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Originals

Bone involvement in idiopathic hypercalciuria

A.M. Misael da Silva, L.M. dos Reis, R.C. Pereira, E. Futata, C.T. Branco-Martins, I.L. Noronha, B.L. Wajchemberg and V. Jorgetti

Volume 57 (2002) p. 183 - 191

Abstract

A.M. Misael da Silva, L.M. dos Reis, R.C. Pereira, E. Futata, C.T. Branco-Martins, I.L. Noronha, B.L. Wajchemberg and V. Jorgetti

¹Nephrology Division, ²Immunology Division, and ³Endocrinology Division, University of São Paulo Medical School, São Paulo, Brazil
Background: To evaluate bone involvement in idiopathic hypercalciuria, 40 lithiasic patients and 10 controls were studied. Methods: According to urinary calcium excretion, patients were first classified as hypercalciuric (H_ca, n = 22) and normocalciuric (N_ca,n = 18). The H_ca patients were then subclassified according to bone densitometry (BMD) as osteopenic (H_caO, n = 10) and non-osteopenic(H_caNO,
n = 12). Routine biochemistry, dietary records, bone histomorphometry, and cytokines (IL-1b, IL-6, and TNF) production
by peripheral blood mononuclear cell cultures were studied. Results: There were no differences in routine biochemistry between H_ca and N_ca groups
except for urinary calcium. Inadequate nutrition was observed in H_ca group,showing high protein (80.9% of the patients), carbohydrate (76.2%) and sodium (90%) intake. Calcium intake was low in H_ca (57%) and N_ca (83%) groups. IL-6 and TNF were not different between the H_ca and N_ca groups. IL-1b levels were significantly high in both groups when compared to controls. IL-6 and TNF were higher in H_caO than N_ca. BMD in femoral neck in H_caO was lower than in H_caNO and N_ca groups. Eroded surface (ES/BS) increased in 91% of the H_ca group and 36% had a mineralization defect. In the H_caO group serum PTH
correlated negatively with trabecular bone volume (BV/TV) and positively with ES/BS.
1,25(OH)₂D₃ levels correlated positively with osteoblastic surface.
Calcium intake correlated positively with BV/TV and inversely with ES/BS. A negative
correlation was observed between IL-6 levels and Z score of the femoral neck. Conclusion:Bone involvement was detected in a young population with nephrolithiasis demonstrating that a strict follow-up is necessary in order to control hypercalciuria.

Originals

High prevalence of low bone mineral density in pre-dialysis chronic kidney disease patients: bone histomorphometric analysis

R. Lobão, A.B. Carvalho, L. Cuppari, R. Ventura, M. Lazaretti-Castro, V. Jorgetti, J.G. Vieira, M. Cendoroglo and S.A. Draibe

Volume 62 (2004) p. 432 - 439

Abstract

R. Lobão, A.B. Carvalho, L. Cuppari, R. Ventura, M. Lazaretti-Castro, V. Jorgetti, J.G. Vieira, M. Cendoroglo and S.A. Draibe

Nephrology Division, Federal University of São Paulo, Escola Paulista de Medicina, São Paulo, Brazil
Chronic kidney disease (CKD) leads to reduced bone mineral density (BMD) in pre-dialysis and dialysis patients. A few studies have used dual-energy x-ray absorptiometry (DEXA) to assess BMD in pre-dialysis CKD patients and have shown low BMD to be highly prevalent. Until now there have been no studies reporting the histological features of low BMD in pre-dialysis CKD patients. Aim: To determine the prevalence and histological features of low BMD in pre-dialysis CKD patients. Method: Pre-dialysis CKD patients (n = 103, 46 females/57 males), median creatinine clearance of 29 (10 – 78) ml/min/ 1.73 m2, were evaluated using biochemical analysis and DEXA. Bone biopsies were obtained from those with low BMD. Results: Fifty (48.5%) out of the 103 patients had low BMD (LBD group) and 53 (51.5%) had normal BMD (NBD group). The risk for low BMD was increased in those patients with alkaline phosphatase levels above 190 U/l and intact-PTH (iPTH) below 70 pg/ml (p < 0.05). Demographic and biochemical parameters from both groups were comparable, except for lower body mass index (BMI) in LBD subjects (p = 0.04). Women who had been post-menopausal for at least 1 year comprised 65% (13/20) and 50% (13/26) of the LBD and NBD groups, respectively (p = NS). In 40 LBD patients, bone histomorphometry revealed adynamic bone disease (ABD, 52.5%), osteomalacia (OM, 42.5%) and mixed bone disease (MBD, 5%). Trabecular bone volume (BV/TV) was lower in ABD and OM patients. A nearly significant association was found between ABD and iPTH £ 150 pg/ml (p = 0.056), whereas higher values of iPTH were associated with OM. Total alkaline phosphatase £ 190 U/l was significantly associated with ABD, whereas higher values were associated with OM. No correlation was observed between BV/TV and BMD. Conclusion: Low BMD is frequent in pre-dialysis CKD patients, and low turnover bone disease, manifesting as ABD and OM, was the hallmark of this bone loss.Correspondence to:
Dr. S.A. Draibe
Rua Borges Lagoa,
960 4° andar, CEP 04038-002, São Paulo, Brazil
Email: [email protected]

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