Abnormalities of Calcium, Phosphorus and Vitamin D Metabolism with Proximal Renal Tubular Dysfunction in Subjects Environmetally Exposed to Cadmium
Abnormalities of Calcium, Phosphorus and Vitamin D Metabolism with Proximal Renal Tubular Dysfunction in Subjects Environmetally Exposed to Cadmium
复制标题
镉环境暴露者钙、磷、维生素D代谢异常及近端肾小管功能障碍
DOI：
--
复制
发表时间：
1993
期刊：
影响因子：
--
通讯作者：
M. Kasuya
中科院分区：
文献类型：
--
作者：
K. Aoshima;T. Katoh;H. Teranishi;H. Horiguchi;M. Kasuya
对日本富山县金足河流域镉污染地区21名男性和13名女性肾小管功能障碍患者的钙、磷和维生素D代谢进行了检测。所有受试者均检测到多发近端肾小管功能障碍，表现为FE β 2-m和FFua升高，广泛性氨基酸尿和肾性血糖升高。管状再吸收磷酸盐的能力降低导致31%的女性出现低磷血症。尽管钙的小管重吸收减少，但所有受试者的血清钙水平仍保持正常。血清中25-羟基维生素d [25OHD]经1 α -羟基化作用在近端小管中产生的1,25-二羟基维生素d [1,25(OH)2D]正常或升高至60pg/ml以上。血清1,25(OH)2D水平与男性和女性的肌酐清除率呈负相关（p < 0.05）。血清iPTH轻微升高至0.9 mg/ml以上，而其他激素水平，包括25OHD、降钙素、甲状腺素（T4）和三碘甲状腺原氨酸（T3）均正常。血清碱性磷酸酶活性和骨钙素浓度均显著高于对照组。通过骨密度测量检测到的骨质流失在女性受试者中尤为突出。这些结果支持了在镉致肾小管功能障碍中，血清磷酸盐浓度比血清125 (OH)2D浓度更重要的骨代谢异常的假设。
Calcium, phosphorus and vitamin D metabolism were examined in 21 male and 13 female subjects with renal tubular dysfunction in the cadmium-polluted Jinzu River basin in Toyama prefecture, Japan. