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Biomedical subjects

B Wikström

Publications and source records attributed to B Wikström.

At least 127 records · Page 7Linked to original sources
PubMed1982

Renal handling of urate in patients with calcium stone disease.

The renal handling of urate was investigated in 28 recurrent calcium stone formers and 12 healthy controls. 12 patients were hyperuricosuric and 16 patients had incomplete proximal or distal acidification defects. Measurements of the glomerular filtration and the tubular reabsorption of filtered urate were made through the pyrazinamide (PZA)-suppression test of urate secretion. Hyperuricosuria could not be explained by defects in the renal handling of urate. Patients with proximal acidification defects had a higher tubular reabsorption of filtered urate than the other subjects. Tubular reabsorption of filtered urate was inversely correlated, and filtered urate escaping reabsorption positively correlated to the 24-hour excretion of urate. In contrast, the PZA-suppressible fraction of urate excretion, which is the net effect of tubular secretion and post-secretory reabsorption and thought to be the main regulator of urate excretion, was not correlated to the 24-hour excretion of urate. It is concluded that the renal handling of urate is basically normal in calcium stone disease, whereas minor deviations may co-exist with renal tubular acidification dysfunction.

Calcium↗
PubMed1981

Hemodialysis-induced increase in serum lactoferrin and serum eosinophil cationic protein as signs of local neutrophil and eosinophil degranulation.

Transient reduction in circulating polymorphonuclear granulocytes and eosinophils were observed early in hemodialysis. About a threefold increase in serum-lactoferrin occurred 2 h from the start of hemodialysis. Increments of the serum levels of eosinophil cationic protein (ECP) were observed as early as 1 h after initiation of hemodialysis, reaching maximum levels (about a fourfold increase from initial levels) 1 h later. When fresh blood was circulated through a dialyzer without having a patient in the circuit considerable increases of lactoferrin and ECP were also found. The intracellular contents of lactoferrin and ECP in granulocytes isolated from peripheral blood were unaffected throughout the dialysis period. Sera obtained at different times during dialysis induced no release of granular proteins from isolated granulocytes in vitro. The raised serum concentrations of lactoferrin and ECP during dialysis suggest that a local degranulation of neutrophils and eosinophils may take place probably in the dialyzer.

Adult↗
PubMed1981

Calcium and magnesium metabolism during long-term treatment with thiazides.

The effects of treatment with bendroflumethiazide (2.5 mg twice daily with potassium supplements) on mineral metabolism were evaluated in 111 patients followed for a minimum period of one year. The urinary calcium decreased with approximately 30% irrespective of the pretreatment levels and remained on this lower level during follow-up. This reduction of urinary calcium was associated with a reduction of the intestinal calcium absorption. The serum calcium increased slightly in most of the patients and in 10% of them hypercalcaemia could be demonstrated at some time. In most of these cases the hypercalcaemia was slight and temporary and when sustained rapidly reversed upon withdrawal of therapy. Initially the urinary magnesium excretion increased but after two years' treatment the values were no longer raised. The serum magnesium levels showed a continued decrease during follow-up but in muscle biopsies, performed after three years treatment, no magnesium deficiency was evident. During treatment also the fasting urinary calcium was reduced, suggesting reduced bone resorption, but urinary hydroxyproline was unchanged. The serum PTH levels appeared unchanged during follow-up. Thiazides appear to cause a persisting reduction of calcium excretion, which is compensated by reduced intestinal uptake, whereas parathyroid function is unaffected. Although there was a gradual decline of serum magnesium, magnesium deficiency was not demonstrated.

Adult↗
PubMed1981

Phosphate metabolism in renal stone formers. (II): Relation to renal tubular functions and calcium metabolism.

