scholarly journals Problems in differential diagnosis of secondary hyperparathyroidism

2021 ◽  
Vol 38 (1) ◽  
pp. 161-167
Author(s):  
S. G. Shulkina ◽  
D. O. Sirin ◽  
E. N. Smirnova ◽  
V. G. Zhelobov ◽  
N. Yu. Kolomeets ◽  
...  
Keyword(s):  
Vitamin D ◽  
Differential Diagnosis ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Vitamin D Deficiency ◽  
Clinical Case ◽  
Kidney Diseases ◽  
Active Form ◽  
Renal Tubules ◽  
Vitamin D Metabolism

Hyperparathyroidism is an endocrine disease characterized by excessive production of parathyroid hormone in the main cells of the parathyroid glands. Depending on the cause of this disease, there are primary, secondary (SHPT) and tertiary hyperparathyroidism. The most common causes of SHPT are vitamin D deficiency and chronic kidney disease (CKD). Vitamin D is converted to its active form by hydroxylation in the renal tubules. Developmental abnormalities and chronic kidney diseases lead to atrophy of the tubular epithelial cells that causes a violation of vitamin D metabolism and the development of SHPT, which in turn are accompanied by a violation of calcium-phosphorus metabolism and a syndrome of musculoskeletal disorders. This article presents an analysis of a clinical case of a patient diagnosed secondary hyperparathyroidism against the background of vitamin D deficiency combined with polycystic kidney disease. This clinical case reflects the complexity of the differential diagnosis of the disease and the tactics of patient's management.

scholarly journals Vitamin D Metabolism and Its Role in Mineral and Bone Disorders in Chronic Kidney Disease in Humans, Dogs and Cats

Metabolites ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. 499
Author(s):  
Fernanda C. Chacar ◽  
Márcia M. Kogika ◽  
Rafael V. A. Zafalon ◽  
Marcio A. Brunetto
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Secondary Hyperparathyroidism ◽  
Vitamin D Deficiency ◽  
Comparative Studies ◽  
Mineral Metabolism ◽  
Vitamin D Metabolism ◽  
Bone Disorders

Some differences regarding Vitamin D metabolism are described in dogs and cats in comparison with humans, which may be explained by an evolutionary drive among these species. Similarly, vitamin D is one of the most important regulators of mineral metabolism in dogs and cats, as well as in humans. Mineral metabolism is intrinsically related to bone metabolism, thus disturbances in vitamin D have been implicated in the development of chronic kidney disease mineral and bone disorders (CKD-MBD) in people, in addition to dogs and cats. Vitamin D deficiency may be associated with Renal Secondary Hyperparathyroidism (RSHPT), which is the most common mineral disorder in later stages of CKD in dogs and cats. Herein, we review the peculiarities of vitamin D metabolism in these species in comparison with humans, and the role of vitamin D disturbances in the development of CKD-MBD among dogs, cats, and people. Comparative studies may offer some evidence to help further research about vitamin D metabolism and bone disorders in CKD.

scholarly journals Role of calcitriol in modulating of placental dysfunction in pregnant women with chronic kidney disease

2020 ◽  
Vol 17 (4) ◽  
pp. 493-499
Author(s):  
G. S. Manasova ◽  
N. V. Didenkul ◽  
L. V. Mnich ◽  
Z. V. Chumak ◽  
N. V. Kuzmin
Keyword(s):  
Vitamin D ◽  
Kidney Disease ◽  
Pregnant Women ◽  
Kidney Diseases ◽  
Active Form ◽  
Decisive Role ◽  
Control Group ◽  
National Academy Of Sciences ◽  
Placental Dysfunction ◽  
Group I

The pleiotropic effects of vitamin D (VD), whose active form is synthesized in the kidneys, play a certain role both in forming and functioning the feto-placental system, including various pregnancy complications. The aim of the study was to evaluate the vitamin D status in pregnant women with placental dysfunction (PD) and chronic inflammatory kidney disease (CIKD). During 24–34 pregnancy weeks, 56 pregnant women with PD were examined (main group ‒ I); 24 patients (42.85 %) had chronic pyelonephritis (group IA). The control group (group II) had 31 conditionally healthy pregnant women. The total VD level in the blood was determined by ELISA; in addition to the general clinical standard examination, the urine also underwent bacteriological examination. The VD mean level in pregnant women with PD and CIKD was significantly lower than that in the control group (31.08 ± 7.2 and 45.42 ± 9.67 ng/ml (p <0.01)). Only 33.33 % of pregnant women in group IA had a VD optimum, as well as 93.55 % (p < 0.01) in the control group and 17.86 % in group I. 8.33 % of pregnant women had a VD deficiency in group IA (RR = 2.09; CI 95 % ‒ 1.8‒2.42). The patients with a VD-deficiency were absent in the control group. 58.33 % of women in group ІА had a suboptimal VD level and 6.45% in the control group (RR = 3.57; CI 95 % ‒ 1.62‒7.88). Bacteriuria was observed in all pregnant women with a VD-deficient or suboptimal level. At the optimum VD level, bacteriuria was diagnosed twice less (χ2 = 66.67; p <0.01). In patients with an inadequate VD level, CIKD was diagnosed 3.8 times more (RR = 3.57; CI 95 % ‒ 1.62‒7.88). 494 Proceedings of the National Academy of Sciences of Belarus. Medical series, 2020, vol. 17, no. 4, pp. 493–499 A significantly calcitriol reduction in pregnant women with placental dysfunction suggests that the deficiency or the suboptimal level of vitamin D and inflammatory kidney diseases may be the interdependent processes that play a decisive role in the formation of placental dysfunction.

