Calciphylaxis is a rare, but serious disorder that is usually observed in patients with renal disease and secondary hyperparathyroidism. It is characterized by the ischemic necrosis of the skin, the underlying tissue and other organs, as well as rapid vascular calcification. Prompt diagnosis and management is required because the intractable skin necrosis sometimes causes lethal sepsis. Sevelamer hydrochloride is an ion-exchanging resin that binds phosphates in the gut without increasing the calcium load. Treatment with it may lead to less vascular calcification and better survival for patients with chronic renal disease. Herein we present a case of calciphylaxis with renal failure and the patient improved after treatment with sevelamer hydrochloride therapy.
Calciphylaxis ; Calcium ; Humans ; Hyperparathyroidism, Secondary ; Necrosis ; Phosphates ; Polyamines ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Sepsis ; Skin ; Vascular Calcification ; Sevelamer

PURPOSE: Chitin and chitosan are nontoxic natural chelators that chelate radiostrontium effectively. The purpose of this study was to compare radiostrontium chelation of chitin and chitosan with that of well known chemical chelators, namely EDTA and DTPA. MATERIALS AND METHODS: The chelaton rates of chitin, chitosan, EDTA and DTPA were compared using a column chromatography method (Sephadex G-25M, Sweden). Three kinds of chitins and four kinds of chitosans were used. All of them were water soloble. RESULTS: Phosphated chitosan showed the highest chelation yield of more than 97% at pH 7. All of chitins, chitosans, EDTA and DTPA showed chelation yield of more than 90% independent of varing pH level. CONCLUSION: Chitin and chitosan have similar chelation rate as compared with EDTA and DTPA.
Chelating Agents ; Chitin* ; Chitosan* ; Chromatography ; Edetic Acid* ; Hydrogen-Ion Concentration ; Pentetic Acid*

PURPOSE: We propose a quantitative Tc-99m diethylenetriaminepentaacetic acid (DTPA) single-photon emission computed tomography/computed tomography (SPECT/CT) for glomerular filtration rate (GFR) measurement.METHODS: Quantitative SPECT/CT data obtained at 2–3 min post-Tc-99m DTPA injection (370 MBq) were used to determine % injected doses (%IDs) for individual kidneys. The reproducibility of %ID measurement was tested and compared with planar scintigraphy. Cr-51 ethylenediaminetetraacetic acid (EDTA) GFR was used as reference standard. Nine young volunteers, representing normal GFR, and ten older volunteers, reflecting impaired GFR, were enrolled. The established GFR equation derived from these volunteerswas applied to 19 renal tumor patients post-partial nephrectomy.RESULTS: At 2–3 min, %ID was most reproducible with the highest intraclass correlation (ICC) (0.9379) and lowest % coefficient of variation (CV) (6.5259%), which were more reliable than the ICC (0.9368) and %CV (6.7689%) of planar scintigraphy. Cr-51 EDTA GFR (93.16 ± 24.81 ml/min) correlated significantly with %ID (7.66 ± 2.15%, r = 0.7906, p = 0.0001), yielding an equation: Cr-51 EDTA GFR (ml/min) = (%ID × 9.1462) + 23.0653. This equation revealed significant decreases in total and nephrectomized kidney GFR (p = 0.0012 and p < 0.0001, respectively) from preoperative to 3-month postoperative measurements.CONCLUSIONS: Quantitative Tc-99m DTPA SPECT/CT produces reliable and clinically applicable %ID estimates that translate to the GFR of individual kidneys.
Edetic Acid ; Glomerular Filtration Rate ; Humans ; Kidney ; Nephrectomy ; Pentetic Acid ; Radionuclide Imaging ; Volunteers