Patients with idiopathic recurrent calcium nephrolithiasis (n = 57) and controls (n = 16) were investigated regarding the relationship between renal phosphate handling, other renal tubular functions and calcium metabolism. Incomplete renal tubular acidosis (RTA) was disclosed in 13 patients. RTA patients together with stone formers with normal renal acidification capacity (SF) exhibited low values for serum phosphate and renal threshold phosphate concentration (TmP/GFR) compared with controls. TmP/GFR was lower in RTA patients than in stone formers with normal renal acidification. Hypercalciuria of the absorptive type with normal serum PTH and urinary cAMP concentrations was a common finding in both stone patient groups, whereas no patient displayed unequivocal evidence of parathyroid hyperfunction. Fractional excretion of sodium was raised in both SF and RTA patients compared with controls. There was a positive relationship between the fractional excretion of phosphate and sodium in all subjects as a group. TmP/GFR was negatively correlated to fractional excretion of sodium. Twenty-three percent of RTA patients and 8% of SF displayed tubular proteinuria which often was associated with low TmP/GFR levels and enhanced natriuresis. It is concluded that a defective renal tubular phosphate handling is common in calcium stone formers and often associated with signs of other tubular dysfunctions. The altered phosphate handling seems to be unrelated to hypercalciuria.

Adolescent↗
PubMed1981

Phosphate metabolism and renal calcium stone disease.

The purpose of the present investigation was to study various aspects of phosphate metabolism in renal calcium stone patients with special reference to the renal handling of phosphate and its relationship to other renal tubular functions and calcium metabolism. Serum phosphate and the capacity for renal tubular reabsorption of phosphate were lower in stone patients than in controls and decreased with advancing age. Reduced tubular phosphate reabsorption was particularly evident in stone patients with other tubular dysfunctions. Absorptive hypercalciuria was common, but unrelated to the renal tubular reabsorption of phosphate. Parathyroid hyperfunction was not observed in stone formers. Various loads of dietary phosphate resulted in similar renal adaptive responses in controls and stone formers. Orthophosphate supplementation had metabolic consequences with potentially beneficial effects for stone prevention (increased urinary pyrophosphate, decreased urinary calcium). The altered renal handling of phosphate in calcium stone formers may reflect a primary (independent of parathyroid hormone) renal tubular dysfunction in phosphate reabsorption.

Absorption↗
PubMed1981

Phosphate metabolism in renal stone formers. (I): Indices of phosphate handling in calcium stone patients and healthy subjects.

Healthy subjects (n = 112) and patients with recurrent idiopathic calcium nephrolithiasis (n = 44) were evaluated regarding various indices of phosphate handling: serum phosphate concentration, renal tubular reabsorption of phosphate, index of phosphate excretion and renal threshold concentration for phosphate (TmP/GFR). The 24 hour and fasting 2 hour urinary phosphate excretions were similar in the two groups and the index of phosphate excretion was higher in stone formers, but for all the other variables lower mean values were found in the group of stone formers than in the group of normal subjects. The renal tubular capacity for reabsorption of phosphate (as evaluated by the different indices) appeared to decrease with advancing age concomitant with a reduction of the serum phosphate concentration. When age- and sex-matched subjects from the two groups were compared with regard to the phosphate variables lower values were still found in the group of stone forming subjects. This study gives support to earlier observations that renal stone formers tend to waste phosphate by and altered renal handling.

Absorption↗
PubMed1980

Biochemical and clinical effects of the prophylactic treatment of renal calcium stones with magnesium hydroxide.

Prophylactic treatment with magnesium hydroxide ws instituted in 56 consecutive cases with renal calcium stones. The patients had been investigated previously with regard to the magnesium metabolism. The urinary magnesium excretion increased promptly and remained on a higher level during treatment. No changes were observed in the serum or urinary calcium concentrations. Most patients have undergone treatment for at least 2 years and 45 have been free of recurrences of formations of new stones. The mean stone episode rate during treatment was 0.03 stones per year compared to 0.8 stones per year before treatment was instituted. The natural history of stone disease also was followed in 34 patients with stones who had received no prophylactic therapy and 15 have experienced recurrences after 2 years. Therefore, in comparison, treatment with magnesium hydroxide appeared to reduce the recurrence rate. Apart from minor gastrointestinal discomfort no adverse effects were observed during treatment.

Adult↗
PubMed1980

Treatment of recurrent calcium stone formation with cellulose phosphate.

