Derleme
BibTex RIS Kaynak Göster

Böbrek Yetmezliklerinde Kalsiyum Metabolizması Değişiklikleri ve Olası Riskleri

Yıl 2019, Cilt: 8 Sayı: 4, 444 - 450, 31.12.2019

Beraat Dener , Hilal Yıldıran

Öz

Kalsiyum,
vücutta baskın bulunan elementler arasındadır ve tamamına yakını kemik ile
dişlerin yapısında bulunur. Kas kasılması, sinir iletimi, hücre bölünmesi,
hücreler arası iletişim ve hormon salınımında önemli rol oynamaktadır.
Kalsiyumun vücuttan uzaklaştırılması idrar, gastrointestinal sistem ve deri
yolu ile gerçekleşirken organizmaya sadece besinler aracılığıyla alınmaktadır.
Böbrekler D vitamini ile birlikte kalsiyum ve fosfor arasındaki dengenin
korunmasına yardımcı olmaktadır. Ancak böbrek yetmezliğinde hiperfosfatemi ve
hiperkalsemi ile beraber hiperparatiroidi gözlenmekte ve dokularda
kalsifikasyon, osteopeni, osteoporoz, bireyin hastanede kalış süresinde uzama
gibi sağlık sorunları ile karşılaşılmaktadır. Tüm bunlara ek olarak serum
kalsiyum ve fosfor düzeylerinin mortalite riski ile ilişkili olduğu da
belirtilmektedir. Bu derleme ile böbrek yetmezliğinde kalsiyum
metabolizmasındaki değişiklikleri incelemek, kemik mineral yoğunluğuna etkisini
gözlemlemek ve tıbbi beslenme tedavisi açısından yaklaşımları vurgulamak
hedeflenmektedir.

