Fibroblast growth factor 23 production in bone is directly regulated by 1{alpha},25-dihydroxyvitamin D, but not PTH.

Fibroblast growth factor 23 (FGF23), which is primarily produced by osteocytes in bone, regulates renal phosphate excretion and 1α,25-dihydroxyvitamin D [1,25(OH)(2)D(3)] metabolism. Patients with chronic kidney disease (CKD) have increased levels of circulating serum FGF23, but the direct effect on circulating FGF23 levels in renal insufficiency is still unclear. To identify the major regulator of FGF23 synthesis in renal insufficiency, we compared the effect of parathyroid hormone (PTH) and 1,25(OH)(2)D(3) on FGF23 synthesis in the calvariae of normal rats with that of uremic rats in vitro.

[Secondary osteoporosis UPDATE. Therapy for bone-mineral disease in CKD-5D patients].

Recently, much of the attention given to bone-mineral disorder as the prognostic factor for mortality has focused on their links to chronic kidney disease (CKD-MBD; chronic kidney disease-mineral bone disease), especially in dialysis patients. Bone disease in dialysis patients showed heterogeneity caused by multiple factors other than postmenopausal osteoporosis. Evaluation of the bone mineral density with DEXA and the bone metabolic markers becomes useless for the assessment of bone fragility in dialysis patients.

[Phosphate binder up to date].

It has become clear that hyperphosphatemia is the major risk factor on the patients' survival undergoing regular renal replacement therapy. One of the mechanism of this impact on survival is ectopic calcification like vascular calcification. The standard therapy for hyperphosphatemia is phosphate removal by renal replacement therapy.

[Enhanced expression of EGFR, TGF-alpha, EGF in hyperplastic parathyroid glands in established stage of renal failure in rats].

It was reported that the parathyroid gland hyperplasia correlated with enhanced co-expression of TGF-alpha and its receptor EGFR at early stages of renal failure. This time, we investigated the time course for EGFR and its ligands, TGF-alpha, and EFG expression, and the influence of high-phosphorus (P) diet to EGFR and EGF expression, and the effect of EGFR-tyrosine kinase inhibitor (Gefitinib, [IRESSA; AstraZeneca]; TKI) in rat PTGs with established stage of renal failure. The levels of EGFR, EGF, TGF-alpha mRNA in rat PTGs were increased for the time periods.

Symptomatic bradycardia probably due to tizanidine hydrochloride in a chronic hemodialysis patient.

A 71-year-old woman was admitted to the Wakayama Medical University Hospital with dizziness and loss of body balance. She had started hemodialysis at the age of 70. During the 33 days before admission, she received oral tizanidine hydrochloride at 3 mg/day for leg cramps.

[The new trend on the treatment of secondary hyperparathyroidism].

Recently various treatments for secondary hyperparathyroidism were developed. Those include a cation polymer as phosphate binder, active metabolite of vitamin D and its analogue, and various kinds of calcimimetics as Ca-sensing receptor agonist. For the secondary hyperparathyroidism refractory to those medication, direct injection of ethanol or vitamin D and its analogue is considered.

[Outlines of K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease].

Recently "K/DOQI Clinical Practice Guidelines for Bone Metabolism and Disease in Chronic Kidney Disease" was published. It consists of sixteen precise guidelines which cover the wide range of this field. It is expected that these guidelines contribute ESRD treatment in Japan in spite of some differences in medical practice for dialysis therapy between Japan and the United States.

Effect of beta(2)-microglobulin adsorption column on dialysis-related amyloidosis.

Background: beta2-microglobulin (beta2-m) is considered a major pathogenic factor in dialysis-related amyloidosis (DRA), often seen in long-term dialysis patients. No effective therapy for this severely debilitating disease is currently available. Lixelle, an adsorption column, has been developed for the elimination of beta2-m; the efficacy of this column has been evaluated in this study.