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Both corticosteroids and bisphosphonates effectively duced decreases in serum phosphorus potentially contribute treat hypercalcemia in vitamin D intoxication. The latter result after one year showed that 12 patients developed normal or suggests that calcitriol treatment may have decreased the 662 Nefrologia 2014;34(5):658-69 Barton S. Serum calcium and bone revisiones bone formation rate similar to results seen in intestinal-spe be a major contributor to hypercalcemia. Treatment with normal saline improves renal um dialysis in the first study, serum calcium, which started at function by correcting the decreased extracellular volume, 10. After which in turn, increases renal excretion of calcium lower calcitriol treatment, despite a similar starting serum calcium con ing serum calcium. As a result, the supersaturated bone re centration, serum calcium decreased to less than 8mg/dL after leases more calcium for several reasons. Studies with the high an increasing calcium gradient between bone and blood, calcium dialysate showed marked differences in bone buffering reduced serum phosphorus from improved renal function, of calcium. Such actions could account for the enhanced cal ol treatment, serum calcium increased to 12. When dialysis studies were repeated after calcitriol may occur during the hypercalcemia of vitamin D intox had been stopped for 6 weeks, results were similar to those ication is the report of increased bone mineral density in before calcitriol was started (Figure 3). In the first ment was present due to high dialysate calcium, the use of study it could be argued that the decrease in osteoblasts and calcium-based phosphate binders, and intermittent or contin osteoclasts, which reflects bone remodeling, is different from ual hypercalcemia. In the dialysis patients, calcitriol administration and patients with vitamin D intoxication In dialysis patients, was intermittent in contrast to continuously elevated, endog calcitriol treatment reduced calcium efflux from bone during enous 1,25D values. In the dialysis patients, hypercalcemia and Nefrologia 2014;34(5):658-69 663 Barton S. In the reported dialysis patient,64 all in vitro and animal studies have shown that the calcemic increases in serum calcium were not seen with calcitriol treat effect of paricalcitol is less than that of calcitriol. A summary of the dis calcification has been seen with paricalcitol than with cal cussion on 1,25D and bone is provided Table 3. Both agents have been used for the past 10 to 15 roidism in the uremic animals and dialysis patient. Because years for the treatment of hyperparathyroidism in dialysis pa of its calcimimetic activity, hypocalcemia generally develops 664 Nefrologia 2014;34(5):658-69 Barton S. Calcitriol and calcium efflux from bone factor binding proteins 4 and 5 respectively, are altered and may contribute to abnormal osteoblast proliferation.

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If symptoms persist or worsen, patients should be instructed to consult a physician before continuing treatment [see Warnings and Precautions (5. Potential manifestations of hypocalcemia include paresthesias, myalgias, muscle cramping, tetany, and convulsions. Serum calcium should be measured within 1 week after initiation or dose adjustment of Sensipar. Treatment should be reinitiated using the next lowest dose of Sensipar [see Dosage and Administration (2. Less than 1% of patients in each group permanently discontinued study drug due to hypocalcemia. Therefore, serum calcium levels should be closely monitored in patients receiving Sensipar, particularly in patients with a history of a seizure disorder [see Warnings and Precautions (5. One clinical study evaluated bone histomorphometry in patients treated with Sensipar for 1 year. In patients with end-stage renal disease, testosterone levels are often below the normal range. The most frequently reported adverse reactions in the Sensipar group were nausea, vomiting, and diarrhea. Adverse Reaction Incidence (5%) in Patients on Dialysis Placebo Sensipar (n = 470) (n = 656) Event*: (%) (%) Nausea 19 31 Vomiting 15 27 Diarrhea 20 21 Myalgia 14 15 Dizziness 8 10 Hypertension 5 7 Asthenia 4 7 Anorexia 4 6 Pain Chest, Non-Cardiac 4 6 Access Infection 4 5 *Included are events that were reported at a greater incidence in the Sensipar group than in the placebo group. The most frequent adverse reactions and the most frequent cause of withdrawal in these patient populations were nausea and vomiting. Causes of death were cardiovascular (5 patients), multi-organ failure (1 patient), gastrointestinal hemorrhage (1 patient) and metastatic carcinoma (1 patient). Isolated, idiosyncratic cases of hypotension, worsening heart failure, and/or arrhythmia have been reported in Sensipar-treated patients with impaired cardiac function in postmarketing safety surveillance. Reductions in maternal food consumption and body weight gain were seen at doses of 12 and 25 mg/kg/day. Sensipar should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Considering these data in rats, and because many drugs are excreted in human milk and there is a potential for clinically significant adverse reactions in infants who ingest Sensipar, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the lactating woman. No differences in the safety and efficacy of Sensipar were observed in patients greater or less than 65 years of age. No dosage adjustment is required for geriatric patients [see Clinical Pharmacology (12. In the event of overdosage, patients should be monitored for signs and symptoms of hypocalcemia and appropriate measures taken to correct serum calcium levels [see Warnings and Precautions (5. The R-enantiomer is the more potent enantiomer and has been shown to be responsible for pharmacodynamic activity. The hydrochloride salt of cinacalcet is a white to off-white, crystalline solid that is soluble in methanol or 95% ethanol and slightly soluble in water.

