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Renal tubular acidosis - underrated problem?

100%
|
2012
|
vol. 59
|
issue 2
213-217
EN
Renal tubular acidosis (RTA) is a hyperchloremic metabolic acidosis characterized by a normal anion gap and normal (or near normal) glomerular filtration rate in the absence of diarrhoea. Inherited isolated forms of renal tubular acidosis are not common. However, they can also be a part of a more generalized tubule defect, like in Fanconi syndrome. In recent years more and more gene mutations have been found which are associated with RTA (mutations in the gene SLC4A4, encoding a Na+-HCO3- cotransporter (NBC-1); in the gene SLC4A1, encoding Cl-/HCO3- exchanger (AE1); in the gene ATP6B1, encoding B1 subunit of H+-ATPase; in the gene CA2 encoding carbonic anhydrase II; and others) and allow better understanding of underlying processes of bicarbonate and H+ transport. Isolated renal tubular acidosis can be frequently acquired due to use of certain drug groups, autoimmune disease or kidney transplantation. As the prevalence of acquired forms of RTA is common, new therapeutic options for the currently used supplementation of oral alkali, are awaited.
EN
Aim: Active vitamin D (1,25-dihydroxyvitamin D3), PTH, fibroblast growth factor-23 (FGF-23) and Klotho protein are key regulators of phosphate metabolism. Hyperphosphatemia and increased FGF-23 level in patients with end-stage renal disease are associated with increased morbidity and mortality. The relationships among key regulators of phosphate metabolism are still being investigated. FGF-23, the humoral factor involved in phosphate metabolism, is strongly associated with serum phosphorus level. Klotho, a transmembrane protein expressed primarily in renal tubules, functions as an obligatory co-receptor for FGF-23. The soluble form of Klotho, produced by the shedding of the transmembrane protein, is detectable in body fluids. The purpose of the study was to assess if serum soluble alpha-Klotho level was related to phosphate metabolism parameters and residual renal function (RRF) in incident peritoneal dialysis (PD) patients. Methods: Thirty-five clinically stable patients 4 to 6 weeks after the onset of PD were included in the study. For each patient, clinical and laboratory data were reviewed. Serum phosphorus concentration, urinary and peritoneal phosphate clearance, serum FGF-23 and soluble Klotho protein concentrations were determined. Results: Serum soluble alpha-Klotho was strongly negatively correlated with 24-hour diuresis (Rs = -0.55, p = 0.004) and renal phosphate clearance (Rs = -0.40, p = 0.049), but not with RRF. Conclusions: Serum soluble Klotho protein concentration is inversely related to residual diuresis and renal phosphate clearance in incident PD patients.
EN
Aim: Adiponectin and leptin are two adipokines playing important roles in the regulation of body weight, appetite, carbohydrate and lipid metabolism. In patients with chronic kidney disease (CKD) adipokines accumulate in serum due to reduced renal clearance. Since adipokines have pleiotropic actions, the adipokine balance may have an impact on peritoneal membrane transport. The aim of this study was to assess whether serum adiponectin and leptin levels were related to peritoneal transport and residual renal function (RRF) in newly started peritoneal dialysis patients. Methods: 25 clinically stable patients, 4 to 6 weeks after the onset of PD, were included in the study. For each patient clinical and laboratory data were reviewed and standard PET test was performed. Serum adiponectin and leptin concentrations were determined and leptin/adiponectin (L/A) ratio was calculated. Results: Serum adiponectin correlated negatively with weight, BMI and glucose concentration. Serum leptin and L/A ratio correlated positively with BMI. Serum adiponectin correlated positively with dialysate to plasma (D/P) creatinine ratio and ultrafiltration in PET test. Serum leptin level and L/A ratio correlated strongly negatively with peritoneal creatinine clearance. Conclusions: Serum adiponectin concentration is positively associated with baseline solute transport. Leptin concentration and L/A ratio are negatively associated with dialysis adequacy in newly started PD patients.
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