Abstract:
AIMS:To investigate whether increasing the daily baseline of gut calcium can cause a gradual downregulation of the active intestinal transport of calcium via reduced parathyroid hormone (PTH) mediated activation of vitamin D, and to discuss why such a mechanism might prevent calcium oxalate rich stones. To demonstrate the importance of seasonal effects upon the evaluation of such data. METHODS:Within an intensive 24 hour urine collection regimen, daily calcium supplementation (500 mg) was given to five stone formers for a 10 week period during a six month crossover study. In a further population of patients on follow up for previous renal stone disease, observations were made on 1066 24 hour urine samples collected over five years in respect of seasonal effects relevant to the interpretation of the study. RESULTS:In the group of patients on calcium supplements the following results were found. During calcium supplementation, the proportion of urine calcium to oxalate was higher (increased calcium to oxalate molar ratio), the 24 hour urine product of calcium and oxalate did not rise, and urine oxalate was lower during the first six weeks of supplementation. Twenty four hour urine calcium was 10.2% higher than baseline in the final four weeks of the 10 weeks of supplementation. Twenty four hour urine phosphate was 11.4% lower during the first six weeks of supplementation, but then rose while the patients were still on supplementation; renal tubular reabsorption of phosphate (TmP/GFR) mirrored the urine phosphate changes inversely. PTH was higher after stopping supplementation, but 1,25-(OH)2-cholecalciferol changes were not detected. In the 1066 urine samples collected over five years the following results were found. Calcium and oxalate excretion correlated positively and not inversely. Urine calcium and phosphate excretion were 5.5% and 2.5% higher, respectively, in "light" months of the year compared with "dark" months. A post summer decline in both urine calcium and urine phosphate was relevant to the interpretation of the study. CONCLUSIONS:Regular calcium supplementation does not raise the product of calcium and oxalate in urine and the proportion of oxalate to calcium is reduced. The underlying mechanisms of the changes seen in phosphate, calcium, and PTH and the observations on 1,25-(OH)2-cholecalciferol are not clear. Observed changes in phosphate could possibly be part of a calcium regulating feedback loop operating over a period of weeks. In evaluating these mechanisms background seasonal effects are important. It is possible that "programming" of the gut mucosa in terms of calcium transport is a major determinant of the relation between calcium and oxalate concentrations in urine and their relative abundance. Increased oral calcium, in association with a reduction of the relative proportion absorbed, may be pertinent to the prevention of calcium oxalate rich stones.
journal_name
J Clin Patholjournal_title
Journal of clinical pathologyauthors
Williams CP,Child DF,Hudson PR,Davies GK,Davies MG,John R,Anandaram PS,De Bolla ARdoi
10.1136/jcp.54.1.54keywords:
subject
Has Abstractpub_date
2001-01-01 00:00:00pages
54-62issue
1eissn
0021-9746issn
1472-4146journal_volume
54pub_type
临床试验,杂志文章,随机对照试验abstract::Antibodies against alpha smooth muscle actin (ASMA) and S100 protein were applied to paraffin wax embedded sections from 40 salivary gland tumours and seven normal salivary glands. The results indicate that ASMA is useful in the diagnosis of epithelial-myoepithelial carcinoma, but is otherwise only of limited use in d...
journal_title:Journal of clinical pathology
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journal_title:Journal of clinical pathology
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journal_title:Journal of clinical pathology
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journal_title:Journal of clinical pathology
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journal_title:Journal of clinical pathology
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journal_title:Journal of clinical pathology
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journal_title:Journal of clinical pathology
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journal_title:Journal of clinical pathology
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journal_title:Journal of clinical pathology
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journal_title:Journal of clinical pathology
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journal_title:Journal of clinical pathology
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