Assessment of intestinal calcium absorption and calcium kinetics for bone resorption and bone formation rates using dual stable isotopes
Summary
All subjects will undergo screening to determine eligibility. This will include a blood draw and/or 24-hour urine collection.
AIM 1: On Day 0, subjects will be admitted to the CTRC. They will be given a metabolic dinner. They will fast from 6PM on. On Day 1, subjects will collect a 2-hour fasting urine, after which they will begin a 24-hour urine collection. They will drink a mixture of non-isotopic calcium and stable calcium isotope mixed in Ensure. Simultaneously, a stable calcium isotope will be infused intravenously. Breakfast will be withheld, but a metabolic lunch and dinner will be served. A blood sample will be collected. Blood sampling will continue hourly for 8 hours and every 2 hrs afterward. On day 2, a fasting blood sample will be collected and the subject discharged from the CTRC.
AIM 2 and amp; 3: On Day 0, subjects will be admitted to the CTRC. They will be given a standard metabolic dinner. They will fast from 6PM on. On Day 1, subjects will collect a 2-hour fasting urine, after which they will begin a 24-hour urine collection. They will drink a mixture of non-isotopic calcium and stable calcium isotope mixed in Ensure. Simultaneously, a stable calcium isotope will be infused intravenously. Breakfast will be withheld, but a metabolic lunch and dinner will be served. A blood sample will be collected and a second blood sample will be collected at the time determined based on Aim 1. On day 2, the subject will be discharged from CTRC.
AIM 4: On days 0-1, Patients will eat a low salt/low calcium diet for 2 days. Dietary records will be kept. On days 2-3, subjects will receive a frozen metabolic diet. They will be admitted to the CTRC on day 3. A standard metabolic dinner will be provided. They will fast from 6PM on. On day 4 subjects will collect a 2-hour fasting urine, begin a 24-hour urine collection, and a fasting blood sample will be drawn. Subjects will drink a mixture of stable calcium isotope and Ensure. Simultaneously, a stable calcium isotope will be infused intravenously. Blood will be collected at specific time points over 8 hours. Breakfast will be withheld, but a metabolic lunch and dinner will be served. The patient will complete their 24-h urine collection on day 5, after which they will be given a metabolic breakfast and 300cc distilled water. They will be discharged from the CTRC the morning of day 5 following a spot urine at 10:00am. Another spot urine will be collected at 8:00pm. Two spot urines will be collected at 8:00am/8:00pm on days 6-10. Spot urine specimens will be returned to the CTRC on days 8 and amp; 11.
Participant Eligibility
Aim 1: 6 healthy adult patients (20-50 years of age) of either gender.
Aim 2: 2 healthy adult subjects (>20 years of age < 40 years, premenopausal) of either gender, 2 elderly subjects (> 60 years and < 80 years) of either gender with urinary calcium of less than 150 mg in 24 hours, and 2 subjects (>20 years of age < 80 years) of either gender with primary hyperparathyroidism.
Aim 3: 4 subjects (>20 years of age < 80 years) with reduced GFR (15-30 cc/min). Vitamin D supplements, calcium supplements and calcium based phosphate binders will be held 4 week prior to the study
Aim 4: 10 hypercalciuric stone forming subjects and 10 normocalciuric stone forming subjects. 21-50 years of age, any ethnicity, and either gender.