頁籤選單縮合
題 名 | Hypocalciuria in Patients with Gitelman's Syndrome: Role of Hypomagnesemia |
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作 者 | Chen, Chun-chi; Wu, Hsin-chi; Hsu, Yu-juei; Cheng, Chih-jen; Yang, Sung-sen; Chu, Pauling; Lin, Shih-hua; | 書刊名 | 臺灣腎臟醫學會雜誌 |
卷 期 | 25:2 2011.06[民100.06] |
頁 次 | 頁70-76 |
分類號 | 415.597 |
關鍵詞 | Gitelman's syndrome; Hypocalciuria; Hypomagnesemia; Hypovolemia; |
語 文 | 英文(English) |
英文摘要 | BACKGROUND: Hypocalciuria and hypomagnesemia are two characteristic findings in patients with Gitelman’s syndrome (GS). Several hypomagnesemic states with intact renal medulla in humans also have hypocalciuria, suggesting the association of hypomagnesemia with hypocalciuria. We evaluate the role of hypomagnesemia on hypocalciuria in human GS. METHODS: Twelve GS patients with thiazide-sensitive sodium-chloride cotransporter (NCC) mutations received acute magnesium sulfate (MgSO4 0.35 mmol/kg) for one hour and chronic oral magnesium oxide (MgO 37 mmol daily) for four weeks. Urine and blood were obtained for determination of electrolytes, biochemistries and hormones. Twelve age- and sex-matched healthy normotensive volunteers were enrolled as controls. RESULTS: Compared with healthy subjects, GS patients had severe hypocalciuria (FECa 0.15 ± 0.03 vs. 1.49 ± 0.23%, P < 0.05; daily urinary Ca2+ excretion 4.2 ± 1.6 vs. 50.4 ± 10.8 mmol, P < 0.05), hypomagnesemia (0.52 ± 0.1 vs. 0.85 ± 0.1 mmol/L, P < 0.05) and low intact parathyroid hormone (iPTH) (4.6 ± 2.1 vs. 34.1 ± 8.6 ng/L, P < 0.05). Acute MgSO4 infusion remarkably increased urinary Ca2+ excretion (FECa/FENa, 0.19 ± 0.11 to 3.42 ± 2.37, P < 0.05) and serum iPTH levels (4.6 ± 2.1 to 16.3 ± 5.3 ng/L, P < 0.05). Chronic MgO supplementation significantly raised serum Mg2+ and i-PTH level but not urinary Ca2+ excretion. Furthermore, four patients whose serum Mg2+ level became normal after chronic Mg2+ repletion had persistent hypocalciuria. CONCLUSION: Hypomagnesemia alone cannot explain completely the pathogenesis of hypocalciuria in patients with GS. Other mechanisms are worth further exploration for understanding the renal Ca2+ and Mg2+ handling in GS patients. |
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