Faculty Opinions recommendation of Unravelling the links between calcium excretion, salt intake, hypertension, kidney stones and bone metabolism.

2016 ◽  
Author(s):  
Giovanni Gambaro
Keyword(s):  
Bone Metabolism ◽  
Kidney Stones ◽  
Salt Intake ◽  
Calcium Excretion

scholarly journals ‘Low-Salt’ Bread as an Important Component of a Pragmatic Reduced-Salt Diet for Lowering Blood Pressure in Adults with Elevated Blood Pressure

Nutrients ◽  
2019 ◽  
Vol 11 (8) ◽  
pp. 1725 ◽  
Author(s):  
Kevin D. Cashman ◽  
Sorcha Kenny ◽  
Joseph P. Kerry ◽  
Fanny Leenhardt ◽  
Elke K. Arendt
Keyword(s):  
Blood Pressure ◽  
Bone Metabolism ◽  
Plasma Lipids ◽  
Salt Intake ◽  
Elevated Blood Pressure ◽  
Elevated Blood ◽  
Salt Diet ◽  
Low Salt ◽  
Dietary Period ◽  
Reduced Salt

Reformulation of bread in terms of salt content remains an important measure to help achieve a reduction in salt intake in the population and for the prevention of hypertension and elevated blood pressure (BP). Our fundamental studies on the reduction of salt on dough and bread characteristics showed that wheat breads produced with 0.3 g salt/100 g (“low-salt”) were found to be comparable quality to that produced with the typical level of salt (1.2%). This food-based intervention trial examined, using a 5 week cross-over design, the potential for inclusion of “low-salt” bread as part of a pragmatic reduced-salt diet on BP, markers of bone metabolism, and plasma lipids in 97 adults with slightly to moderately elevated BP. Assuming all sodium from dietary intake was excreted through the urine, the intake of salt decreased by 1.7 g/day, on average, during the reduced-salt dietary period. Systolic BP was significantly lower (by 3.3 mmHg on average; p < 0.0001) during the reduced-salt dietary period compared to the usual-salt dietary period, but there was no significant difference (p = 0.81) in diastolic BP. There were no significant differences (p > 0.12, in all cases) in any of the urinary- or serum-based biochemical indices of calcium or bone metabolism or in plasma lipids between the two periods. In conclusion, a modest reduction in dietary salt intake, in which the use of “low-salt” (i.e., 0.3 g/100g) bread played a key role along with dietary advice, and led to a significant, and clinically meaningful, decrease in systolic, but not diastolic, BP in adults with mildly to moderately elevated BP.

Mechanisms Underlying Calcium Nephrolithiasis

2021 ◽  
Vol 84 (1) ◽  
Author(s):  
R.T. Alexander ◽  
D.G. Fuster ◽  
H. Dimke
Keyword(s):  
Kidney Stones ◽  
Kidney Stone ◽  
Stone Formation ◽  
Urinary Calcium ◽  
Annual Review ◽  
Publication Date ◽  
Calcium Excretion ◽  
Thick Ascending Limb ◽  
Renal Tubular ◽  
Kidney Stone Formation

Nephrolithiasis is a worldwide problem with increasing prevalence, enormous costs, and significant morbidity. Calcium-containing kidney stones are by far the most common kidney stones encountered in clinical practice. Consequently, hypercalciuria is the greatest risk factor for kidney stone formation. Hypercalciuria can result from enhanced intestinal absorption, increased bone resorption, or altered renal tubular transport. Kidney stone formation is complex and driven by high concentrations of calcium-oxalate or calcium-phosphate in the urine. After discussing the mechanism mediating renal calcium salt precipitation, we review recent discoveries in renal tubular calcium transport from the proximal tubule, thick ascending limb, and distal convolution. Furthermore, we address how calcium is absorbed from the intestine and mobilized from bone. The effect of acidosis on bone calcium resorption and urinary calcium excretion is also considered. Although recent discoveries provide insight into these processes, much remains to be understood in order to provide improved therapies for hypercalciuria and prevent kidney stone formation. Expected final online publication date for the Annual Review of Physiology, Volume 84 is February 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

scholarly journals High Rate of Occult Urolithiasis in Normocalcemic Primary Hyperparathyroidism