The present study investigated the stimulatory effects of iron (or ascorbate) on cyclosporine-induced kidney mitochondrial damage. Damaging effect of 50 muM cyclosporine plus 20 muM Fe2+ on mitochondrial lipids and proteins of rat kidney and hyaluronic acid was greater than the summation of oxidizing action of each compound alone, except sulfhydryl oxidation. Cyclosporine and 100 muM ascorbate showed an enhanced damaging effect on lipids but not on proteins. The peroxidative action of cyclosporine on lipids was enhanced with increasing concentrations of Fe2+. Ferric ion (20 muM) also interacted with cyclosporine to stimulate lipid peroxidation. Damaging action of cyclosporine on mitochondrial lipids was enhanced by ascorbate (100 muM and 1 mM). Iron chelators, DTPA and EDTA, attenuated carbonyl formation induced by cyclosporine plus ascorbate. Cyclosporine (100 muM) and 50 muM Fe2+ (or 100 muM ascorbate) synergistically stimulated degradation of 2- alpha deoxyribose. Cyclosporine (1 to 100 muM) reduced ferric ion in a dose dependent manner, which is much less than ascorbate action. Addition of Fe2+ caused a change in absorbance spectrum of cyclosporine in 230~350 nm of wavelengths. The results show that cyclosporine plus iron (or ascorbate) exerts an enhanced damaging effect on kidney mitochondria. Iron and ascorbate appear to promote the nephrotoxicity induced by cyclosporine.
Animals ; Chelating Agents ; Cyclosporine ; Deoxyribose ; Edetic Acid ; Hyaluronic Acid ; Iron* ; Kidney* ; Lipid Peroxidation ; Mitochondria* ; Pentetic Acid ; Rats

OBJECTIVE: This study was to determine the effect of different concentration of calcium in medium on the preimplantational development of zygotes and early 2-cell embryos. METHODS: Female mice of ICR strain (5~8 weeks old) were superovulated and mated with fertile males. Zygotes or early 2-cell embryos were collected by flushing the oviducts 31~32 hours after hCG injection. The embryos were cultured in various concentrations of Ca2+ in medium or with EDTA, EGTA and Ni2+. RESULT AND CONCLUSION: Treatment of high concentration of Ca2+ (3.42 mM (2X)~17.1 mM (10X) in medium didn't develop well compared to the control Low concentrations of Ca2+ (0.214 mM (1/8X)~0.855 mM (1/2X)) were deterimental to development beyond 2-cell stage. EDTA, Ca2+ chelating agent was treated with ranged concentrations of eDTA (0.014 mM~0.107 mM) to medium contaning 1.71 mM Ca2+ showed beneficial effect to development to blastocyst compared to the control. EGTA, extracellular Ca2+ chelator, was treated with ranged concentrations of EGTA (0.014~0.107 mM) to the medium contaning 1.71 mM Ca2+. There is no significant difference with the control. Ni2+ (50 micrometer), T-type Ca2+-channel blocker was treated to medium contaning low concentration of Ca2+. It overcame 2-cell block significantly. Rate of degenerated embryos decreased and developmental rate to morula and blastocyst increased more than low Ca2+ concentration alone. Further studies are needed for the overcoming effect of 2-cell block by Ni2+.
Animals ; Blastocyst ; Calcium ; Edetic Acid ; Egtazic Acid ; Embryonic Structures* ; Female ; Flushing ; Humans ; Male ; Mice* ; Morula ; Oviducts ; Zygote

Aminophylline*

OBJECTIVE: This study was conducted to investigate the different cause of pelvicectasia and its clinical outcome. The most important management of pelvicectasia consist of the early diagnosis and evaluation of the pathologic abnormalities of congenital pelvicectasia. This will help to offer the guideline on management of neonatal pelvicectasia. METHODS: We examined one hundred and seventy-one live neonates who were hospitalized and diagnosed with pelvicectasia at Soonchunhyang University Cheonan Hospital from January 2008 to December 2008. A retrospective study was carried out in these patients for last three years. Renal ultrasonography was repeated at 1 month after birth and then 3 months interval. Diuretic renal scan with (99m)Tc-labeled diethylenetriamine pentaacetic acid augmented with furosemide and voiding cystourethrogram was done after 4 to 6 weeks of first renal ultrasonography. Patients were followed-up for 1 to 30 months (average, 7.2 months). RESULTS: Pelvicectasia was postnatally detected in 171 cases (33.7%) among 507 neonates. Males were twice than females. Additional imaging studies revealed that normal kidney structure was the most common postnatal diagnosis (97.1%), followed by ureteropelvic obstruction, vesicoureteral reflux, multicystic kidney, ureteric duplication. Spontaneous regression of pelvicectasia was revealed in 165 renal units (67.6%). CONCLUSION: There are many cause of spontaneous regression in mild to moderate pelvicectasia. Urinary tract infection occurs in many neonates with pelvicectasia. Mild to moderate neonatal pelvicectasia without vesicoureteral reflux is clinically much less significant. Accordingly, close observation with serial renal ultrasonography may be sufficient.
Early Diagnosis ; Female ; Furosemide ; Humans ; Infant, Newborn ; Kidney ; Male ; Multicystic Dysplastic Kidney ; Parturition ; Pentetic Acid ; Polyamines ; Retrospective Studies ; Ureter ; Urinary Tract Infections ; Vesico-Ureteral Reflux

