Metastatic calcinosis cutis refers to the deposition of calcium salts in normal tissue secondary to an underlying defect in calcium and/or phosphate metabolism. It commonly affects periarticular areas in patients with chronic renal failure. We report a case of a 51-year-old man with a past medical history of peritoneal dialysis for chronic renal failure, who presented with multiple yellowish nodules on his right thumb. In view of the asymptomatic non-inflamed fluctuating nodules, the differential diagnoses included bacterial, tuberculous, atypical mycobacterial, or fungal infections. Histopathological and radiological examinations revealed calcifications in the right thumb and shoulder with elevated serum phosphorus and parathyroid hormone levels. The lesions improved after the patient was switched from peritoneal dialysis to hemodialysis. We report a case of metastatic calcinosis cutis in a patient with chronic renal failure. We emphasize the importance of imaging for accurate diagnosis and follow-up of calcinosis cutis and that hemodialysis scores over peritoneal dialysis in the treatment of this condition.
Calcinosis ; Calcium ; Diagnosis ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Kidney Failure, Chronic ; Metabolism ; Middle Aged ; Parathyroid Hormone ; Peritoneal Dialysis ; Phosphorus ; Renal Dialysis ; Salts ; Shoulder ; Thumb

BACKGROUND: We investigated the associations between mineral metabolism parameters and mortality to identify optimal targets in Korean hemodialysis patients. METHODS: Among hemodialysis patients registered in the end-stage renal disease registry of the Korean Society of Nephrology between March 2012 and June 2017, those with serum calcium, phosphorus, and intact parathyroid hormone (iPTH) measured at enrollment were included. Association of serum levels of calcium, phosphorus, and iPTH with all-cause mortality was analyzed. RESULTS: Among 21,433 enrolled patients, 3,135 (14.6%) died during 24.8 ± 14.5 months of follow-up. After multivariable adjustment, patients in the first quintile of corrected calcium were associated with lower mortality (hazard ratio [HR], 0.84; 95% confidence interval [95% CI], 0.71–0.99; P = 0.003), while those in the fifth quintile were associated with higher mortality (HR, 1.39; 95% CI, 1.20–1.61; P < 0.001) compared with those in the third quintile. For phosphorus, only the lowest quintile was significantly associated with increased mortality (HR, 1.24; 95% CI, 1.08–1.43; P = 0.003). The lowest (HR, 1.18; 95% CI, 1.02–1.36; P = 0.026) and highest quintiles of iPTH (HR, 1.24; 95% CI, 1.05–1.46; P = 0.013) were associated with increased mortality. For target counts achieved according to the Kidney Disease Outcomes Quality Initiative guideline, patients who did not achieve any mineral parameter targets hadhigher mortality than those who achieved all three targets (HR, 1.37; 95% CI, 1.12–1.67; P = 0.003). CONCLUSION: In Korean hemodialysis patients, high serum calcium, low phosphorus, and high and low iPTH levels were associated with increased all-cause mortality.
Calcium ; Follow-Up Studies ; Humans ; Kidney Diseases ; Kidney Failure, Chronic* ; Metabolism ; Miners* ; Mortality* ; Nephrology ; Parathyroid Hormone ; Phosphorus ; Renal Dialysis*

OBJECTIVE: Autism spectrum disorder (ASD) is a complex neurodevelopmental syndrome with an increasingly prevalent etiology, yet not fully understood. It has been thought that vitamin D, complex B vitamin levels and homocysteine are associated with environmental factors and are important in ASD. The aim of this study was to examine serum vitamin D, vitamin D receptor (VDR), homocysteine, vitamin B6, vitamin B12 and folate levels in ASD. METHODS: In this study, serum vitamin D and VDR, homocysteine, vitamins B6, B12 and folate levels were determined in 60 patients with ASD (aged 3 to 12 years) and in 45 age-gender matched healthy controls. In addition, calcium, phosphorus and alkaline phosphatase, which are associated with vitamin D metabolism, were measured from serum in both groups. ASD severity was evaluted by the Childhood Autism Rating Scale (CARS). RESULTS: Serum vitamin D and VDR were substantially reduced in patients with ASD in comparision to control group. However, homocysteine level was significantly higher and vitamin B6, vitamin B12 and folate were also reduced in patients with ASD. Total CARS score showed a positive association with homocysteine and a negative correlation with vitamins D, B6, B12, folate and VDR. CONCLUSION: This comprehensive study, which examines many parameters has shown that low serum levels of vitamins D, B6, B12, folate and VDR as well as high homocysteine are important in the etiopathogenesis of ASD. However, further studies are required to define the precise mechanism(s) of these parameters and their contributions to the etiology and treatment of ASD.
Alkaline Phosphatase ; Autism Spectrum Disorder* ; Autistic Disorder* ; Calcium ; Child* ; Folic Acid ; Homocysteine ; Humans ; Metabolism ; Phosphorus ; Receptors, Calcitriol* ; Vitamin B 12 ; Vitamin B 6 ; Vitamin D* ; Vitamins*