2019 ◽  
Vol 44 (5) ◽  
pp. 1189-1195 ◽  
Author(s):  
Alyne Layane Pereira Lemos ◽  
Sergio Ricardo de Lima Andrade ◽  
Lívia Laeny Henrique Pontes ◽  
Patricia Moura Cravo Teixeira ◽  
Elba Bandeira ◽  
...  
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Kidney Stones ◽  
Urinary Calcium ◽  
Normal Serum ◽  
Urinary Calcium Excretion ◽  
High Rate ◽  
Calcium Excretion ◽  
History Of ◽  
Serum Pth

Introduction: Normocalcemic primary hyperparathyroidism (NPHPT) is characterized by elevations in serum parathyroid hormone levels in the presence of normal serum calcium concentrations after exclusion of secondary hyperparathyroidism. We have previously demonstrated no differences in the prevalence of clinically active urolithiasis between NPHPT and hypercalcemic asymptomatic PHPT, and that it is significantly higher in postmenopausal osteoporotic women with NPHPT in comparison to women with normal serum PTH and calcium concentrations. Few studies have addressed the occurrence of silent or occult kidney stones in asymptomatic hypercalcemic PHPT, but no data are available for NPHPT. Objective: To determine the presence of occult urolithiasis in NPHPT patients using routine abdominal ultrasonography. Methods and Results: We studied 35 patients with NPHPT (mean age 63.2 ± 10.7 years, 96% women; serum PTH 116.5 ± 39.2 pg/mL, 25OHD 38.5 ± 6.82 ng/mL, total calcium 9.1 ± 0.56 mg/dL; albumin 4.02 ± 0.37 g/dL; BUN 34.35 ±10.23 mg/dL; p = 3.51 ± 0.60 mg/dL; estimated glomerular filtration rate 88.44 ± 32.45 mL/min/1.73 m2, and 24-h urinary calcium excretion 140.6 ± 94.3 mg/24 h). The criteria for the diagnosis of NPHPT were as follows: serum PTH above the reference range (11–65 pg/mL), normal albumin-corrected serum calcium concentrations, normal 24-h urinary calcium excretion, serum 25OHD above 30 ng/mL, estimated GFR (MDRD) above 60 mL/min/1.73 m2 (with the exclusion of medications such as thiazide diuretics, lithium, bisphosphonates, and denosumab), a history of clinical symptoms of urolithiasis, and a family history of kidney stones. Thirty-five patients were evaluated and 25 of them met the inclusion criteria. Five patients presented nephrolithiasis corresponding to 20% of the study population. There were no statistically significant differences in any of the clinical or laboratory variables studied between patients with or without urolithiasis, although mean serum PTH levels were higher in patients with stones (180.06 ± 126.48 vs. 100.72 ± 25.28 pg/mL, p = 0.1). The size of the stones ranged from 0.6 to 0.9 cm and all of the stones were located in the renal pelvis. Conclusion: We found a high prevalence of occult kidney stones in NPHPT patients, similar to what is observed in clinically manifested urolithiasis, in hypercalcemic PHPT.

scholarly journals A 7-week reduction in salt intake does not contribute to markers of bone metabolism in young healthy subjects

2005 ◽  
Vol 59 (3) ◽  
pp. 311-317 ◽  
Author(s):  
A -M Natri ◽  
M U M Kärkkäinen ◽  
M Ruusunen ◽  
E Puolanne ◽  
C Lamberg-Allardt
Keyword(s):  
Bone Metabolism ◽  
Healthy Subjects ◽  
Salt Intake

Genetic Contribution to Bone Metabolism, Calcium Excretion, and Vitamin D and Parathyroid Hormone Regulation

2001 ◽  
Vol 16 (2) ◽  
pp. 371-378 ◽  
Author(s):  
D. Hunter ◽  
M. De Lange ◽  
H. Snieder ◽  
A. J. MacGregor ◽  
R. Swaminathan ◽  
...  
Keyword(s):  
Vitamin D ◽  
Parathyroid Hormone ◽  
Bone Metabolism ◽  
Calcium Excretion ◽  
Hormone Regulation ◽  
Genetic Contribution

scholarly journals Disentangling the Relationships Between the Renin–Angiotensin–Aldosterone System, Calcium Physiology, and Risk for Kidney Stones