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Potwierdzeniem tego sie pojawic rowniez w przebiegu niektorych schorzen, ta jest stwierdzenie dwukrotnie mniejszego rozszerzenia na kich jak niewydolnosc nerek, nowotwory (glownie jajni czyn wywolanego przekrwieniem w grupie osob z hiper ka, sutka, trzustki), bialaczka limfoblastyczna, niedoczyn homocysteinemia [56]. Nadmiar Hcy dziala tez mitogennie, pobudzajac prolifera Stwierdzono, ze hiperhomocysteinemia wystepuje row cje miesni gladkich tetnic i gromadzenie kolagenu w scia niez u chorych z zespolem Cushinga, a stezenie jej jest nie naczynia [54]. Badacze suge Podwyzszone stezenie Hcy ma takze dzialanie trombogen ruja, ze byc moze zwiekszone ryzyko zakrzepowo-zatoro ne. Hcy obniza tez zdolnosc wiazania mie Stezenie Hcy wzrasta po podaniu lekow wplywajacych an dzy tkankowym aktywatorem plazminogenu a komorka tagonistycznie na wchlanianie i metabolizm kwasu folio mi srodblonka [43]. Inne leki podwyzszajace stezenie Hcy to: sprzyjaja zapoczatkowaniu i przyspieszaniu rozwoju miaz cyklosporyna, aminoglutetymid, L-dopa, braty, niektore dzycy oraz procesom zakrzepowo-zatorowym. Jest wyzsze u mezczyzn szkodliwego dzialania ogolnego ani na naczynia krwiono i u kobiet po menopauzie niz u kobiet w okresie rozrod sne, a dopiero jej nadmiar dziala aterogenne i prokogula czym [4,20,44,69]. Molekularne mechanizmy patogennego dzialania hormonow plciowych na metabolizm Hcy. Wiekszosc ba hiperhomocysteinemii na uklad krazenia nie zostaly jesz daczy potwierdzila, ze po menopauzie stezenie Hcy wzrasta cze calkowicie poznane. Niektorzy dziela je na mechani znaczaco w stosunku do stwierdzanego u kobiet premeno zmy aterogenne i trombogenne [44]. Nie stwierdzono jednak znaczacej odbywa sie prawdopodobnie glownie poprzez mechanizm statystycznie korelacji miedzy stezeniem estrogenow a ste wolnorodnikowy. Z badan in vitro wiadomo, ze Hcy po zeniem Hcy, co moze wskazywac, ze hormony plciowe je budza wytwarzanie wolnych rodnikow tlenowych (w. Niektorzy autorzy kwestionuja, aby istniala jaka 385 Postepy Hig Med Dosw (online), 2004; tom 58: 381-389 kolwiek zaleznosc miedzy stezeniem estrogenow a steze li, ze rowniez niskodawkowa terapia estrogenowa w postaci niem Hcy. Autorzy nie obserwowa nopauzie i 26 premenopauzalnych, nie wykazali istotnej li obnizenia stezenia Hcy podczas stosowania estradiolu roznicy w srednim stezeniu Hcy pomiedzy tymi grupami przezskornie [50]. Nie stwierdzili takze wplywu leczenia estradiolem i estro-progestagenami na stezenie Hcy. Inni badacze rowniez stwierdzili spadek stezenia Hcy, kto ry wynosil az 12,6% po podaniu niskodawkowej terapii es Niektorzy twierdza, ze wzrost stezenia Hcy jest zalezny trogenowej wraz z dydrogesteronem [32]. Dane na temat wplywu estradiolu podawanego przez Badajac zwiazek miedzy stezeniem estrogenow a stezeniem skornie na stezenie Hcy sa nieliczne i niejednoznaczne. Dolaczenie progestagenu do tej terapii pach byly rozne, co mozna wiazac z roznymi sposobami te nasilalo nieznacznie obnizanie stezenie Hcy uzyskane po rapii hormonalnej. Dotad zbadano wplyw tylko kilku rodzajow hormonalnej terapii Analiza wynikow cytowanych prac wskazuje, ze spadek na stezenie Hcy. Najczesciej oceniano wplyw preparatow stezenia Hcy jest wiekszy po leczeniu estradiolem niz po estrogenowych i estro-progestagenowych podawanych do skoniugowanych estrogenach konskich, ktore sa mieszanina ustnie [11,67,69].