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| Name | Class |
|---|---|
| Ural Institute of Cardiology | OTHER |
| De Haar Research Foundation | OTHER |
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We hypothesize that paricalcitol and calcitriol in dose-dependent manner are effective for the management of chronic allograft dysfunction (CAD), protection and repair of kidney and heart, management of chronic renocardiac syndrome (CRS). We assume that paricalcitol can have some advantages if compare with calcitriol or cholecalciferol due to absence of calcemic and phosphatemic complications alongside with great beneficial potential.
Paricalcitol and calcitriol are identically effective for the management of chronic allograft dysfunction (CAD), protection and repair of kidney and heart, management of chronic renocardiac syndrome (CRS). Vitamin D can reduce progression of CAD. Activation of VDR in proximal part of nephron leads to rapid non-genomic beneficial effects with urgent multilevel protection of the most functionally important portion of kidney. Rising expression of VDR in distal portions of nephron stimulates slows genomic effects with some local repair responses.
Hormone D may stimulate recruitment and activity of the different origin stem-progenitor cells (SPCs) with beneficial effects on different stages of regeneration by force of para- and autocrine activity. SPCs are revealing mostly in interstitium and among fibroblast-like cells. Vitamin D did not confirm efficacy as a tool for management of mesenchymal stem cells (MSCs) in human however it needs more research experimental evidences due to multifactorial influence on SPCs in human being including immunosuppressive and bone-marrow-related effects of cyclosporine in kidney transplant (Tx) patients. Paricalcitol and calcitriol can slow down migration and infiltration of MSC into interstitium and vessel wall. The side population of mature and SPCs (first of all, with bone-marrow and mesenchymal phenotype) is the most metabolically and functionally active portion of cells with high sensitivity to vitamin D receptor (VDR) activation that responsible for repair of tissue.
The most optimal scheme of treatment with vitamin D in patients with CAD and CRS is an administration of paricalcitol with dose 2-4 μg daily and supplemental intake of vitamin D including special diet, multivitamins, and others with optimal dose until 1800 international units (IU) but excluding insolation as a factor of skin carcinoma. High-dose medicinal intake of calcitriol (until 6 mcg and higher) showed relatively high efficacy but rather excessive level of complications mediated with mineral metabolism.
Paricalcitol and calcitriol may significantly improve contractility of myocardium and reduce cardiovascular risk, heart failure (HF) and hypertension with some beneficial effects on cardiorenal axis and renin-angiotensin-aldosterone system.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Paricalcitol treatment | Active Comparator | 6-8 μg daily per os (orally) without special diet |
|
| Calcitriol treatment | Active Comparator | 2-4 μg daily orally under with dietary restrictions of vitamin D |
|
| Cholecalciferol | Active Comparator | alendronate sodium/ cholecalciferol capsules with recommended daily allowance equals 1200-2400 IU per day |
|
| Supplemental | Other | intake of cholecalciferol in food and multivitamins, less than 400-900 IU per day |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Paricalcitol | Drug | paricalcitol group (6-8 μg daily per os - orally - without special diet) |
|
| Measure | Description | Time Frame |
|---|---|---|