2020 ◽  
Vol 105 (6) ◽  
pp. 1937-1946 ◽  
Author(s):  
Omar Bayomy ◽  
Sarah Zaheer ◽  
Jonathan S Williams ◽  
Gary Curhan ◽  
Anand Vaidya
Keyword(s):  
Confidence Interval ◽  
Serum Calcium ◽  
Calcium Homeostasis ◽  
Kidney Stones ◽  
Sodium Excretion ◽  
Urinary Sodium Excretion ◽  
Urinary Sodium ◽  
Dietary Sodium ◽  
Calcium Excretion ◽  
Intravascular Volume

Abstract Context Complex relationships between aldosterone and calcium homeostasis have been proposed. Objective To disentangle the influence of aldosterone and intravascular volume on calcium physiology. Design Patient-oriented and epidemiology studies. Setting Clinical research center and nationwide cohorts. Participants/Interventions Patient-oriented study (n = 18): Participants were evaluated after completing a sodium-restricted (RES) diet to contract intravascular volume and after a liberalized-sodium (LIB) diet to expand intravascular volume. Cross-sectional studies (n = 3755): the association between 24h urinary sodium and calcium excretion and risk for kidney stones was assessed. Results Patient-oriented study: compared to a RES-diet, a LIB-diet suppressed renin activity (LIB: 0.3 [0.1, 0.4] vs. RES: 3.1 [1.7, 5.3] ng/mL/h; P &lt; 0.001) and plasma aldosterone (LIB: 2.0 [2.0, 2.7] vs. RES: 20.0 [16.1, 31.0] vs. ng/dL; P &lt; 0.001), but increased calciuria (LIB: 238.4 ± 112.3 vs. RES: 112.9 ± 60.8 mg/24hr; P &lt; 0.0001) and decreased serum calcium (LIB: 8.9 ± 0.3 vs. RES: 9.8 ± 0.4 mg/dL; P &lt; 0.0001). Epidemiology study: mean urinary calcium excretion was higher with greater urinary sodium excretion. Compared to a urinary sodium excretion of &lt; 120 mEq/day, a urinary sodium excretion of ≥220 mEq/day was associated with a higher risk for having kidney stones in women (risk ratio = 1.79 [95% confidence interval 1.05, 3.04]) and men (risk ratio = 2.06 [95% confidence interval 1.27, 3.32]). Conclusions High dietary sodium intake suppresses aldosterone, decreases serum calcium, and increases calciuria and the risk for developing kidney stones. Our findings help disentangle the influences of volume from aldosterone on calcium homeostasis and provide support for the recommendation to restrict dietary sodium for kidney stone prevention.

scholarly journals Hypercalciuria in Postmenopausal Women With Reduced Bone Mineral Density Is Associated With Different Mineral Metabolic Profiles: Effects of Treatment With Thiazides and Anti-resorptives

2021 ◽  
Vol 8 ◽  
Author(s):  
Federico Nicoli ◽  
Giorgia Dito ◽  
Gregorio Guabello ◽  
Matteo Longhi ◽  
Sabrina Corbetta
Keyword(s):  
Bone Mineral Density ◽  
Postmenopausal Women ◽  
Bone Mineral ◽  
Kidney Stones ◽  
Real Life ◽  
Calcium Excretion ◽  
Mineral Density ◽  
Diagnostic Challenge ◽  
Wide Range ◽  
Significant Difference