Anahtar Kelimeler

Kalsiyum Akut böbrek yetmezliği Kronik böbrek yetmezliği D vitamini

Kaynakça

  • 1. Schulze, K. J. (2013). Calcium A2 - Caballero, Benjamin. In Encyclopedia of Human Nutrition (Third Edition) (pp. 228-234). Waltham: Academic Press.
  • 2. Santella, L. (2004). Calcium Signaling: Cell Cycle A2 - Lennarz, William J. In M. D. Lane (Ed.), Encyclopedia of Biological Chemistry (pp. 246-249). New York: Elsevier.
  • 3. Clapham, D. E. (2007). Calcium Signaling. Cell, 131(6), 1047-1058.
  • 4. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium (2011). In A. C. Ross, C. L. Taylor, A. L. Yaktine, & H. B. D. Valle (Eds.), Dietary Reference Intakes for Calcium and Vitamin D. . Washington (DC): National Academies Press (US).
  • 5. ‘’Türkiye Beslenme Rehberi TÜBER 2015’’ ‘’ T.C. Sağlık Bakanlığı Yayın No: 1031, Ankara 2016.’’
  • 6. Webster, A. C., Nagler, E. V., Morton, R. L., & Masson, P. (2017). Chronic Kidney Disease. The Lancet, 389(10075), 1238-1252. doi:https://doi.org/10.1016/S0140-6736(16)32064-5
  • 7. DiMeglio, L. A., & Imel, E. A. (2014). Chapter 13 - Calcium and Phosphate: Hormonal Regulation and Metabolism A2 - Burr, David B. In M. R. Allen (Ed.), Basic and Applied Bone Biology (pp. 261-282). San Diego: Academic Press.
  • 8. Goodman, H. M. (2003). Chapter 8 - Hormonal Regulation of Calcium Metabolism. In Basic Medical Endocrinology (Third Edition) (pp. 255-289). San Diego: Academic Press.
  • 9. Fleet, J. C., & Schoch, R. D. (2011). Chapter 19 - Molecular Mechanisms for Regulation of Intestinal Calcium and Phosphate Absorption by Vitamin D A2 - Feldman, David. In J. W. Pike & J. S. Adams (Eds.), Vitamin D (Third Edition) (pp. 349-362). San Diego: Academic Press.
  • 10. Wasserman, R. H. (2005). CHAPTER 24 - Vitamin D and the Intestinal Absorption of Calcium: A View and Overview A2 - FELDMAN, DAVID. In Vitamin D (Second Edition) (pp. 411-428). Burlington: Academic Press.
  • 11. Bouillon, R., Carmeliet, G., & Van Cromphaut, S. (2005). CHAPTER 25 - Intestinal Calcium Absorption: Lessons from Knockout Mice and Men A2 - FELDMAN, DAVID. In Vitamin D (Second Edition) (pp. 429-451). Burlington: Academic Press.
  • 12. Tebben, P. J., & Kumar, R. (2013). Chapter 65 - The Hormonal Regulation of Calcium Metabolism A2 - Alpern, Robert J. In O. W. Moe & M. Caplan (Eds.), Seldin and Giebisch's The Kidney (Fifth Edition) (pp. 2249-2272): Academic Press.
  • 13. Peacock, M. (2010). Calcium metabolism in health and disease. Clin J Am Soc Nephrol, 5 Suppl 1, S23-30. doi:10.2215/cjn.05910809
  • 14. Hoenderop, J. G., Nilius, B., & Bindels, R. J. (2005). Calcium absorption across epithelia. Physiol Rev, 85(1), 373-422. doi:10.1152/physrev.00003.2004
  • 15. Wei, K., Yin, Z., & Xie, Y. (2016). Roles of the kidney in the formation, remodeling and repair of bone. Journal of Nephrology, 29, 349-357. doi:10.1007/s40620-016-0284-7
  • 16. Bernardo, J. F., & Friedman, P. A. (2013). Chapter 64 - Renal Calcium Metabolism A2 - Alpern, Robert J. In O. W. Moe & M. Caplan (Eds.), Seldin and Giebisch's The Kidney (Fifth Edition) (pp. 2225-2247): Academic Press.
  • 17. Dvorak, M. M., Siddiqua, A., Ward, D. T., Carter, D. H., Dallas, S. L., Nemeth, E. F., & Riccardi, D. (2004). Physiological changes in extracellular calcium concentration directly control osteoblast function in the absence of calciotropic hormones. Proc Natl Acad Sci U S A, 101(14), 5140-5145. doi:10.1073/pnas.0306141101
  • 18. Liu, S., Tang, W., Zhou, J., Stubbs, J. R., Luo, Q., Pi, M., & Quarles, L. D. (2006). Fibroblast growth factor 23 is a counter-regulatory phosphaturic hormone for vitamin D. J Am Soc Nephrol, 17(5), 1305-1315. doi:10.1681/asn.2005111185
  • 19. Shimada, T., Hasegawa, H., Yamazaki, Y., Muto, T., Hino, R., Takeuchi, Y., . . . Yamashita, T. (2004). FGF-23 is a potent regulator of vitamin D metabolism and phosphate homeostasis. J Bone Miner Res, 19(3), 429-435. doi:10.1359/jbmr.0301264
  • 20. Sasaki, M., Hasegawa, T., Yamada, T., Hongo, H., de Freitas, P. H., Suzuki, R., . . . Amizuka, N. (2013). Altered distribution of bone matrix proteins and defective bone mineralization in klotho-deficient mice. Bone, 57(1), 206-219. doi:10.1016/j.bone.2013.08.008