| CAD (Chronic Allograft Dysfunction) Degree | Beyond 180 days, chronic allograft dysfunction (CAD) was characterized by mean Banff degree (revised 2005/2007 criteria) with the data of renal biopsy material. Renal tissue was recovered during routined biopsy. We assessed antibody-mediated rejection, borderline changes, T-cell-mediated rejection, interstitial fibrosis and tubular atropthy, and other changes. Grades: Grade I. Mild interstitial fibrosis and tubular atrophy (<25% of cortical area) II. Moderate (26-50%) III. Severe (>50%) (may include non-specific vascular and glomerular sclerosis) | day 180 after Tx (transplantation) |
| Measure | Description | Time Frame |
|---|---|---|
| Heart Failure (HF) | NYHA (New York Heart Association) functional class verified with veloergometry probe and by NYHA clinical classification NYHA Class Symptoms I No symptoms and no limitation in ordinary physical activity, e.g. shortness of breath when walking, climbing stairs etc. II Mild symptoms and slight limitation during ordinary activity. III Marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g. walking short distances (20-100 m). Comfortable only at rest. IV Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Alexander Kharlamov, M.D. | Ural Institute of Cardiology | Principal Investigator |
| Alexander Perrish, M.D. | Ural State Medical University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| De Haar Research Foundation | Rotterdam | South Holland | 3071PR | Netherlands | ||
| Ural Institute of Cardiology |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 22839442 | Result | Kharlamov AN, Perrish AN, Gabiskii IaL, Ronne Kh, Ivanova EIu. [Vitamin D in the treatment of cardiorenal syndrome in patients with chronic nephropathy]. Kardiologiia. 2012;52(3):33-44. Russian. |
| Label | URL |
|---|---|
| Ural Institute of Cardiology | View source |
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A total of 120 patients (Russian and dutch caucasian, kidney recipients with vitamin D deficiency defined as 25(OH)D < 30 ng/mL) were assigned on the basis of Ural Institute of Cardiology. Nine of the 120 patients were subsequently excluded due to protocol violation. All the patients had given their written informed consents.
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| ID | Title | Description |
|---|---|---|
| FG000 | Paricalcitol Treatment | 6-8 μg daily per os without special diet |
| FG001 | Calcitriol Treatment | 2-4 μg daily orally under with dietary restrictions of vitamin D |
| FG002 | Cholecalciferol | alendronate sodium/ cholecalciferol capsules with recommended daily allowance equals 1200-2400 IU per day |
| FG003 | Supplemental | intake of cholecalciferol in food and multivitamins, less than 400-900 IU per day |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
Not provided
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| ID | Title | Description |
|---|---|---|
| BG000 | Paricalcitol Treatment | 6-8 μg daily per os without special diet |
| BG001 | Calcitriol Treatment | 2-4 μg daily orally under with dietary restrictions of vitamin D |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | CAD (Chronic Allograft Dysfunction) Degree | Beyond 180 days, chronic allograft dysfunction (CAD) was characterized by mean Banff degree (revised 2005/2007 criteria) with the data of renal biopsy material. Renal tissue was recovered during routined biopsy. We assessed antibody-mediated rejection, borderline changes, T-cell-mediated rejection, interstitial fibrosis and tubular atropthy, and other changes. Grades: Grade I. Mild interstitial fibrosis and tubular atrophy (<25% of cortical area) II. Moderate (26-50%) III. Severe (>50%) (may include non-specific vascular and glomerular sclerosis) | Posted | Sep 2010 | Mean | Standard Deviation | Scores on a Banff scale | day 180 after Tx (transplantation) |
|
6 months
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Paricalcitol Treatment | 6-8 μg daily per os without special diet |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Hypercalcemia | Endocrine disorders | MedDRA (10.0) | Systematic Assessment |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Pain | General disorders | MedDRA (10.0) | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Alexander Kharlamov | Ural Institute of Cardiology, Ural State Medical Academy | +79638547663 | drskharlamov@gmail.com |
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| ID | Term |
|---|---|
| D059347 | Cardio-Renal Syndrome |
| ID | Term |
|---|---|
| D051437 | Renal Insufficiency |
| D007674 | Kidney Diseases |
| D014570 | Urologic Diseases |
| D052776 | Female Urogenital Diseases |
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| ID | Term |
|---|---|
| C084656 | paricalcitol |
| D002117 | Calcitriol |
| D002762 | Cholecalciferol |
| D019386 | Alendronate |
| D019587 | Dietary Supplements |
| D004032 | Diet |
| D016082 | Solar System |
| D005502 | Food |
| ID | Term |
|---|---|
| D004100 | Dihydroxycholecalciferols |
| D006887 | Hydroxycholecalciferols |
| D002782 | Cholestenes |
| D002776 | Cholestanes |
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Not provided
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| Calcitriol | Drug | calcitriol group (2-4 μg daily orally under with dietary restrictions of vitamin D) |
|
|
| Cholecalciferol | Drug | cholecalciferol group (intake of cholecalciferol with recommended daily allowance equals 1200-2400 IU per day) |
|
|
| Supplemental | Dietary Supplement | intake of cholecalciferol in food and multivitamins, less than 400-900 IU per day |
|
|
| on day 180 after Tx (transplantation) |
| GFR (Glomerular Filtration Rate) | Estimated glomerular filtration rate (eGFR) was calculated using the abbreviated form of the Modification of Diet in Renal Disease (MDRD) study equation: eGFR = exp (5.228 - 1.154 × ln (serum creatinine) - 0.203 × ln (age). Concerning of GFR with Tc99m DTPA renography was used for the complex analysis of renal function. Camera based GFR estimated from Tc99m DTPA renography was named Gates GFR. | on day 180 |
| CAD (Chronic Allograft Dysfunction) Degree | CAD degree measured by Banff score after routine renal biopsy (revised 2005/2007 criteria). We assessed antibody-mediated rejection, borderline changes, T-cell-mediated rejection, interstitial fibrosis and tubular atropthy, and other changes. Grades: Grade I. Mild interstitial fibrosis and tubular atrophy (<25% of cortical area) II. Moderate (26-50%) III. Severe (>50%) (may include non-specific vascular and glomerular sclerosis) | on day 90 |
| Serum Creatinine | After an overnight fast, plasma concentrations of hemoglobin, creatinine, cholesterol, glucose, total calcium, and phosphate were measured using an autoanalyzer as described by Adorini L. (2005) | on day 180 after Tx |
| Number of Circulating SP (Side Population) Stem-Progenitor Cells | Renal cells and solid tissue were obtained from the normal portion of cortex obtained from surgically removed kidneys or by standart biopsy on day 180. Cytofluorimetric analysis and immunofluorescence were performed as described by Oliver J.A. (2004). Sorting and analysis of different cells was done on a FACS (fluorescent activated cell sorting) and by flow cytometry. Cells were analyzed with EPICS systems (Beckman Coulter). Quantification of mRNA expression was achieved using Assays-on-Demand gene expression kits and the ABI PRISM 7000 Sequence Detection System (Applied Biosystem). | on day 180 |
| VDR (Vitamin D Receptor) Expression in Myocardium | VDR content was determined by using an ELISA developed in this laboratory. The protein concentration of the homogenates was determined by the method of Bradford (1976), using BSA as a standard. | on day 180 |
| VDR (Vitamin D Receptor) Expression in Kidney | VDR content was determined by using an ELISA developed in this laboratory. The protein concentration of the homogenates was determined by the method of Bradford (1976), using BSA as a standard. | on day 180 |
