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Several factors contribute to renal-function decline in CKD patients, and the role of phosphate content in the diet is still a matter of debate. This study aims to analyze the mechanism by which phosphate, independent of protein, is associated with the progression of CKD. Adult Munich-Wistar rats were submitted to 5/6 nephrectomy (Nx), fed with a low-protein diet, and divided into two groups. Only phosphate content (low phosphate, LoP, 0.2%; high phosphate, HiP, 0.95%) differentiated diets. After sixty days, biochemical parameters and kidney histology were analyzed. The HiP group presented worse renal function, with higher levels of PTH, FGF-23, and fractional excretion of phosphate. In the histological analysis of the kidney tissue, they also showed a higher percentage of interstitial fibrosis, expression of α-actin, PCNA, and renal infiltration by macrophages. The LoP group presented higher expression of beclin-1 in renal tubule cells, a marker of autophagic flux, when compared to the HiP group. Our findings highlight the action of phosphate in the induction of kidney interstitial inflammation and fibrosis, contributing to the progression of renal disease. A possible effect of phosphate on the dysregulation of the renal cell autophagy mechanism needs further investigation with clinical studies.
Irene Duayer; Eduardo Duque; Clarice Fujihara; Ivone de Oliveira; Luciene dos Reis; Flavia Machado; Fabiana Graciolli; Vanda Jorgetti; Roberto Zatz; Rosilene Elias; Rosa Moysés. The Protein-Independent Role of Phosphate in the Progression of Chronic Kidney Disease. Toxins 2021, 13, 503 .
AMA StyleIrene Duayer, Eduardo Duque, Clarice Fujihara, Ivone de Oliveira, Luciene dos Reis, Flavia Machado, Fabiana Graciolli, Vanda Jorgetti, Roberto Zatz, Rosilene Elias, Rosa Moysés. The Protein-Independent Role of Phosphate in the Progression of Chronic Kidney Disease. Toxins. 2021; 13 (7):503.
Chicago/Turabian StyleIrene Duayer; Eduardo Duque; Clarice Fujihara; Ivone de Oliveira; Luciene dos Reis; Flavia Machado; Fabiana Graciolli; Vanda Jorgetti; Roberto Zatz; Rosilene Elias; Rosa Moysés. 2021. "The Protein-Independent Role of Phosphate in the Progression of Chronic Kidney Disease." Toxins 13, no. 7: 503.
Introduction: Body composition is critical for the evaluation of patients with Chronic Kidney Disease (CKD) and can be obtained from either multifrequency bioelectrical impedance analysis (BIA) or dual-energy absorptiometry (DXA). Although the discrepancy between the results obtained from both methods has already been described, reasons are unknown, and might be related to secondary hyperparathyroidism, which is associated with bone loss. Methods: We have evaluated 49 patients (25 males and 24 females): 20 with CKD not on dialysis and 29 on maintenance hemodialysis [18 with severe hyperparathyroidism (HD-SHPT) and 11 submitted to parathyroidectomy (HD-PTX)]. All patients underwent DXA and BIA. Results: The median age and body mass index (BMI) were 49 years and 25.6 kg/m2, respectively. Patients exhibited low bone mineral content (BMC) measured by DXA, particularly those from the HD-SHPT group. The largest BMC measurement disagreement between DXA and BIA was found in the HD-SHPT group (p=0.004). Factors independently associated with this discrepancy in BMC measurement were serum phosphate (p=0.003) and patient group (p=0.027), even after adjustments for age, BMI, and gender (adjusted r2=0.186). PTX attenuated this difference. Discussion: BIA should be interpreted with caution in patients with SHPT due to a loss of accuracy, which can compromise the interpretation of body composition.
Shirley Ferraz Crispilho; Eduardo Jorge Duque; Kalyanna Soares Bezerra; Rosa Maria R. Pereira; Vanda Jorgetti; Rosilene M. Elias; Rosa M. A. Moysés. The disparity of measuring bone mineral content using bioimpedance and dual-energy absorptiometry in the context of hyperparathyroidism. Brazilian Journal of Nephrology 2021, 43, 269 -273.
AMA StyleShirley Ferraz Crispilho, Eduardo Jorge Duque, Kalyanna Soares Bezerra, Rosa Maria R. Pereira, Vanda Jorgetti, Rosilene M. Elias, Rosa M. A. Moysés. The disparity of measuring bone mineral content using bioimpedance and dual-energy absorptiometry in the context of hyperparathyroidism. Brazilian Journal of Nephrology. 2021; 43 (2):269-273.
Chicago/Turabian StyleShirley Ferraz Crispilho; Eduardo Jorge Duque; Kalyanna Soares Bezerra; Rosa Maria R. Pereira; Vanda Jorgetti; Rosilene M. Elias; Rosa M. A. Moysés. 2021. "The disparity of measuring bone mineral content using bioimpedance and dual-energy absorptiometry in the context of hyperparathyroidism." Brazilian Journal of Nephrology 43, no. 2: 269-273.
Parathyroid hormone (PTH) has an important role in the maintenance of serum calcium levels. It activates renal 1α-hydroxylase and increases the synthesis of the active form of vitamin D (1,25[OH]2D3). PTH promotes calcium release from the bone and enhances tubular calcium resorption through direct action on these sites. Hallmarks of secondary hyperparathyroidism associated with chronic kidney disease (CKD) include increase in serum fibroblast growth factor 23 (FGF-23), reduction in renal 1,25[OH]2D3 production with a decline in its serum levels, decrease in intestinal calcium absorption, and, at later stages, hyperphosphatemia and high levels of PTH. In this paper, we aim to critically discuss severe CKD-related hyperparathyroidism, in which PTH, through calcium-dependent and -independent mechanisms, leads to harmful effects and manifestations of the uremic syndrome, such as bone loss, skin and soft tissue calcification, cardiomyopathy, immunodeficiency, impairment of erythropoiesis, increase of energy expenditure, and muscle weakness.
Eduardo J. Duque; Rosilene M. Elias; Rosa M. A. Moysés. Parathyroid Hormone: A Uremic Toxin. Toxins 2020, 12, 189 .
AMA StyleEduardo J. Duque, Rosilene M. Elias, Rosa M. A. Moysés. Parathyroid Hormone: A Uremic Toxin. Toxins. 2020; 12 (3):189.
Chicago/Turabian StyleEduardo J. Duque; Rosilene M. Elias; Rosa M. A. Moysés. 2020. "Parathyroid Hormone: A Uremic Toxin." Toxins 12, no. 3: 189.
E J Duque De Sá Carneiro Filho; L B Jorge; L Testagrossa; C Bitencourt; L Yu; Viktoria Woronik. Worse renal outcome of subclass IV-G lupus nephritis patients over IV-S. Lupus 2017, 27, 584 -590.
AMA StyleE J Duque De Sá Carneiro Filho, L B Jorge, L Testagrossa, C Bitencourt, L Yu, Viktoria Woronik. Worse renal outcome of subclass IV-G lupus nephritis patients over IV-S. Lupus. 2017; 27 (4):584-590.
Chicago/Turabian StyleE J Duque De Sá Carneiro Filho; L B Jorge; L Testagrossa; C Bitencourt; L Yu; Viktoria Woronik. 2017. "Worse renal outcome of subclass IV-G lupus nephritis patients over IV-S." Lupus 27, no. 4: 584-590.