  • 21. Hruska, K. A., Seifert, M. E., & Surendran, K. (2015). Chapter 27 - Disorders of Mineral and Bone Metabolism in Chronic Kidney Disease. In Chronic Renal Disease (pp. 320-331). San Diego: Academic Press.
  • 22. Staude, H., Jeske, S., Schmitz, K., Warncke, G., & Fischer, D. C. (2013). Cardiovascular Risk and Mineral Bone Disorder in Patients with Chronic Kidney Disease. Kidney and Blood Pressure Research, 37(1), 68-83.
  • 23. Hu, M. C., Shiizaki, K., Kuro-o, M., & Moe, O. W. (2013). Fibroblast growth factor 23 and Klotho: physiology and pathophysiology of an endocrine network of mineral metabolism. Annu Rev Physiol, 75, 503-533. doi:10.1146/annurev-physiol-030212-183727
  • 24. Manjunath, V., Moeckel, G., & Dahl, N. K. (2013). Acute kidney injury in a patient with sarcoidosis: hypercalciuria and hypercalcemia leading to calcium phosphate deposition. Clin Nephrol, 80(2), 151-155.
  • 25. Golzy, M., Bessette, R. W., & Carter, R. L. (2013). Renal function, calcium regulation, and time to hospitalization of patients with chronic kidney disease. BMC Nephrol, 14, 154. doi:10.1186/1471-2369-14-154
  • 26. Sigrist, M. K., Taal, M. W., Bungay, P., & McIntyre, C. W. (2007). Progressive vascular calcification over 2 years is associated with arterial stiffening and increased mortality in patients with stages 4 and 5 chronic kidney disease. Clin J Am Soc Nephrol, 2(6), 1241-1248. doi:10.2215/cjn.02190507
  • 27. Dhingra, R., Sullivan, L. M., Fox, C. S., Wang, T. J., D'Agostino, R. B., Sr., Gaziano, J. M., & Vasan, R. S. (2007). Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community. Arch Intern Med, 167(9), 879-885. doi:10.1001/archinte.167.9.879
  • 28. Afshinnia, F., Belanger, K., Palevsky, P. M., & Young, E. W. (2013). Effect of ionized serum calcium on outcomes in acute kidney injury needing renal replacement therapy: secondary analysis of the acute renal failure trial network study. Ren Fail, 35(10), 1310-1318. doi:10.3109/0886022x.2013.828258
  • 29. Lim, L.-M., Kuo, H.-T., Kuo, M.-C., Chiu, Y.-W., Lee, J.-J., Hwang, S.-J., . . . Chen, H.-C. (2014). Low serum calcium is associated with poor renal outcomes in chronic kidney disease stages 3–4 patients. BMC Nephrology, 15(1), 183. doi:10.1186/1471-2369-15-183
  • 30. Hill, K. M., Martin, B. R., Wastney, M. E., McCabe, G. P., Moe, S. M., Weaver, C. M., & Peacock, M. (2013). Oral calcium carbonate affects calcium but not phosphorus balance in stage 3-4 chronic kidney disease. Kidney Int, 83(5), 959-966. doi:10.1038/ki.2012.403
  • 31. Tsuruoka, S., Sugimoto, K., Ohmori, M., Kawaguchi, A., Saito, T., & Fujimura, A. (1999). Chronotherapy of high-dose 1,25-dihydroxyvitamin D3 in hemodialysis patients with secondary hyperparathyroidism: a single-dose study. Clin Pharmacol Ther, 66(6), 609-616. doi:10.1016/s0009-9236(99)90070-x
  • 32. Mustafar, R., Mohd, R., Ahmad Miswan, N., Cader, R., Gafor, H. A., Mohamad, M., . . . Chiew Tong, N. K. (2014). The Effect of Calcium With or Without Calcitriol Supplementation on Renal Function in Patients With Hypovitaminosis D and Chronic Kidney Disease. Nephro-urology Monthly, 6(1), e13381. doi:10.5812/numonthly.13381
  • 33. Bosworth, C., de Boer, I. H., Targher, G., Kendrick, J., Smits, G., & Chonchol, M. (2012). The effect of combined calcium and cholecalciferol supplementation on bone mineral density in elderly women with moderate chronic kidney disease. Clin Nephrol, 77(5), 358-365.
  • 34. Zhang, D.-l., Wang, L.-y., Sun, F., Zhou, Y.-l., Duan, X.-f., Liu, S., . . . Liu, W.-h. (2014). Is the Dialysate Calcium Concentration of 1.75 mmol/L Suitable for Chinese Patients on Maintenance Hemodialysis? Calcified Tissue International, 94(3), 301-310. doi:10.1007/s00223-013-9811-x
  • 35. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). (2009). Kidney Int Suppl(113), S1-130. doi:10.1038/ki.2009.188
  • 36. Cano, N., Fiaccadori, E., Tesinsky, P., Toigo, G., Druml, W., Kuhlmann, M., . . . Horl, W. H. (2006). ESPEN Guidelines on Enteral Nutrition: Adult renal failure. Clin Nutr, 25(2), 295-310. doi:10.1016/j.clnu.2006.01.023
  • 37. Cano, N. J., Aparicio, M., Brunori, G., Carrero, J. J., Cianciaruso, B., Fiaccadori, E., . . . Guarnieri, G. (2009). ESPEN Guidelines on Parenteral Nutrition: adult renal failure. Clin Nutr, 28(4), 401-414. doi:10.1016/j.clnu.2009.05.016

Yıl 2019, Cilt: 8 Sayı: 4, 444 - 450, 31.12.2019

Beraat Dener , Hilal Yıldıran

Öz

Kaynakça

  • 1. Schulze, K. J. (2013). Calcium A2 - Caballero, Benjamin. In Encyclopedia of Human Nutrition (Third Edition) (pp. 228-234). Waltham: Academic Press.
  • 2. Santella, L. (2004). Calcium Signaling: Cell Cycle A2 - Lennarz, William J. In M. D. Lane (Ed.), Encyclopedia of Biological Chemistry (pp. 246-249). New York: Elsevier.
  • 3. Clapham, D. E. (2007). Calcium Signaling. Cell, 131(6), 1047-1058.
  • 4. Institute of Medicine (US) Committee to Review Dietary Reference Intakes for Vitamin D and Calcium (2011). In A. C. Ross, C. L. Taylor, A. L. Yaktine, & H. B. D. Valle (Eds.), Dietary Reference Intakes for Calcium and Vitamin D. . Washington (DC): National Academies Press (US).
  • 5. ‘’Türkiye Beslenme Rehberi TÜBER 2015’’ ‘’ T.C. Sağlık Bakanlığı Yayın No: 1031, Ankara 2016.’’
  • 6. Webster, A. C., Nagler, E. V., Morton, R. L., & Masson, P. (2017). Chronic Kidney Disease. The Lancet, 389(10075), 1238-1252. doi:https://doi.org/10.1016/S0140-6736(16)32064-5
  • 7. DiMeglio, L. A., & Imel, E. A. (2014). Chapter 13 - Calcium and Phosphate: Hormonal Regulation and Metabolism A2 - Burr, David B. In M. R. Allen (Ed.), Basic and Applied Bone Biology (pp. 261-282). San Diego: Academic Press.
  • 8. Goodman, H. M. (2003). Chapter 8 - Hormonal Regulation of Calcium Metabolism. In Basic Medical Endocrinology (Third Edition) (pp. 255-289). San Diego: Academic Press.
  • 9. Fleet, J. C., & Schoch, R. D. (2011). Chapter 19 - Molecular Mechanisms for Regulation of Intestinal Calcium and Phosphate Absorption by Vitamin D A2 - Feldman, David. In J. W. Pike & J. S. Adams (Eds.), Vitamin D (Third Edition) (pp. 349-362). San Diego: Academic Press.
  • 10. Wasserman, R. H. (2005). CHAPTER 24 - Vitamin D and the Intestinal Absorption of Calcium: A View and Overview A2 - FELDMAN, DAVID. In Vitamin D (Second Edition) (pp. 411-428). Burlington: Academic Press.
  • 11. Bouillon, R., Carmeliet, G., & Van Cromphaut, S. (2005). CHAPTER 25 - Intestinal Calcium Absorption: Lessons from Knockout Mice and Men A2 - FELDMAN, DAVID. In Vitamin D (Second Edition) (pp. 429-451). Burlington: Academic Press.
  • 12. Tebben, P. J., & Kumar, R. (2013). Chapter 65 - The Hormonal Regulation of Calcium Metabolism A2 - Alpern, Robert J. In O. W. Moe & M. Caplan (Eds.), Seldin and Giebisch's The Kidney (Fifth Edition) (pp. 2249-2272): Academic Press.
  • 13. Peacock, M. (2010). Calcium metabolism in health and disease. Clin J Am Soc Nephrol, 5 Suppl 1, S23-30. doi:10.2215/cjn.05910809
  • 14. Hoenderop, J. G., Nilius, B., & Bindels, R. J. (2005). Calcium absorption across epithelia. Physiol Rev, 85(1), 373-422. doi:10.1152/physrev.00003.2004
  • 15. Wei, K., Yin, Z., & Xie, Y. (2016). Roles of the kidney in the formation, remodeling and repair of bone. Journal of Nephrology, 29, 349-357. doi:10.1007/s40620-016-0284-7
  • 16. Bernardo, J. F., & Friedman, P. A. (2013). Chapter 64 - Renal Calcium Metabolism A2 - Alpern, Robert J. In O. W. Moe & M. Caplan (Eds.), Seldin and Giebisch's The Kidney (Fifth Edition) (pp. 2225-2247): Academic Press.
  • 17. Dvorak, M. M., Siddiqua, A., Ward, D. T., Carter, D. H., Dallas, S. L., Nemeth, E. F., & Riccardi, D. (2004). Physiological changes in extracellular calcium concentration directly control osteoblast function in the absence of calciotropic hormones. Proc Natl Acad Sci U S A, 101(14), 5140-5145. doi:10.1073/pnas.0306141101
  • 18. Liu, S., Tang, W., Zhou, J., Stubbs, J. R., Luo, Q., Pi, M., & Quarles, L. D. (2006). Fibroblast growth factor 23 is a counter-regulatory phosphaturic hormone for vitamin D. J Am Soc Nephrol, 17(5), 1305-1315. doi:10.1681/asn.2005111185
  • 19. Shimada, T., Hasegawa, H., Yamazaki, Y., Muto, T., Hino, R., Takeuchi, Y., . . . Yamashita, T. (2004). FGF-23 is a potent regulator of vitamin D metabolism and phosphate homeostasis. J Bone Miner Res, 19(3), 429-435. doi:10.1359/jbmr.0301264
  • 20. Sasaki, M., Hasegawa, T., Yamada, T., Hongo, H., de Freitas, P. H., Suzuki, R., . . . Amizuka, N. (2013). Altered distribution of bone matrix proteins and defective bone mineralization in klotho-deficient mice. Bone, 57(1), 206-219. doi:10.1016/j.bone.2013.08.008
  • 21. Hruska, K. A., Seifert, M. E., & Surendran, K. (2015). Chapter 27 - Disorders of Mineral and Bone Metabolism in Chronic Kidney Disease. In Chronic Renal Disease (pp. 320-331). San Diego: Academic Press.
  • 22. Staude, H., Jeske, S., Schmitz, K., Warncke, G., & Fischer, D. C. (2013). Cardiovascular Risk and Mineral Bone Disorder in Patients with Chronic Kidney Disease. Kidney and Blood Pressure Research, 37(1), 68-83.
  • 23. Hu, M. C., Shiizaki, K., Kuro-o, M., & Moe, O. W. (2013). Fibroblast growth factor 23 and Klotho: physiology and pathophysiology of an endocrine network of mineral metabolism. Annu Rev Physiol, 75, 503-533. doi:10.1146/annurev-physiol-030212-183727
  • 24. Manjunath, V., Moeckel, G., & Dahl, N. K. (2013). Acute kidney injury in a patient with sarcoidosis: hypercalciuria and hypercalcemia leading to calcium phosphate deposition. Clin Nephrol, 80(2), 151-155.
  • 25. Golzy, M., Bessette, R. W., & Carter, R. L. (2013). Renal function, calcium regulation, and time to hospitalization of patients with chronic kidney disease. BMC Nephrol, 14, 154. doi:10.1186/1471-2369-14-154
  • 26. Sigrist, M. K., Taal, M. W., Bungay, P., & McIntyre, C. W. (2007). Progressive vascular calcification over 2 years is associated with arterial stiffening and increased mortality in patients with stages 4 and 5 chronic kidney disease. Clin J Am Soc Nephrol, 2(6), 1241-1248. doi:10.2215/cjn.02190507
  • 27. Dhingra, R., Sullivan, L. M., Fox, C. S., Wang, T. J., D'Agostino, R. B., Sr., Gaziano, J. M., & Vasan, R. S. (2007). Relations of serum phosphorus and calcium levels to the incidence of cardiovascular disease in the community. Arch Intern Med, 167(9), 879-885. doi:10.1001/archinte.167.9.879
  • 28. Afshinnia, F., Belanger, K., Palevsky, P. M., & Young, E. W. (2013). Effect of ionized serum calcium on outcomes in acute kidney injury needing renal replacement therapy: secondary analysis of the acute renal failure trial network study. Ren Fail, 35(10), 1310-1318. doi:10.3109/0886022x.2013.828258
  • 29. Lim, L.-M., Kuo, H.-T., Kuo, M.-C., Chiu, Y.-W., Lee, J.-J., Hwang, S.-J., . . . Chen, H.-C. (2014). Low serum calcium is associated with poor renal outcomes in chronic kidney disease stages 3–4 patients. BMC Nephrology, 15(1), 183. doi:10.1186/1471-2369-15-183
  • 30. Hill, K. M., Martin, B. R., Wastney, M. E., McCabe, G. P., Moe, S. M., Weaver, C. M., & Peacock, M. (2013). Oral calcium carbonate affects calcium but not phosphorus balance in stage 3-4 chronic kidney disease. Kidney Int, 83(5), 959-966. doi:10.1038/ki.2012.403
  • 31. Tsuruoka, S., Sugimoto, K., Ohmori, M., Kawaguchi, A., Saito, T., & Fujimura, A. (1999). Chronotherapy of high-dose 1,25-dihydroxyvitamin D3 in hemodialysis patients with secondary hyperparathyroidism: a single-dose study. Clin Pharmacol Ther, 66(6), 609-616. doi:10.1016/s0009-9236(99)90070-x
  • 32. Mustafar, R., Mohd, R., Ahmad Miswan, N., Cader, R., Gafor, H. A., Mohamad, M., . . . Chiew Tong, N. K. (2014). The Effect of Calcium With or Without Calcitriol Supplementation on Renal Function in Patients With Hypovitaminosis D and Chronic Kidney Disease. Nephro-urology Monthly, 6(1), e13381. doi:10.5812/numonthly.13381
  • 33. Bosworth, C., de Boer, I. H., Targher, G., Kendrick, J., Smits, G., & Chonchol, M. (2012). The effect of combined calcium and cholecalciferol supplementation on bone mineral density in elderly women with moderate chronic kidney disease. Clin Nephrol, 77(5), 358-365.
  • 34. Zhang, D.-l., Wang, L.-y., Sun, F., Zhou, Y.-l., Duan, X.-f., Liu, S., . . . Liu, W.-h. (2014). Is the Dialysate Calcium Concentration of 1.75 mmol/L Suitable for Chinese Patients on Maintenance Hemodialysis? Calcified Tissue International, 94(3), 301-310. doi:10.1007/s00223-013-9811-x
  • 35. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). (2009). Kidney Int Suppl(113), S1-130. doi:10.1038/ki.2009.188
  • 36. Cano, N., Fiaccadori, E., Tesinsky, P., Toigo, G., Druml, W., Kuhlmann, M., . . . Horl, W. H. (2006). ESPEN Guidelines on Enteral Nutrition: Adult renal failure. Clin Nutr, 25(2), 295-310. doi:10.1016/j.clnu.2006.01.023
  • 37. Cano, N. J., Aparicio, M., Brunori, G., Carrero, J. J., Cianciaruso, B., Fiaccadori, E., . . . Guarnieri, G. (2009). ESPEN Guidelines on Parenteral Nutrition: adult renal failure. Clin Nutr, 28(4), 401-414. doi:10.1016/j.clnu.2009.05.016
Toplam 37 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Derlemeler
Yazarlar

