Somatostatin and intestinal calcium transport in the rat

Blood levels of glucometabolic hormones and urinary saturation with stone forming phases after an oral test meal in male patients with recurrent idiopathic calcium urolithiasis and in healthy controls

Male patients with recurrent calcium (Ca) urolithiasis (RCU) with idiopathic hypercalciuria (I-HC, n = 12) or normocalciuria (NC, n = 12), and age, sex, and weight-matched controls (C, n = 12) were evaluated before and after a carbohydrate-rich synthetic meal for blood glucose, free fatty acids (FFA), alpha-amino-nitrogen, several glucometabolic hormones and parathyroid hormone (PTH), and urine Ca, phosphate, oxalate, and cyclic adenosine monophosphate (cAMP) levels as well as saturation. Fasting serum Ca was significantly higher and PTH significantly lower in I-HC than in controls, whereas in fasting urine cAMP and phosphate were unchanged. There were only minor differences between fasting blood glucose levels and postprandial glucose tolerance of RCU patients and controls. However, serum insulin was significantly elevated in I-HC versus C, but serum C-peptide, plasma glucagon, and somatostatin levels were comparable in RCU and C. FFA were significantly lower in RCU than C. Postprandial phosphaturia and urinary saturation with Ca-phosphates were significantly higher in RCU versus C, whereas urinary cAMP, pH, and oxalate were similar. We conclude that: (1) in RCU patients some postabsorptive steps in glucose metabolism may be abnormal; (2) those with I-HC have enhanced postprandial Ca and phosphate excretion concomitantly with disordered insulin metabolism; and (3) RCU patients may suffer from a postprandial renal phosphate leak, which may make their urine more lithogenic.

The influence of progressive hyperinsulinemia on duodenal calcium absorption in the rat

Using an in situ loop technique, we studied the influence of moderate hyperinsulinemia on the bidirectional fluxes [lumen-to-plasma (LP), plasma-to-lumen (PL)] and on the net absorption of calcium (Ca) in the duodenum of the rat. Under hyperinsulinemic euglycemic clamp conditions, three different steady-state plasma insulin levels (66 +/- 16, 187 +/- 13, 263 +/- 24 microU/mL) were maintained by intravenous (IV) infusion of either 20, 40, or 60 mU/h of insulin. LP flux and net Ca absorption (CaA) increased significantly under all, while the PL flux was not changed by any of the three insulin doses. Under 40 and 60 mU/h of IV insulin, the individual plasma insulin levels and LP fluxes were positively and significantly correlated, suggesting a dose-dependent action of insulin on duodenal CaA. No significant changes were seen in plasma somatostatinlike immunoreactivity (SLI), parathyroid hormone (PTH), and serum Ca, while serum inorganic phosphate (Pi) and 1,25(OH)2 vitamin D levels fell with increasing doses of IV insulin. It is concluded for the rat that physiologic degrees of hyperinsulinemia enhance duodenal CaA by an as yet unknown mechanism, this action seems to be independent of PTH and, the role of 1,25(OH)2 vitamin D in this context is poorly understood.