Background: Hyperphosphatemia is a risk factor associated with mortality in patients on maintenance hemodialysis. Gut absorption of phosphate is the major source. Recent studies indicated that the intestinal flora of uremic patients changed a lot compared with the healthy population, and phosphorus is an essential element of bacterial survival and reproduction. The purpose of this study was to explore the role of intestinal microbiota in phosphorus metabolism. Methods: A prospective self-control study was performed from October 2015 to January 2016. Microbial DNA was isolated from the stools of 20 healthy controls and 21 maintenance hemodialysis patients. Fourteen out of the 21 patients were treated with lanthanum carbonate for 12 weeks. Thus, stools were also collected before and after the treatment. The bacterial composition was analyzed based on 16S ribosomal RNA pyrosequencing. Bioinformatics tools, including sequence alignment, abundance profiling, and taxonomic diversity, were used in microbiome data analyses. Correlations between genera and the serum phosphorus were detected with Pearson's correlation. For visualization of the internal interactions and further measurement of the microbial community, SparCC was used to calculate the Spearman correlation coefficient with the corresponding P value between each two genera. Results: Thirteen genera closely correlated with serum phosphorus and the correlation coefficient was above 0.4 (P < 0.05). We also found that 58 bacterial operational taxonomic units (OTUs) were significantly different and more decreased OTUs were identified and seven genera (P < 0.05) were obviously reduced after using the phosphate binder. Meanwhile, the microbial richness and diversity presented downward trend in hemodialysis patients compared with healthy controls and more downward trend after phosphorus reduction. The co-occurrence network of genera revealed that the network complexity of hemodialysis patients was significantly higher than that of controls, whereas treatment with lanthanum carbonate reduced the network complexity. Conclusions Gut flora related to phosphorus metabolism in hemodialysis patients, and improving intestinal microbiota may regulate the absorption of phosphate in the intestine. The use of phosphate binder lanthanum carbonate leads to a tendency of decreasing microbial diversity and lower network complexity.
Child ; Female ; Gastrointestinal Microbiome ; drug effects ; physiology ; Humans ; Lanthanum ; therapeutic use ; Male ; Middle Aged ; Phosphorus ; metabolism ; Prospective Studies ; Renal Dialysis ; Risk Factors ; Uremia ; drug therapy ; metabolism ; microbiology

PURPOSE: This randomized control trial was designed to examine the effect on the self-managing ability for promoting bone health of mobile typeebone health intervention (mobile typeeBHI). METHODS: The mobile typeeBHI consisted of amobile application called “Strong bone, Fit body” (SbFb) and group education. A total of 82 college women with low bone mass (Z score <−1) participated. They were assigned randomly to three groups, experimental group I, (n = 28), experimental group II (n = 32), and control group (n = 22). This study ran from June 2014 to January 2015. The outcome variables were bone mineral density, minerals related to bone metabolism (calcium, phosphorus, vitamin D), biochemical markers related to bone remodeling (osteocalcin, C-terminal telopeptide, sclerostin), food intake diary by 24 hours recall, and psychosocial variables related to bone health (knowledge, health belief and selfefficacy). Data were analyzed using SAS program and a computer aided nutritional analysis program. RESULTS: Both the experimental group I, who used mobile typeeBHI, and experimental group II, who only received group education, showed outcomes regarding knowledge of the benefits of exercise and calcium as compared with the control group. The two experimental groups also demonstrated results in the serum levels of calcium, vitamin D, and sclerostin compared to those of the control group. CONCLUSION: Although both experimental groups exhibited positive outcomes in regards to the promotion of bone health, this study did not show an additional effect of the mobile application on selfmanagement ability for the promotion of bone health. Nonetheless, the SbFb application is very meaningful as it is the first application developed with the aim of improving women's bone health.
Biomarkers ; Bone Density ; Bone Remodeling ; Calcium ; Eating ; Education ; Female ; Humans ; Metabolism ; Minerals ; Miners ; Mobile Applications ; Nutrition Assessment ; Phosphorus ; Vitamin D ; Vitamins ; Young Adult*

