American journal of kidney diseases : the official journal of the National Kidney Foundation
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We have previously reported that 19-nor-1,25-(OH)2D2, a new analog of 1,25-(OH)2D3, suppresses parathyroid hormone (PTH) secretion in uremic rats in the absence of hypercalcemia or hyperphosphatemia. In the current study, we examined the effect of 19-nor-1,25-(OH)2D2 on parathyroid gland growth and intestinal vitamin D receptor (VDR) content. After induction of uremia by 5/6 nephrectomy, rats were divided into five experimental groups and received intraperitoneal injections of vehicle, 1,25-(OH)2D3 (2 or 6 ng/rat), or 19-nor-1,25-(OH)2D2 (25 or 100 ng/rat) three times a week for 8 weeks. ⋯ Thus, 19-nor-1,25-(OH)2D2 appears to exert a selective action on the parathyroid glands compared with the intestine. Its low calcemic and phosphatemic properties may result from the decreased endogenous 1,25-(OH)2D3 levels that lead to a reduction in intestinal VDR. This selectivity makes this analog ideal for the treatment of secondary hyperparathyroidism.
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Review Case Reports
Calciphylaxis in a patient with Crohn's disease in the absence of end-stage renal disease.
Calciphylaxis is a rare and life-threatening condition of progressive cutaneous necrosis secondary to small and medium-sized vessel calcification previously described in patients with end-stage renal disease and hyperparathyroidism. Early diagnosis may be important in improving the poor outcome in these patients since early intervention may forestall the development of life-threatening complications. ⋯ It appears that longstanding Crohn's disease and the short-bowel syndrome accelerated the development of calciphylaxis as the chronic renal disease was not end stage. Considering the possibility of calciphylaxis in this setting may avoid delaying the diagnosis and its consequences.
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In 1993, there were 4,355 active, postresident physicians in the United States who, according to the American Medical Association (AMA) Physician Masterfile, had their primary specialty in either adult nephrology or pediatric nephrology. These renal physicians constituted 0.8% of the active postresident physician population, and there were 1.67 renal physicians for every 100,000 people in the United States. The population of renal physicians has grown at a significantly greater rate than the physician population as a whole. ⋯ The prevalence rate of end-stage renal disease (ESRD) more than doubled between 1984 and 1993, and a continuation of this trend will expand the need for more nephrologists. The long-term growth of the ESRD population will also be sustained, to some extent, by the aging of the US population, because the prevalence of ESRD is relatively high in the older age categories. However, long-term increases in the demand for nephrologists may be restricted by the growth of managed care, the use of nonphysician providers, and the implementation of other cost-cutting measures that impact the delivery of services to the ESRD population.