Sodium cellulose phosphate was given to 35 patients for recurrent formation of calcium-containing stones. During therapy urinary calcium decreased by 40% in the first month and remained at this lower level. In addition, urinary magnesium excretion was reduced and the urinary magnesium/calcium ratio remained unaffected. In these patients, who mostly had had calcium oxalate stones, the prophylactic effects of sodium cellulose phosphate was poor, with a 47% recurrence rate after 2 years. This lack of prevention, despite the significant reduction of the urinary calcium, is assumed to be owing to the effects of treatment on magnesium and oxalate metabolism. Side effects were common, mainly consisting of moderate gastrointestinal discomfort, and caused withdrawal of treatment in 8 patients. This fact contributes further to our opinion that sodium cellulose phosphate is not the drug of choice in cases of calcium oxalate stone formation.

Adult↗
PubMed1980

Incidence and clinical importance of renal tubular defects in recurrent renal stone formers.

Renal tubular function was studied in 318 consecutive recurrent renal stone formers. Impaired acidification capacity was found in 19% of the patients, and tubular proteinuria in 13% of the patients. Most of the patients with defective acidification of the urine had the incomplete form of renal tubular acidosis (RTA), rpoximal and distal defects being equally common. The incidence of impaired acidification was much higher in the female (38%) than in the male (13%) stone formers. A further analysis of the clinical picture in patients with acidification defects revealed a more severe stone disease than among other stone formers. Characteristic findings were an early onset, multiple recurrences were an increased need for surgery. Stone analyses showed a high frequency of calcium phosphate stones. Investigations of renal tubular functions appear to be a valuable adjunct in the evaluation of recurrent renal stone disease.

Acid-Base Equilibrium↗
PubMed1980

Kidney stone disease. Experiences from Uppsala, Sweden.

In summary, several biochemical investigations give valuable information about a possible etiological explanation for the stone formation but to get a more complete picture of the individual stone former, some clinical aspects should be considered such as heredity for stone disease and the age of onset. All these factors are relevant when considering prophylactic treatment to stone formers.

Adult↗
PubMed1980

Renal transplantation in polycystic renal disease--a joint Scandinavian report.

During the period 1965-1977, a total of 339 patients with polycystic renal disease received at least 1 renal transplant at one of 10 transplant centres in Scandinavia. Patient survival at one year was 67%. The one year graft survival of 319 cadaveric grafts was 40%. The average age of the patient was 56.7 years. Patients who were 60 years or older (93 patients) had a significantly poorer patient and graft survival at one year (50% and 29.5% respectively). Patients receiving kidneys with O incompatibilities did significantly better than other donor-recipient combinations. Previous blood transfusions were associated with better graft prognosis, though the difference was only significant for 2 years. The incidence of posttransplant urinary tract infection (present in 47% of all the patients) was twice as common in patients with a history of pretransplant urinary tract infection (seen in 41% of all the patients). There was no association between posttransplant septicaemia and either pre- or post-transplant urinary tract infection. Only 10.5% of the patients were nephrectomized at the time of transplantation, half of these had urinary tract infection. Twenty-four per cent of the patients were nephrectomized in the posttransplant period, half of these because of infection. There was no difference in the graft survival data of the patients with or without pretransplant urinary tract infection. These findings justify a restrictive practice with regard to pretransplant nephrectomy in patients with polycystic renal disease.

Blood Transfusion↗
PubMed1980

Magnesium metabolism in renal stone disease.

Magnesium metabolism in 70 consecutive patients with renal stone disease was evaluated and compared with that of a control group matched for age and sex. Serum and urinary magnesium values were not different in the two groups, but magnesium output was greater in males than in females. Stone-formers excreted more calcium in their urine than did controls, and the urinary calcium and magnesium values for both groups were positively correlated. For both groups, the magnesium/calcium ratio in the urine declined with increasing calcium values but was lower in stone-formers than in controls for corresponding calcium values. Intestinal magnesium uptake was the same in both groups. Magnesium deficiency was not evident among stone-formers as assessed by the determination of the magnesium content in muscle specimens or by the retention of an intravenously administered magnesium load. Although stone-formers were not found to display any features of magnesium metabolism that were different from those in the control group, their lower urinary excretion of magnesium in relation to calcium may be a factor in their increased stone-forming propensity.

Adult↗