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Physiologic age modifies the association between visceral fat predominance and urinary calcium excretion in adults with nephrolithiasis.

Although adiposity is associated with kidney stone disease, the relationship between abdominal fat distribution and urinary calcium excretion remains unclear. We investigated whether the CT-derived visceral-to-subcutaneous fat ratio (VSR) was associated with 24-hour urinary calcium excretion and whether physiologic age modified this association. This retrospective cross-sectional study included 308 adults with nephrolithiasis who underwent preoperative CT, stone removal, and postoperative metabolic evaluation. Participants were stratified into prespecified younger (men aged&#x2009;<&#x2009;50 years and premenopausal women) and older (men aged&#x2009;&#x2265;&#x2009;50 years and postmenopausal women) physiologic-age groups. Multivariable linear regression assessed the association between VSR and urinary calcium excretion and its modification by physiologic age. Results showed that VSR was not associated with urinary calcium excretion in the overall cohort, but its association differed significantly by physiologic age (P for interaction&#x2009;<&#x2009;0.001). Among younger participants, each 1-unit higher VSR was associated with 2.07 mmol/day greater urinary calcium excretion (95% CI, 1.23-2.90), whereas no significant association was observed in the older group. These findings suggest that the metabolic relevance of visceral fat predominance differs by physiologic age, with a significant association observed only in younger adults. Prospective studies are needed to confirm these findings and determine their clinical implications.

Humans

Oestrogen-progestogen oral contraceptives and urinary calcium excretion.

To examine the effects of age and use of oestrogen-progestogen oral contraceptive agents (OCA) on urinary calcium excretion, 24 h urine collections were obtained from 525 women aged 16-69 years during a health survey, and measurements made of the amounts of calcium, creatinine, sodium, potassium and magnesium excreted. Younger women using OCA excreted more potassium and creatinine but less calcium, and less calcium and magnesium relative to creatinine, than corresponding controls using no OCA. Older women excreted less creatine, but significantly greater amounts of calcium, sodium, potassium and magnesium relative to creatinine than younger women. It is postulated that the diminished urinary calcium excretion observed in women using OCA resulted from suppression of bone resorption by oestrogens in OCA.

Adolescent

[Biological activity of 1alpha-hydroxycholecalciferol (II). Effect on the metabolism of calcium and phosphorus in rats (author's transl)].

Effect of 1alpha-hydroxycholecalciferol on the metabolism of calcium and phosphorus was studied using Ca-labelled and non-labelled rats. With an oral daily dose of 2.5 or 12.5 microgram/kg of 1alpha-hydroxycholecalciferol, serum calcium, urine volume, urinary calcium excretion, urinary calcium concentration and water consumption increased, while fecal concentration, urinary phosphorus concentration and food consumption decreased. There was a lag time (1 or 2 days) between the increase of serum calcium and that of specific activity of serum calcium, and bone resorption was stimulated later than was intestinal calcium transport. After 10 days treatment, calcium concentration in the femur decreased, while a remarkable calcification was noted in soft tissues such as kidney, intestine, aorta, heart and muscle, although these effects were reduced with lower doses of the drug. With a smaller oral daily dose (0.1 or 0.5 microgram/kg), for 6 months, bone calcium and phosphorus concentration increased without soft tissue calcification. Thus, 1alpha-hydroxycholecalciferol may be an effective drug for patients with metabolic bone diseases.

Animals

[The action of vitamin D2 and of 25-hydroxy-cholecalciferol on calcemia and urinary calcium excretion in the alcoholic cirrhotic (author's transl)].

In 2 similar groups of alcoholic cirrhotics with definite hepatic failure, the results of the oral administration of 25-hydroxycholecalciferol and of vitamin d2 on calcemia and urinary calcium excretion were studied. 25-hydroxycholecalciferol definitely increases calcemia and urinary calcium excretion, this action being superior to that of vitamin D2. This action which occurs, at least in part, by an increase in intestinal calcium absorption, deomonstrated the true nature of the "hepatic block" of vitamin D2 in alcoholic cirrhosis and the value of the administration of 25-hydroxycholecalciferol.