scholarly journals Vitamin D Metabolism Is Significantly Impaired in COVID-19 Inpatients

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A281-A282
Author(s):  
Alexandra Povaliaeva ◽  
Liudmila Ya Rozhinskaya ◽  
Ekaterina A Pigarova ◽  
Larisa K Dzeranova ◽  
Nino N Katamadze ◽  
...  
Keyword(s):  
Vitamin D ◽  
Secondary Hyperparathyroidism ◽  
Vitamin D Deficiency ◽  
Serum Calcium ◽  
Vitamin D Supplementation ◽  
Vitamin D Metabolites ◽  
Lung Involvement ◽  
Hydroxylase Activity ◽  
Vitamin D Metabolism ◽  
Vitamin D Levels

Abstract Objective: to assess the state of vitamin D metabolism in patients hospitalized with COVID-19 infection. Materials and methods: We examined 49 patients, which were hospitalized for inpatient treatment of COVID-19 infection from May to June 2020. Study group included 24 men (49%) and 25 women (51%), median age 58 years [48; 70], BMI 26.4 kg/m2 [24.3; 30.5]. All patients were diagnosed with pneumonia due to SARS-CoV-2 with median percent of lung involvement equal to 29% [14; 37], 22 patients (45%) required oxygen support upon admission. Median SpO2 was equal to 95% (92; 97), median NEWS score was equal to 3 [2; 6]. Participants were tested for vitamin D metabolites (25(OH)D3, 1,25(OH)2D3, 3-epi-25(OH)D3, 24,25(OH)2D3 and D3) by UPLC-MS/MS, free 25(OH)D and vitamin D-binding protein by ELISA, as well as PTH by electrochemiluminescence immunoassay and routine biochemical parameters of blood serum (calcium, phosphorus, albumin) at the time of admission. Results: patients had in general very low 25()D3 levels - median 10.9 ng/mL [6.9; 15.6], corresponding to a pronounced vitamin D deficiency in half of the patients. Levels of 24,25(OH)2D3 were also low – 0.5 ng/mL [0.2; 0.9], and resulting vitamin D metabolite ratios (25(OH)D3/24,25(OH)2D3) were high-normal or elevated in most patients – 24.1 [19.0; 39.2], indicating decreased activity of 24-hydroxylase. Levels of 1,25(OH)2D3, on the contrary, were high-normal or elevated - 57 pg/mL [46; 79], which, in accordance with 25(OH)D3/1,25(OH)2D3 ratio (219 [134; 266]) suggests an increase in 1α-hydroxylase activity. Median level of 3-epi-25(OH)D3 was 0.7 ng/mL [0.4; 1.0] and D3 metabolite was detectable only in 6 patients. Median DBP level was 432 mg/L [382; 498], median free 25(OH)D was 5.6 pg/mL [3.3; 6.7], median calculated free 25(OH)D was 2.0 pg/mL [1.4; 3.3]. Most patients had albumin-adjusted serum calcium level in the lower half of reference range (median 2.24 mmol/L [2.14; 2.34]). Seven patients had secondary hyperparathyroidism and one patient had primary hyperparathyroidism, the rest of the patients had PTH levels within the normal range.25(OH)D3 levels showed significant negative correlation with percent of lung involvement (r = -0.36, p&lt;0.05) and positive correlation with SpO2 (r = 0.4, p&lt;0.05). 1,25(OH)2D3 levels correlated positively with 25(OH)D3 levels (r = 0.38, p&lt;0.05) and did not correlate significantly with PTH levels (p&gt;0.05). Conclusion: Our data suggests that hospitalized patients with COVID-19 infection have significant impairment of vitamin D metabolism, in particular, an increase in 1α-hydroxylase activity, which cannot be fully explained by pre-existing conditions such as vitamin D deficiency and secondary hyperparathyroidism. The observed profound vitamin D deficiency and association of vitamin D levels with markers of disease severity indicate the importance of vitamin D supplementation in these patients.

scholarly journals A modern perspective of antiepileptic drugs effect on Vitamin D rate (reference data and clinical case)

2020 ◽  
Vol 10 (4) ◽  
pp. 193-197
Author(s):  
V.V. Povoroznyuk ◽  
Н.S. Dubetska ◽  
N.V. Zaverukha
Keyword(s):  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Antiepileptic Drugs ◽  
Sodium Valproate ◽  
Clinical Case ◽  
Young Patients ◽  
Systemic Review ◽  
Mineral Density ◽  
Vitamin D Metabolism ◽  
Patients With Epilepsy