BACKGROUND: Endothelial adhesion molecule expression induced by pro-inflammatory cytokine plays an important role in vascular endothelial cell injury, leading to vascular disease. Allium tuberosum (AT), which is used as a functional food, has a thrombolytic effect. It contains vitamin A, vitamin C, carbohydrate, calcium, iron, and phosphorus. There are many carotenes that turn into vitamin A in the body. Also, it helps blood circulation and stimulates metabolism. The purpose of the this study was to estimate the anti-inflammatory effects of the AT extract. METHODS: Human vascular endothelial cells were pre-treated with 100 μg/mL AT extract for 30 minutes and subsequently co-treated with TNF-α (10 ng/mL) and AT extract (100 μg/mL) for 1, 4, and 6 hours. After treatment, the cells were lysed and used for quantitative reverse transcription PCR, Western blot analysis, and monocyte adhesion assay. RESULTS: We examined the effect of the AT extract on inflammatory gene expression in TNF-α-induced human umbilical vein endothelial cells (HUVECs). The extract reduced the expression levels of mRNA and protein of intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1 in TNF-α-stimulated HUVECs. It also inhibited the TNF-α-induced phosphorylation of the NF-κB p65 subunit and degradation of IκBα. Furthermore, the AT extract prevented the increased adhesion capacity of monocyte to TNF-α-stimulated vascular endothelial cells by reducing ICAM-1 and VCAM-1 expression. CONCLUSIONS: The AT extract has preventive and anti-inflammatory effect against vascular disease and has potential for supporting prevention against the early process of atherosclerosis.
Allium* ; Ascorbic Acid ; Atherosclerosis ; Blood Circulation ; Blotting, Western ; Calcium ; Carotenoids ; Chive* ; Endothelial Cells* ; Functional Food ; Gene Expression ; Human Umbilical Vein Endothelial Cells ; Humans* ; Inflammation* ; Intercellular Adhesion Molecule-1 ; Iron ; Metabolism ; Monocytes ; Necrosis* ; NF-kappa B ; Phosphorus ; Phosphorylation ; Polymerase Chain Reaction ; Reverse Transcription ; RNA, Messenger ; Vascular Cell Adhesion Molecule-1 ; Vascular Diseases ; Vitamin A

BACKGROUNDMineral and bone disorder (MBD), especially hyperphosphatemia, is an independently risk factor for adverse prognosis in patients with chronic kidney disease (CKD). However, CKD-MBD among Chinese population was poorly studied. This study aimed to investigate the status of MBD and its association with cardiovascular parameters in Chinese patients with predialysis CKD.

METHODSChinese Cohort Study of Chronic Kidney Disease (C-STRIDE) is a prospective multicenter cohort study involving predialysis CKD patients in China. Markers of MBD, including serum phosphorus, calcium, and intact parathyroid hormone, were measured in baseline samples at the patients' entry. The association between serum phosphorus and abdominal aortic calcification (AAC), left ventricular hypertrophy (LVH) were examined by logistic regression models.

RESULTSAltogether 3194 predialysis patients with mean estimated glomerular filtration of 51.8 ± 33.1 ml.min-1.1.73 m-2 were included. The proportion of patients with hyperphosphatemia were 2.6%, 2.9%, 6.8%, and 27.1% in CKD Stages 3a, 3b, 4, and 5, respectively. Moreover, 71.6% of the patients with hyperphosphatemia did not receive any phosphate-binder (PB). Lateral abdominal X-rays were obtained in 2280 patients, 9.8% of the patients were diagnosed as having AAC. Altogether 2219 patients had data of echocardiography, and 13.2% of them were diagnosed with LVH. Multivariate logistic regression analysis showed that serum phosphorus was independently associated with the presence of AAC and LVH.

CONCLUSIONSIn Chinese patients with CKD, the percentage of hyperphosphatemia is comparable to that of other countries while the usage of PBs is suboptimal. The prevalence of vascular calcification in Chinese patients is relatively lower compared with the Caucasian population.