Hypercalciuria may represent a challenge during the workup for osteoporosis management. The present study aimed: (1) to describe the phenotype associated with hypercalciuria in vitamin D-sufficient (serum 25 hydroxyvitamin D (25OHD) &gt; 20 ng/ml) patients with osteopenia/osteoporosis; (2) to analyze the effects of thiazides and anti-resorptive drugs on urine calcium excretion (UCa), mineral metabolic markers, and bone mineral density. Seventy-seven postmenopausal women with hypercalciuria (Uca &gt; 4.0 mg/kg body weight/24 h on two determinations) were retrospectively evaluated in a real-life setting. Median UCa was 5.39 (4.75–6.70) mg/kg/24 h. Kidney stones occurred in 32.9% of patients, who had median UCa similar to that of patients without kidney stones. Clustering analysis considering the three variables, such as serum calcium, phosphate, and parathormone (PTH), identified two main clusters of hypercalciuric patients. Cluster 1 (n = 13) included patients with a primary hyperparathyroidism-like profile, suggesting a certain degree of autonomous PTH secretion from parathyroid glands. Within cluster 2 (n = 61), two subgroups were recognized, cluster 2A (n = 18) that included patients with relatively increased PTH and normophosphatemia, and cluster 2B (n = 43) that included patients with the normal mineral profile. After a follow-up of 33.4 ± 19.6 months, 49 patients treated with thiazidic diuretics (TZD) were reevaluated; 20 patients were treated with hydrochlorothiazide (HCT; 12.5–37.5 mg/day), 29 with indapamide (IND; 1.50–3.75 mg/day). Any significant difference could be detected in all the parameters both basal and treated conditions between patients treated with HCT or IND. TZD induced a mean 39% reduction in UCa and 63.3% of patients obtained Uca &lt; 4.0 mg/kg/24 h, independent of their mineral metabolic profile. Moreover, TZD induced a significant decrease in PTH levels. TZD-treated patients normalizing UCa experienced an increase in bone mineral densities when concomitantly treated with anti-resorptives, while any gain could be observed in TZD-treated patients with persistent hypercalciuria. Finally, multiple regression analysis showed that UCa reduction was at least in part related to denosumab treatment. In conclusion, in postmenopausal osteoporotic women, hypercalciuria is associated with kidney stones in about one-third of patients and with a wide range of impaired PTH secretion, determining a diagnostic challenge. TZD efficiently reduces UCa and normalization contributes to increasing anti-resorptives positive effect on bone mineral density.

scholarly journals Claudin-14 Gene Polymorphisms and Urine Calcium Excretion

2018 ◽  
Vol 13 (10) ◽  
pp. 1542-1549 ◽  
Author(s):  
Teresa Arcidiacono ◽  
Marco Simonini ◽  
Chiara Lanzani ◽  
Lorena Citterio ◽  
Erika Salvi ◽  
...  
Keyword(s):  
Single Nucleotide Polymorphisms ◽  
Kidney Stones ◽  
Saline Infusion ◽  
Calcium Excretion ◽  
Nucleotide Polymorphisms ◽  
Nucleotide Polymorphism ◽  
Urine Calcium ◽  
Single Nucleotide ◽  
Urine Calcium Excretion ◽  
Claudin 14

Background and objectivesClaudin-16 and -19 are proteins forming pores for the paracellular reabsorption of divalent cations in the ascending limb of Henle loop; conversely, claudin-14 decreases ion permeability of these pores. Single-nucleotide polymorphisms in gene coding for claudin-14 were associated with kidney stones and calcium excretion. This study aimed to explore the association of claudin-14, claudin-16, and claudin-19 single-nucleotide polymorphisms with calcium excretion.Design, setting, participants, & measurementsWe performed a retrospective observational study of 393 patients with hypertension who were naïve to antihypertensive drugs, in whom we measured 24-hour urine calcium excretion; history of kidney stones was ascertained by interview; 370 of these patients underwent an intravenous 0.9% sodium chloride infusion (2 L in 2 hours) to evaluate the response of calcium excretion in three different 2-hour urine samples collected before, during, and after saline infusion. Genotypes of claudin-14, claudin-16, and claudin-19 were obtained from data of a previous genome-wide association study in the same patients.ResultsThirty-one single-nucleotide polymorphisms of the 3′ region of the claudin-14 gene were significantly associated with 24-hour calcium excretion and calcium excretion after saline infusion. The most significant associated single-nucleotide polymorphism was rs219755 (24-hour calcium excretion in GG, 225±124 mg/24 hours; 24-hour calcium excretion in GA, 194±100 mg/24 hours; 24-hour calcium excretion in AA, 124±73 mg/24 hours; P<0.001; calcium excretion during saline infusion in GG, 30±21 mg/2 hours; calcium excretion during saline infusion in GA, 29±18 mg/2 hours; calcium excretion during saline infusion in AA, 17±11 mg/2 hours; P=0.03). No significant associations were found among claudin-16 and claudin-19 single-nucleotide polymorphisms and calcium excretion and between claudin-14, claudin-16, and claudin-19 single-nucleotide polymorphisms and stones. Bioinformatic analysis showed that one single-nucleotide polymorphism at claudin-14 among those associated with calcium excretion may potentially influence splicing of transcript.ConclusionsClaudin-14 genotype at the 3′ region is associated with calcium excretion in 24-hour urine and after the calciuretic stimulus of saline infusion.

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