| Systolic Blood Pressure | SBP measured by routine method | on day 180 |
| Coronary Calcium Score | Bone mineral density assessed by dual-energy X-ray absorptiometry (DXA) of the whole body, lumbar spine and hip was performed using Hologic scanners (QDR 1000W or QDR 2000). The total Agatston coronary calcium score (CCS) was measured as the sum of calcified plaque scores of all the coronary arteries. The amount of calcium present in the coronary arteries is scored according to the Agatson scale, as follows: 0 - no identifiable disease; 1 to 99 - mild disease; 100 to 399 - moderate disease; 400 or higher - severe disease. | on day 180 |
| Yekaterinburg |
| 620144 |
| Russia |
| BG002 | Cholecalciferol | alendronate sodium/ cholecalciferol capsules with recommended daily allowance equals 1200-2400 IU per day |
| BG003 | Supplemental | intake of cholecalciferol in food and multivitamins, less than 400-900 IU per day |
| BG004 | Total | Total of all reporting groups |
| Participants |
|
| Age, Continuous | Mean | Standard Deviation | years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Region of Enrollment | Number | participants |
|
2-4 μg daily orally under with dietary restrictions of vitamin D |
| OG002 | Cholecalciferol | alendronate sodium/ cholecalciferol capsules with recommended daily allowance equals 1200-2400 IU per day |
| OG003 | Supplemental | intake of cholecalciferol in food and multivitamins, less than 400-900 IU per day |
|
|
|
| Secondary | Heart Failure (HF) | NYHA (New York Heart Association) functional class verified with veloergometry probe and by NYHA clinical classification NYHA Class Symptoms I No symptoms and no limitation in ordinary physical activity, e.g. shortness of breath when walking, climbing stairs etc. II Mild symptoms and slight limitation during ordinary activity. III Marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g. walking short distances (20-100 m). Comfortable only at rest. IV Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients. | A total of 120 patients (Russian and dutch caucasian, kidney recipients with vitamin D deficiency defined as 25(OH)D < 40 nmol/l) were assigned. Analysis was per protocol. | Posted | Mean | Standard Deviation | NYHA functional class of HF | on day 180 after Tx (transplantation) |
|
|
|
|
| Secondary | GFR (Glomerular Filtration Rate) | Estimated glomerular filtration rate (eGFR) was calculated using the abbreviated form of the Modification of Diet in Renal Disease (MDRD) study equation: eGFR = exp (5.228 - 1.154 × ln (serum creatinine) - 0.203 × ln (age). Concerning of GFR with Tc99m DTPA renography was used for the complex analysis of renal function. Camera based GFR estimated from Tc99m DTPA renography was named Gates GFR. | Posted | Sep 2010 | Mean | Standard Deviation | ml/min/1.73 m^2 | on day 180 |
|
|
|
|
| Secondary | CAD (Chronic Allograft Dysfunction) Degree | CAD degree measured by Banff score after routine renal biopsy (revised 2005/2007 criteria). We assessed antibody-mediated rejection, borderline changes, T-cell-mediated rejection, interstitial fibrosis and tubular atropthy, and other changes. Grades: Grade I. Mild interstitial fibrosis and tubular atrophy (<25% of cortical area) II. Moderate (26-50%) III. Severe (>50%) (may include non-specific vascular and glomerular sclerosis) | Posted | Sep 2010 | Mean | Standard Deviation | Scores on a Banff scale | on day 90 |
|
|
|
|
| Secondary | Serum Creatinine | After an overnight fast, plasma concentrations of hemoglobin, creatinine, cholesterol, glucose, total calcium, and phosphate were measured using an autoanalyzer as described by Adorini L. (2005) | Posted | Sep 2010 | Mean | Standard Deviation | mg/dL | on day 180 after Tx |
|
|
|
|