Beraat Dener 0000-0002-5248-0582

Hilal Yıldıran

Yayımlanma Tarihi 31 Aralık 2019
Yayımlandığı Sayı Yıl 2019 Cilt: 8 Sayı: 4

Kaynak Göster

APA Dener, B., & Yıldıran, H. (2019). Böbrek Yetmezliklerinde Kalsiyum Metabolizması Değişiklikleri ve Olası Riskleri. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 8(4), 444-450.
AMA Dener B, Yıldıran H. Böbrek Yetmezliklerinde Kalsiyum Metabolizması Değişiklikleri ve Olası Riskleri. Gümüşhane Sağlık Bilimleri Dergisi. Aralık 2019;8(4):444-450.
Chicago Dener, Beraat, ve Hilal Yıldıran. “Böbrek Yetmezliklerinde Kalsiyum Metabolizması Değişiklikleri Ve Olası Riskleri”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 8, sy. 4 (Aralık 2019): 444-50.
EndNote Dener B, Yıldıran H (01 Aralık 2019) Böbrek Yetmezliklerinde Kalsiyum Metabolizması Değişiklikleri ve Olası Riskleri. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 8 4 444–450.
IEEE B. Dener ve H. Yıldıran, “Böbrek Yetmezliklerinde Kalsiyum Metabolizması Değişiklikleri ve Olası Riskleri”, Gümüşhane Sağlık Bilimleri Dergisi, c. 8, sy. 4, ss. 444–450, 2019.
ISNAD Dener, Beraat - Yıldıran, Hilal. “Böbrek Yetmezliklerinde Kalsiyum Metabolizması Değişiklikleri Ve Olası Riskleri”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi 8/4 (Aralık 2019), 444-450.
JAMA Dener B, Yıldıran H. Böbrek Yetmezliklerinde Kalsiyum Metabolizması Değişiklikleri ve Olası Riskleri. Gümüşhane Sağlık Bilimleri Dergisi. 2019;8:444–450.
MLA Dener, Beraat ve Hilal Yıldıran. “Böbrek Yetmezliklerinde Kalsiyum Metabolizması Değişiklikleri Ve Olası Riskleri”. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, c. 8, sy. 4, 2019, ss. 444-50.
Vancouver Dener B, Yıldıran H. Böbrek Yetmezliklerinde Kalsiyum Metabolizması Değişiklikleri ve Olası Riskleri. Gümüşhane Sağlık Bilimleri Dergisi. 2019;8(4):444-50.
 Kapak Resmi İndir