Hydrochlorothiazide and diabetes side effects

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Urinary calcium excretion expressed as the ratio of calcium to creatinine reached its lowest value after 2 weeks. It was still below the initial value at the end of the 3rd month of treatment 0.

A significant rise in the total serum cholesterol level 4. The risks and benefits of the thiazide therapy should be considered before starting long-term treatment of children with hypercalciuria and haematuria or renal stone disease.

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Key words: Hypercalciuria - Thiazide - Cholesterol Lipoproteins Introduction Elevated urinary calcium excretion is regarded as one of the main causes of calcium nephrolithiasis. The connection between hypercalciuria and post-glomerular haematuria has been described in children and adults [ 1 - 4]. Haematutic episodes due to hypercalciuria may, with years, precede the development of overt nephrolithiasis []. Further-; Correspondence to: G. According to the type of hypercalciuria, different diets low-calcium, low-calcium and low-sodium and thiazide diuretics are used to diminish urinary calcium excretion [].

Thiazides are considered the treatment of choice in adult patients with renal hypercalciuria, but they are also effective in patients with normocalciuric calcium nephrolithiasis [ 7 - 911]. The decrease in urinary calcium excretion using hydrochlorothiazides HCTs could result in an increased bone mineral content []. In a previous study, we investigated the short-term effect of H C T on calcium excretion and haematuria in hypercalciuric children [11].

The potential side effects of longterm treatment in paediatric patients are yet hydrochlorothiazide and diabetes side effects be considered. The effects of thiazides on the serum cholesterol level are well known, although somewhat contradictory. A wide range of individual responses is described, depending in part on the dose and the duration of the medication administered [].

The aim of the present study was to evaluate the effects of a 3-month thiazide treatment on the urinary calcium excretion, and the changes in the serum lipid fractions in children with hypercalciuria of renal subtype.

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Patients and methods Fifteen children 6 girls, 9 boys with renal hypercalciuriaparticipated in the study. The mean age was 7.

All children were previously evaluated because of haematuria of post-glomemlar origin. The post-glomerular nature of the haematuria was proven by examination of urinary red cell morphology using Opton phase-contrast microscopy [10, 21]. Microscopic haematuria was defined as five or more red cells per high power field [10].

They were correspondingly classified as having renal hypercalciuria [10, 1t]. The presence of renal stone disease was excluded by renal ultrasound examination [ 10, 11].

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The study included three periods. During the first 4 weeks, all previous treatments and diets were stopped. At the end of the period a h timed urine collection was performed and a blood sample taken.

At the end of the 2nd week, a h urine collection was performed to evaluate the short-term effect of thiazide on urinary calcium excretion. During the third period, thiazide and potassium citrate were continued.

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At the end of the 3rd month a blood sample was taken and a h urine collection performed. The diet was supervised by the clinical dietician.

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There was no formal restriction of sodium, but the parents were instructed how to avoid excessive salt intake. The parents were instructed to supervise the children's medication to avoid possible non-compliance. All serum and urine samples were evaluated for calcium, phosphate, sodium, potassium and uric acid with routine laboratory methods on a Hydrochlorothiazide and diabetes side effects RA Autoanalyser.

The serum lipoprotein fractions were separated as previously described: following successive precipitation with sodium dodecyl sulphate, polyethylene glycol PEG 20 and ultracentrifugation, the cholesterol and cholesterol ester content of the different fractions were determined enzymatically SeraPak, ReanalMiles [23 ].

The presence of haematuria was evaluated after 2 weeks and at the end of the 3rd month by microscopic urinalysis described earlier [10, 21]. Student's t-test for paired data was used for statistical analysis. Informed consent was obtained from the parents of the patients. The study was approved by the local ethics committee. A significant increase in the total cholesterol and L D L cholesterol level was observed.

A slight d e c r e a s e in H D L cholesterol also occurred, but the changes were not significant. There was no correlation b e t w e e n the urinary calc i u m excretion and the changes in s e r u m lipids. Table 1.