| Secondary | Number of Circulating SP (Side Population) Stem-Progenitor Cells | Renal cells and solid tissue were obtained from the normal portion of cortex obtained from surgically removed kidneys or by standart biopsy on day 180. Cytofluorimetric analysis and immunofluorescence were performed as described by Oliver J.A. (2004). Sorting and analysis of different cells was done on a FACS (fluorescent activated cell sorting) and by flow cytometry. Cells were analyzed with EPICS systems (Beckman Coulter). Quantification of mRNA expression was achieved using Assays-on-Demand gene expression kits and the ABI PRISM 7000 Sequence Detection System (Applied Biosystem). | Posted | Sep 2010 | Mean | Standard Deviation | per cent of SP cells | on day 180 |
|
|
|
|
| Secondary | VDR (Vitamin D Receptor) Expression in Myocardium | VDR content was determined by using an ELISA developed in this laboratory. The protein concentration of the homogenates was determined by the method of Bradford (1976), using BSA as a standard. | Posted | Sep 2010 | Mean | Standard Deviation | fmol VDR/ mg protein | on day 180 |
|
|
|
|
| Secondary | VDR (Vitamin D Receptor) Expression in Kidney | VDR content was determined by using an ELISA developed in this laboratory. The protein concentration of the homogenates was determined by the method of Bradford (1976), using BSA as a standard. | Posted | Sep 2010 | Mean | Standard Deviation | fmol VDR/ mg protein | on day 180 |
|
|
|
|
| Secondary | Systolic Blood Pressure | SBP measured by routine method | Posted | Sep 2010 | Mean | Standard Deviation | mmHg | on day 180 |
|
|
|
|
| Secondary | Coronary Calcium Score | Bone mineral density assessed by dual-energy X-ray absorptiometry (DXA) of the whole body, lumbar spine and hip was performed using Hologic scanners (QDR 1000W or QDR 2000). The total Agatston coronary calcium score (CCS) was measured as the sum of calcified plaque scores of all the coronary arteries. The amount of calcium present in the coronary arteries is scored according to the Agatson scale, as follows: 0 - no identifiable disease; 1 to 99 - mild disease; 100 to 399 - moderate disease; 400 or higher - severe disease. | Posted | Sep 2010 | Mean | Standard Deviation | units on a scale | on day 180 |
|
|
|
|
| 9 |
| 30 |
| 10 |
| 30 |
| EG001 | Calcitriol Treatment | 2-4 μg daily orally under with dietary restrictions of vitamin D | 21 | 30 | 15 | 30 |
| EG002 | Cholecalciferol | alendronate sodium/ cholecalciferol capsules with recommended daily allowance equals 1200-2400 IU per day | 6 | 30 | 9 | 30 |
| EG003 | Supplemental | intake of cholecalciferol in food and multivitamins, less than 400-900 IU per day | 8 | 30 | 9 | 30 |
| Myocardial infarction | Cardiac disorders | MedDRA (10.0) | Systematic Assessment |
|
| Stroke | Nervous system disorders | MedDRA (10.0) | Systematic Assessment |
|
| Hypophospatemia | Endocrine disorders | MedDRA (10.0) | Systematic Assessment |
|
| Fatigue | General disorders | MedDRA (10.0) | Systematic Assessment |
|
| Viral Infection | Infections and infestations | MedDRA (10.0) | Systematic Assessment |
|
| Allergic Infection | Immune system disorders | MedDRA (10.0) | Systematic Assessment |
|
| Headache | Nervous system disorders | MedDRA (10.0) | Systematic Assessment |
|
| Abdominal Pain | Gastrointestinal disorders | MedDRA (10.0) | Systematic Assessment |
|
| Back Pain | Nervous system disorders | MedDRA (10.0) | Systematic Assessment |
|
| General Infection | Infections and infestations | MedDRA (10.0) | Systematic Assessment |
|
| Asthenia | General disorders | MedDRA (10.0) | Systematic Assessment |
|
| Chest Pain | General disorders | MedDRA (10.0) | Systematic Assessment |
|
| Fever | General disorders | MedDRA (10.0) | Systematic Assessment |
|
| Infection Fungal | Infections and infestations | MedDRA (10.0) | Systematic Assessment |
|
| Conjuctivitis | Eye disorders | MedDRA (10.0) | Systematic Assessment |
