour) and 93% for CCCR (cut-off <0.02).Conclusions24-hour UCE is more sensitive in diagnosing PHPT; however, it is less specific in ruling out FHH as compared with CCCR, when the cut-offs suggested by the International guidelines from the fourth international workshop are used. A significant proportion of patients with PHPT would have also required genetic studies if the guidelines were followed.

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Effect of intravenous gentamicin on urinary calcium excretion in newborns

Paediatrica Indonesiana ◽

10.14238/pi55.4.2015.185-8 ◽

2015 ◽

Vol 55 (4) ◽

pp. 185

Author(s):

Kurniawan Tan ◽

Adrian Umboh ◽

Ari Runtunuwu

Keyword(s):

Informed Consent ◽

Cumulative Effect ◽

Urinary Calcium ◽

Full Term ◽

Urinary Calcium Excretion ◽

Calcium Excretion ◽

Creatinine Ratio ◽

Urine Calcium ◽

Term Newborns ◽

Urine Calcium Excretion

Background Studies in newborns and animals have shown that gentamicin increases urinary calcium excretion. New recommendation for gentamicin in newborns is administered intravenously 36-48 hourly. Subsequent to this new recommendation, there have been no further studies on the effects of extended gentamicin dosage on urinary calcium excretion in newborns.Objective To assess the effect of intravenous gentamicin on urinary calcium excretion in newborns.Methods This pretest – posttest study was done in the Neonatology Division of Prof. DR. R. D. Kandou Hospital, Manado, from August to November 2013. Subjects were full-term newborns who received intravenous gentamicin every 36 hours and whose parents provided informed consent. We excluded newborns with asphyxia and cardiovascular shock, also those who received diuretics or steroids. Urine spot collection was done before, after the first dose, and after the second dose of intravenous gentamicin. Urinary calcium and creatinine levels were measuerd. Urine calcium excretion was defined as the ratio of urinary calcium to creatinine level.Results Of 28 newborns, there were 16 males and 12 females. The median of urine calcium creatinine ratio before intravenous gentamicin was 0.021 (range 0.004 to 0.071) mg/mg. After first dose of gentamicin, the median ratio was 0.043 (range 0.009 to 0.156) mg/mg, and after the second dose of gentamicin, the median ratio was 0.144 (range 0.015 to 1.160) mg/mg.Conclusion There is a significant increase in urinary calcium excretion after the first and second doses of intravenous gentamicin. Furthermore, a cumulative effect of gentamicin on urinary calcium excretion is observed after the second dose.

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P0237COMPARISONS OF CLINICAL FEATURES IN GITELMAN SYNDROME PATIENTS WITH DIFFERENT URINARY CALCIUM EXCRETIONS

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p0237 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Lei Zhang ◽

Bingbin Zhao ◽

Xiaoyan Peng ◽

Ying Wang ◽

Limeng Chen

Keyword(s):

Clinical Features ◽

Clinical Symptoms ◽

Urinary Calcium ◽

Gitelman Syndrome ◽

Urinary Calcium Excretion ◽

P Value ◽

Calcium Excretion ◽

College Hospital ◽

Female Ratio ◽

Gene Testing

Abstract Background and Aims Hypocalciuria is considered typical in Gitelman syndrome (GS). However, a few GS cases diagnosed by gene testing presented as normocalciuria have been reported in recent years. Our study is to observe the clinical features in GS patients with different urinary calcium excretions, and investigate the value of urinary calcium excretion in the clinical classification for GS. Method GS cases from the National Rare Diseases Registry System of China (NRSC) (2016-2018) with SLCl2A3 gene screened in Peking Union Medical College Hospital were collected. The features of urinary calcium excretion were analyzed, and the phenotypes of patients with hypocalciuria were compared to those with normocalciuria. Hydrochlorothiazide (HCT) test was performed and the maximal increasement of chloride excretion fraction (△FECl) was calculated to evaluate the extent of NCC dysfunction. Results A total of 83 genetically proven GS patients was included, with the mean age at diagnosis of 31.0±13.0 years, and the male/female ratio was 1.4:1. Among them, 53 (63.9%) patients had hypocalciuria. The ratio of urinary calcium/creatine was significantly lower in patients with hypocalciuria (0.08±0.06mmol/mmol) compared to those with normocalciuria (0.47±0.28mmol/mmol), with a P value of <0.001. Age, gender, estimated glomerular filtration rate, blood pressure, alkalosis, and serum and urinary electrolytes including potassium, magnesium, natrium, chloride, and phosphorus were all comparable between patients with hypocalciuria and normocalciuria. Based on a standardized symptom questionnaire, fatigue (52.8% vs. 76.7%, P=0.03) and polyuria (9.4% vs. 30.0%, P=0.02) were less frequently reported in hypocalciuria patients, while all the other clinical symptoms were comparable. Sixteen patients in each group underwent HCT test, and the △FECl value was comparable between patients with hypocalciuria and normocalciuria (median, 0.54% vs. 0.83%, P=0.88), both of which indicated a blunt response to HCT (<2.86% according to our previous study). Conclusion The results show that 63.9% of the GS patients in this study had hypocalciuria. There is no definite relationship between urinary calcium excretion, phenotype and the extent of NCC dysfunction.

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Inhibition of calbindin D28K expression by cyclosporin A in rat kidney: the possible pathogenesis of cyclosporin A-induced hypercalciuria.

Journal of the American Society of Nephrology ◽

10.1681/asn.v981416 ◽

1998 ◽

Vol 9 (8) ◽

pp. 1416-1426

Author(s):

C W Yang ◽

J Kim ◽

Y H Kim ◽

J H Cha ◽

S Y Mim ◽

...

Keyword(s):

Cyclosporin A ◽

Serum Calcium ◽

Protein Level ◽

Rat Kidney ◽

Urinary Calcium ◽

Calcium Handling ◽

Calcium Excretion ◽

Urine Calcium ◽

Calbindin D28k ◽

Urine Calcium Excretion

A recent study by Steiner et al. (Biochem Pharmacol 51: 253-258, 1996) demonstrated a decreased calbindin D28K expression in the kidneys of cyclosporin A (CsA)-treated rats. To evaluate the association of renal calcium handling with calbindin D28K expression in CsA-treated rats, two separate experiments (vehicle [VH] versus CsA groups, 1,25-dihydroxyvitamin D3 [VitD] versus VitD + CsA groups) were done simultaneously. CsA (25 mg/kg per d, subcutaneously) and VitD (0.5 microg/kg per d, subcutaneously) were given for 7 d. The CsA group showed decreased serum calcium, increased urine calcium excretion, and decreased calbindin D28K protein level and immunoreactivity compared with the VH group. The VitD + CsA treatment decreased serum calcium, increased urine calcium excretion, and decreased calbindin D28K protein level and immunoreactivity compared with the VitD alone. CsA treatment did not affect the serum parathyroid hormone and VitD levels. This study demonstrates an association of calbindin D28K expression with the urinary calcium excretion in CsA-treated rats, and suggests that decreased calbindin D28K expression may play a role in renal calcium wasting.

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Mechanism of chronic hypercalciuria with furosemide: increased calcium absorption

AJP Renal Physiology ◽

10.1152/ajprenal.1986.251.1.f17 ◽

1986 ◽

Vol 251 (1) ◽

pp. F17-F24 ◽

Cited By ~ 2

Author(s):

D. A. Bushinsky ◽

M. J. Favus ◽

C. B. Langman ◽

F. L. Coe

Keyword(s):

Calcium Absorption ◽

Chronic Administration ◽

Urinary Calcium ◽

Intestinal Calcium Absorption ◽

Calcium Excretion ◽

Calcium Balance ◽

Urine Calcium ◽

Calcium Diet ◽

Filtered Load ◽

Urine Calcium Excretion

Furosemide produces chronic hypercalciuria. The source of the additional urinary calcium is not known but must be either bone mineral or calcium absorbed by the intestine. Without bone calcium dissolution or increased absorption the filtered load of calcium would fall and urinary calcium excretion would return to pretreatment levels. To determine whether furosemide alters intestinal calcium absorption, we fed furosemide (75 mg . kg body-1 wt . day-1) to 11 rats eating 15 g/day of a 0.60% calcium diet. Compared with 11 control rats, furosemide increased urine calcium (15.6 +/- 0.8 mg/5 days vs. 4.1 +/- 0.3, P less than 0.001). Fecal calcium excretion fell (194 +/- 7 mg/5 days vs. 223 +/- 12, P less than 0.05), indicating an increase in intestinal calcium absorption sufficient to sustain the hypercalciuria. The increase in absorption occurred without an increase in the level of serum 1,25-dihydroxycholecalciferol (180 +/- 20 pg/ml vs. 220 +/- 16, furosemide vs. control, respectively, P = NS). To determine whether the intestinal effect of furosemide persists after the initial sodium diuresis abates, we analyzed only the last 3 days of balance. Again, rats fed furosemide had increased urine excretion and intestinal absorption of calcium, so that net calcium balance was not different from that of controls. Twelve additional rats were fed a 0.02% calcium diet to which 35 mg . kg body wt-1 . day-1 of furosemide was added. Compared with eleven controls, urine calcium increased and fecal calcium excretion again fell, but balance was not different. Chronic administration of furosemide increases intestinal calcium absorption enough to permit urine calcium excretion to remain elevated without the necessity for bone dissolution.

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