No abstract available.
Humans ; Polyamines*

Polyamines are non-specific marker of cellular proliferation in many malignant tumors, and it is also increase in certain benign conditions. We measured the urinary polyamines to investigate the possibility as a marker of abnormal prostate growth and the correlation with various clinical parameters. Urinary polyamine concentrations in 27 cases of symptomatic benign prostatic hyperplasia (BPH) were compared with those in 32 cases of age matched normal controls. Urinary concentration of polyamine profiles were quantitatively determined by Gas Chromatography/Nitrogen Phosphorus Detector and they were calculated by the correction of gram creatinine. The concentrations of N-acetyl putrescine, N-acetyl cadaverine, spermidine(spd), N1-acetyl spermidine, N8-acetyl spermidine, and spermine(spm) showed significant increase in BPH compared with normal control(all p<0.05). Level of serum prostate specific antigen(PSA) in BPH patients was negatively correlated with the concentration of urinary spermidine(p=0.049). And the ratio of spm/spd correlated with the level of prostate volume(p=0.046). No significant correlations was found between other clinical parameters such as age, level of hemoglobin or erythrocyte count with polyamine profiles concentration. These data suggested that urinary concentration of polyamines in BPH are elevated compared with those in normal control. Altered regulation of the biosynthesis and metabolism of spermidine and spermine may be involved in BPH.
Cadaverine ; Cell Proliferation ; Creatinine ; Erythrocyte Count ; Humans ; Metabolism ; Phosphorus ; Polyamines ; Prostate ; Prostate-Specific Antigen ; Prostatic Hyperplasia* ; Putrescine ; Spermidine ; Spermine

INTRODUCTIONSevelamer hydrochloride (Renagel) is frequently used as a second-line phosphate binder in patients on renal replacement therapy. Many studies have shown that sevelamer can improve vascular calcification, serum uric acid and low-density lipoprotein (LDL) cholesterol levels. The main objectives of this study were to assess the efficacy of sevelamer against calcium-based phosphate binders, as well as its tolerability and side-effect profile.

METHODSThis was a retrospective study that included all patients on renal replacement therapy (between 2008 and 2011) who had previously received calcium-based binders for ≥ 6 months and were subsequently switched to sevelamer. Data collected from the patients' medical records included demographics, as well as renal parameters three months prior to sevelamer treatment, and at three and six months post treatment. The study excluded patients on multiple, concomitant phosphate binders or with functioning renal transplants, and those who were noncompliant or had inadequate follow-up blood investigations.

RESULTSA total of 39 patients were included in the study. No major side effects were reported by any of the patients. There were improvements in calcium, phosphate, uric acid and LDL cholesterol levels at three and six months post-sevelamer treatment.

CONCLUSIONWe found sevelamer to be superior to calcium-based phosphate binders in reducing serum calcium, phosphate, uric acid and LDL cholesterol levels in our patient population with advanced renal bone disease. Sevelamer also appears to be well tolerated with no significant side effects.

Adult ; Bone Diseases ; complications ; Chelating Agents ; therapeutic use ; Female ; Humans ; Hypercalcemia ; drug therapy ; Hyperphosphatemia ; drug therapy ; Kidney Failure, Chronic ; drug therapy ; Male ; Middle Aged ; Phosphates ; chemistry ; Polyamines ; therapeutic use ; Renal Replacement Therapy ; methods ; Retrospective Studies ; Sevelamer ; Treatment Outcome ; Uric Acid ; blood