Adolescent ; Adult ; Aged ; China ; Chronic Kidney Disease-Mineral and Bone Disorder ; blood ; metabolism ; physiopathology ; Female ; Glomerular Filtration Rate ; physiology ; Humans ; Hyperphosphatemia ; blood ; metabolism ; physiopathology ; Hypertrophy, Left Ventricular ; blood ; metabolism ; physiopathology ; Logistic Models ; Male ; Middle Aged ; Phosphorus ; blood ; Prospective Studies ; Renal Insufficiency, Chronic ; blood ; metabolism ; physiopathology ; Vascular Calcification ; blood ; metabolism ; physiopathology ; Young Adult

With the population aging and declining incidence of rheumatic heart disease, calcific aortic valve disease (CAVD) has become the most frequent valve disease and the common cause of aortic valve replacement. Patients with CAVD need to cope with a deteriorating quality of life and valve replacement is the only effective clinical option for the patients. Therefore, early pharmacotherapy is of great significance in prevention or slow-down of the progression of CAVD. For years CAVD was considered to be a passive wear and tear process of valves, but now it is recognized as an active and multi-factorial process. Histopathologic studies have revealed that inflammation, disorder of calcium and phosphorus metabolism and dyslipidemia are involved in the process of CAVD. Clinical trials of CAVD pharmacotherapy have been carried out based on those histopathologic studies. Statin, renin-angiotensin inhibitors and anti-osteoporosis drug are well studied in recent years. This article reviews the recent research progress of the pharmacotherapy for CAVD.
Angiotensin Receptor Antagonists ; therapeutic use ; Angiotensin-Converting Enzyme Inhibitors ; therapeutic use ; Aortic Valve ; pathology ; Aortic Valve Stenosis ; complications ; drug therapy ; etiology ; Calcinosis ; complications ; drug therapy ; etiology ; Calcium Metabolism Disorders ; complications ; Disease Progression ; Dyslipidemias ; complications ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; therapeutic use ; Inflammation ; complications ; Phosphorus Metabolism Disorders ; complications ; Quality of Life

Calcium is an essential nutrient that is necessary for many functions in human health. Calcium is the most abundant mineral in the body with 99% found in teeth and bone. Only 1% is found in serum. The serum calcium level is tightly monitored to remain within normal range by a complex metabolic process. Calcium metabolism involves other nutrients including protein, vitamin D, and phosphorus. Bone formation and maintenance is a lifelong process. Early attention to strong bones in childhood and adulthood will provide more stable bone mass during the aging years. Research has shown that adequate calcium intake can reduce the risk of fractures, osteoporosis, and diabetes in some populations. The dietary requirements of calcium and other collaborative nutrients vary slightly around the world. Lactose intolerance due to lactase deficiency is a common cause of low calcium intake. Strategies will be discussed for addressing this potential barrier to adequate intake. The purpose of this narrative review is a) to examine the role of calcium in human health, b) to compare nutrient requirements for calcium across lifecycle groups and global populations, c) to review relationships between calcium intake, chronic disease risk, and fractures, and d) to discuss strategies to address diet deficiencies and lactose intolerance.
Aging* ; Calcium* ; Chronic Disease ; Diet ; Humans ; Lactase ; Lactose Intolerance ; Metabolism ; Nutritional Requirements ; Osteogenesis ; Osteoporosis ; Phosphorus ; Reference Values ; Tooth ; Vitamin D

PURPOSE: In addition to regulating calcium and phosphorus homeostasis and bone metabolism, vitamin D is known as an immune modulator. Recently, there has been increased worldwide interest in the association between low levels of vitamin D and allergic diseases. The purpose of this study was to assess the relationship between serum vitamin D levels and allergic/vasomotor rhinitis (AR/VR) in children. METHODS: This study included 164 patients. The sample included 59 patients with AR, 42 patients with VR, and 63 controls. Their ages ranged from 0 to 16 years. We examined the levels of 25-hydroxyvitamin D, Immunoglobulin E, specific IgE, and eosinophil cationic protein; peripheral blood eosinophil count; and the results of a skin prick test. RESULTS: Serum 25-hydroxyvitamin D levels were 19.0+/-8.5 ng/mL in the AR group, 25.5+/-10.9 ng/mL in the VR group, and 26.9+/-10.7 ng/mL in the control group. After adjustment for body mass index and season at the time of blood sampling, vitamin D levels in the AR group were lower than those of the VR group (P=0.003) and control group (P<0.001). Vitamin D levels were inversely correlated with Immunoglobulin E levels (r=-0.317, P<0.001). AR patients with food allergy or atopic dermatitis did not have lower levels of 25-hydroxyvitamin D than AR patients without these diseases. CONCLUSION: This study demonstrates a possible relationship between vitamin D levels and allergic rhinitis in Korean children.
Body Mass Index ; Calcium ; Child* ; Dermatitis, Atopic ; Eosinophil Cationic Protein ; Eosinophils ; Food Hypersensitivity ; Homeostasis ; Humans ; Immunoglobulin E ; Immunoglobulins ; Metabolism ; Phosphorus ; Rhinitis ; Rhinitis, Vasomotor* ; Seasons ; Skin ; Vitamin D* ; Vitamins*