Calcium

The influence of refined carbohydrate on urinary calcium excretion.

In the course of study of the influence of varying the amount of refined carbohydrate (sugar and sugar products) in an otherwise standardised diet in 18 normal subjects it was evident that the analysis of 24-h urine collections failed to show the profound diurnal variation in urinary electrolyte excretion and, in particular in this instance, calcium excretion. The analysis of individually voided specimens showed some normal subjects to have spontaneously high peaks of urinary calcium concentration throughout the day even whilst on a diet with low refined carbohydrate content. Increase in the refined carbohydrate content of the otherwise standardised diet caused significant increase in the number of urines with a calcium concentration above 9 mmol/1. Refined carbohydrate, a common cinstituent in Western diets, can therefore influence urinary electrolyte excretion in such a way that there may be an increased risk of over-saturation with calcium oxalate.

Adolescent

Urinary calcium excretion in schoolboys. Ethnic group differences.

The urinary calcium/creatinine ratio was estimated in two groups of schoolboys--village Arabs and urban Jewish (Ashkenazic) schoolboys, aged 10 to 11 years. Both the mean calcium/creatinine ratio and the frequency of hypercalciuria were higher among the Arab boys, and may be related to the higher incidence of chilidhood urolithiasis in Arab children in Israel.

Calcium

Urinary calcium excretion in relation to kidney function in the adult.

A study based on 55 hospital patients (age groups 40-59, 60-69, 70-79) demonstrated a significant correlation between the glomerular filtration rate (as expressed by endogenous creatinine clearance) and the mean urinary calcium concentration. Excluded were patients with thyroidal or hypophyseal disorders, osteoporosis, renal stones immobilizing conditions, or those treated with corticosteroids. The study patients had a normal fluid intake and did not receive any diuretics. The urinary calcium concentration test is less laborious and less liable to laboratory errors than the creatinine clearance test, which requires a 24-hour urine collection. Because of the gradual decrease in the glomerular filtration rate in the elderly, this test should be of value in geriatric practice.

Adult

Effects of different diuretics on urinary calcium excretion in a general population.

Calcium excretion by users and non-users of thiazide diuretics and frusemide was studied during a health survey. Men taking thiazides excreted less calcium than age- and weight-matched controls. Both men and women taking thiazides excreted less calcium relative to sodium than controls. Women taking thiazides excreted significantly less calcium than women taking frusemide. Both men and women taking thiazides excreted less calcium relative to creatinine than sex-matched groups taking frusemide.

Adolescent

Intestinal and renal handling of calcium in human diabetes mellitus: influence of acute oral glucose loading and diabetic control.

The intestinal absorption and the urinary excretion of calcium were compared in two groups of diabetic patients during periods of satisfactory and poor control. In a first group of ten patients, periods of isolated high glycosuria were obtained by giving an oral glucose load. The second group consisted of ten patients with a severe endogenous insulin deficiency. The subjects of this latter group were investigated before and after a few days of insulin therapy. In group I, the oral glucose load induced a significant increase in the intestinal calcium absorption and had a tendency to lower the urinary calcium excretion. Furthermore, an inverse relationship was found between the changes in the intestinal calcium absorption and the variations of the urinary calcium excretion. In group II, both intestinal absorption and urinary excretion of calcium fell significantly after recovery of satisfactory metabolic control by insulin therapy. From the results as obtained in group I one can conclude that glucose enhances the calcium transfer from the luminal to the serosal pole of both intestinal and renal tubular cells. During severe ketosis as observed in group II, calcium metabolism is considerably accelerated and the increase in the intestinal calcium absorption rate may be interpreted as compensatory mechanism for the high urinary loss of calcium.

Adolescent