This article presents a clinical case of the antiepileptic drug effect on the Vitamin D rate (namely, the patient has been taking Sodium Valproate for a long time) and new data from the foreign publications on this problem. It is known that there is a list of drugs that adversely affect the Vitamin D metabolism. In particular, the drugs reducing the Vitamin D absorption include drugs for the treatment of epilepsy. Antiepileptic drugs are drugs of va­rious origins that are used to prevent or reduce seizures, their corresponding conditions (loss or impairment of consciousness, behavioral and autonomic disorders, etc.), which are observed with recurrent seizures of various forms of epilepsy. The widespread use of these drugs in medical practice requires a detailed study of possible side effects of these drugs and their timely correction, as foreign sources indicate that antiepileptic drugs increase Vitamin D deficiency and worsen the symptoms of proximal myopathy, requiring mandatory medical correction; patients with epilepsy are deficient in vitamin D; сhronic Valproate therapy is associated with lower bone mineral density in young patients with epilepsy. This clinical case showed how a long-term use of Sodium Valproate led to the development of secondary systemic osteoporosis and Vitamin D deficiency, as evidenced by the results of laboratory and instrumental studies, and the discontinued antiepileptic drugs along with Vitamin D supplementation improved the general health of the patient and Vitamin D blood rates. Based on the systemic review and our own observations, it has been conclu­ded that epilepsy patients taking antiepileptic drugs should be gi­ven Vitamin D supplements to prevent the development of osteoporosis and Vitamin D deficiency.

scholarly journals PREVALENCE OF VITAMIN D DEFICIENCY INPRE-DIALYTIC CHRONIC KIDNEY DISEASE PATIENTS ATTENDING A TERTIARY CENTRE IN NORTH-EAST INDIA

2021 ◽  
Vol 9 (01) ◽  
pp. 758-763
Author(s):  
Sagar Kanta ◽  
◽  
Tridip Kumar Das ◽  
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Kidney Disease ◽  
Vitamin D Deficiency ◽  
Indian Population ◽  
Kidney Diseases ◽  
Sun Exposure ◽  
Assay Method ◽  
North East ◽  
Vitamin D Levels

Introduction: Vitamin D deficiency has not only been associated with bone and muscular complications but also with cancer, cardiovascular diseases, infection, maternal and neonatal complications. There are many causes of vitamin D deficiency including socio-demographic factors, the timing of sun exposure, along with drugs, skin, liver, and kidney diseases. India is closer to the equator so is considered to have a lower risk of Vitamin D deficiency but it is not so, with many studies implicating deficiency even in the general population. There are no studies done on the north-eastern Indian population document on vitamin D levels in Chronic Kidney Disease (CKD) patients. Aim: To study the prevalence of Vitamin D deficiency in the pre-dialytic chronic kidney disease. Material and Methods:Observational study was done. 120 CKD patients were included in the study and staging was done according to the MDRD formula. Total 25-OH Vitamin D was measured by the Enzyme Immuno Assay method. Results: 43.33% of the patients in the group were found to have vitamin D deficiency and 26.66% of patients had vitamin D insufficiency. There was a significant association between vitamin D deficiency and stages 4 and 5 CKD. There was not any significant correlation between vitamin D levels with age, sex, body mass index, serum calcium, or albumin. Conclusion:High levels of vitamin D deficiency were seen in the CKD patients of the northeast Indian population. There were statistically significant changes in vitamin D levels and stages 4 and 5 of CKD.

scholarly journals Differential diagnosis of hypercalcemia in a patient with CKD G5D

2021 ◽  
Author(s):  
A. K. Eremkina ◽  
A. M. Gorbacheva ◽  
D. V. Lisina ◽  
A. A. Povaliaeva ◽  
E. A. Pigarova ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Vitamin D ◽  
Differential Diagnosis ◽  
Secondary Hyperparathyroidism ◽  
Bone Mineralization ◽  
Intact Parathyroid Hormone ◽  
Adynamic Bone Disease ◽  
Vitamin D Metabolism ◽  
Adynamic Bone ◽  
Serum Pth

Patients with chronic kidney disease are characterized by the development of mineral disorders due to a decrease in the number of functioning nephrons. These changes manifest by the development of secondary hyperparathyroidism (the overproduction of intact parathyroid hormone (PTH) associated with the serum hypocalcemia, hyperphosphatemia), dysfunctional vitamin D metabolism, bone mineralization and also extraosseous calcifications. Decreased serum PTH levels associated with hypercalcemia are suspicious for adynamic bone disease, but at the same time requires an extended differential diagnostic search (e.g. metastatic processes). One of the rare causes of hypercalcemia is a defect in 24-hydroxylase (CYP24A1). We present a case of a patient on hemodialysis with atypical secondary hyperparathyroidism and an established CYP24A1 defect.

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