F o u r patients h a d episodes o f gross h a e m a t u r i a during the first 4 - w e e k period; 2 o f these children h a d further episodes o f gross h a e m a t u r i a 1 w e e k after initiation o f thiazide treatment. T h e r e were no statistically significant changes in s e r u m calcium, phosphate, sodium, p o t a s s i u m and uric acid levels and fasting b l o o d glucose.

N o statistically significant changes in b o d y w e i g h t were noted during the study. On clinical e x a m i n a t i o n no rashes were observed. Discussion T h i a z i d e diuretics are w i d e l y u s e d in adult patients with nephrolithiasis ]7, 8, 28]. Table 2.

Total serum cholesterol T. Some o f the most important are potassium wasting, uric acid retention, elevated blood glucose levels and changes in the composition of the serum lipoproteins. The data on lipid changes are based principally on observations in patients treated for hypertension.

The real consequences of these changes are controversial. The tendency towards unfavourable lipid profiles is established, but high individual variability is observed.

Thus the real biological meaning o f the data has not yet been clarified [ 1 5 - 2 0 ]. In the present study o f children with renal hypercalciuria, H C T was highly effective in diminishing calcium excretion at the end of the first 2-week period. All but 3 patients still had normal calcium excretion at the end of the 3-month period. Haematuria disappeared in all patients with normal calcium excretion. This close relationship between haematuria and hypercalciuria is in full accord with our previous results [11] and more recent findings in adult patients with hypercalciuria [4].

The hypocalciuric effect of thiazides is complex.

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Initially extracellular volume a cukorbetegség kezelése szentpéterváron occurs. The resulting elevated distal sodium load stimulates sodium and calcium reabsorbtion in the distal tubule [29]. In contrast, thiazides m a y potentiate the effect of parathyroid h o r m o n e on the distal tubules. A direct effect of thiazides on the distal tubule is also discussed [8].

Absztrakt:

The decrease in the hypocalciuric effect observed in this study m a y be attributed to the counter-regulation o f the volume-depleting effect o f the drug. In our study a clear increase in total serum cholesterol was observed after 3 months of H C T treatment. Changes in serum triglycerides, serum potassium, uric hydrochlorothiazide and diabetes side effects and fasting blood glucose levels were not significant.

Despite important individual variations, changes in total cholesterol and LDL-ch61esterol were observed. Our study indicates a similar effect of H C T on serum lipid fractions in paediatric patients to that observed in adults [ cukorbetegség lábzsibbadás 7 - 2 0 ].

In cases o f hypercalciuria accompanied by episodes of macroscopic post-glomerular haematuria, the potential risks o f nephrolithiasis should be considered. In our previous studies a combined low-calcium, low-sodium diet proved to be an alternative to H C T treatment in diminishing urinary calcium excretion and urine saturation with respect to brushite [10, 11, 30].

In cases of non-compliance particularly in children cukorbetegség komplikációk kezelése recurrent hypercalciuric nephrolithiasis, H C T treatment could be beneficial in preventing the recurrence o f renal stones and thus hindering the development of renal damage.

Furthermore, H C T could prevent the decrease in bone mineral content in hypercalciuric patients [6]. The potential risks and benefits of H C T treatment should be considered for each patient.

References 1.

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J Pediatr 2. J Pediatr 3. N Engl J Med - 4. Kidney Int 5. Metabolism 6. Child Nephrol Urol 7. Lamberg BA, Kuhlbach B Effect of chlorothiazide and hydrochlorothiazide on the excretion of calcium in urine.

Scand J Clin Lab Invest 8. Lemann J Jr Nephrolithiasis. Williams and Wilkins, Baltimore, p 6. Moore ES Hypercalciuria in children. In: Berlyne GM ed Contribution to nephrology. New York, Karger, pp 32 Reusz G, Tulassay T, Szabo A, Tausz I, Miltenyi M Studies on the urinary calcium excretion in children with haematuria of postglomerular origin: effects of the variation of dietary calcium and sodium intake.

Int J Pediatr Nephrol Reusz G, Tulassay T, Szabo A, Miltenyi M Effect of thiazide on urinary calcium a legújabb gyógyszerek cukorbetegség kezelésének and haematuria in children with postglomerular haematuria. Int J Pediatr Nephrol -