|
| Photophobia | Eye disorders | MedDRA (10.0) | Systematic Assessment |
|
| Decreased libido | General disorders | MedDRA (10.0) | Systematic Assessment |
|
| Increased hypertension | Cardiac disorders | MedDRA (10.0) | Systematic Assessment |
|
| Hypotension | Cardiac disorders | MedDRA (10.0) | Systematic Assessment |
|
| Syncope | Cardiac disorders | MedDRA (10.0) | Systematic Assessment |
|
| Cardiac arrhythmias | Cardiac disorders | MedDRA (10.0) | Systematic Assessment |
|
| Anorexia | Psychiatric disorders | MedDRA (10.0) | Systematic Assessment |
|
| Diarrhea | Gastrointestinal disorders | MedDRA (10.0) | Systematic Assessment |
|
| Nausea | Gastrointestinal disorders | MedDRA (10.0) | Systematic Assessment |
|
| Vomiting | Gastrointestinal disorders | MedDRA (10.0) | Systematic Assessment |
|
| Constipation | Gastrointestinal disorders | MedDRA (10.0) | Systematic Assessment |
|
| Gastroenteritis | Gastrointestinal disorders | MedDRA (10.0) | Systematic Assessment |
|
| Taste perversions | Gastrointestinal disorders | MedDRA (10.0) | Systematic Assessment | Predominantly metallic taste |
|
| Polydipsia | Gastrointestinal disorders | MedDRA (10.0) | Systematic Assessment |
|
| Esophageal ulcer | Gastrointestinal disorders | MedDRA (10.0) | Systematic Assessment |
|
| Edema | Metabolism and nutrition disorders | MedDRA (10.0) | Systematic Assessment |
|
| Dehydration | Metabolism and nutrition disorders | MedDRA (10.0) | Systematic Assessment |
|
| Arthritis | Musculoskeletal and connective tissue disorders | MedDRA (10.0) | Systematic Assessment |
|
| Leg Cramps | Musculoskeletal and connective tissue disorders | MedDRA (10.0) | Systematic Assessment |
|
| Dizziness | Nervous system disorders | MedDRA (10.0) | Systematic Assessment |
|
| Vertigo | Nervous system disorders | MedDRA (10.0) | Systematic Assessment |
|
| Somnolence | Nervous system disorders | MedDRA (10.0) | Systematic Assessment |
|
| Depression | Nervous system disorders | MedDRA (10.0) | Systematic Assessment |
|
| Rhinitis | Respiratory, thoracic and mediastinal disorders | MedDRA (10.0) | Systematic Assessment |
|
| Bronchitis | Respiratory, thoracic and mediastinal disorders | MedDRA (10.0) | Systematic Assessment |
|
| Increased Cough | Respiratory, thoracic and mediastinal disorders | MedDRA (10.0) | Systematic Assessment |
|
| Sinusitis | Respiratory, thoracic and mediastinal disorders | MedDRA (10.0) | Systematic Assessment |
|
| Rash | Skin and subcutaneous tissue disorders | MedDRA (10.0) | Systematic Assessment |
|
| Pruritus | Skin and subcutaneous tissue disorders | MedDRA (10.0) | Systematic Assessment |
|
| Skin Ulcer | Skin and subcutaneous tissue disorders | MedDRA (10.0) | Systematic Assessment |
|
| Urinary Tract Infection | Renal and urinary disorders | MedDRA (10.0) | Systematic Assessment |
|
| Polyuria | Renal and urinary disorders | MedDRA (10.0) | Systematic Assessment |
|
Not provided
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| D005261 |
| Female Urogenital Diseases and Pregnancy Complications |
| D000091642 | Urogenital Diseases |
| D052801 | Male Urogenital Diseases |
| D006333 | Heart Failure |
| D006331 | Heart Diseases |
| D002318 | Cardiovascular Diseases |
| D013256 |
| Steroids |
| D000072473 | Fused-Ring Compounds |
| D011083 | Polycyclic Compounds |
| D013261 | Sterols |
| D014807 | Vitamin D |
| D012632 | Secosteroids |
| D008563 | Membrane Lipids |
| D008055 | Lipids |
| D004164 | Diphosphonates |
| D063065 | Organophosphonates |
| D009943 | Organophosphorus Compounds |
| D009930 | Organic Chemicals |
| D000066888 | Diet, Food, and Nutrition |
| D010829 | Physiological Phenomena |
| D019602 | Food and Beverages |
| D009747 | Nutritional Physiological Phenomena |
| D055587 | Astronomical Objects |
| D055580 | Astronomical Phenomena |
| D055585 | Physical Phenomena |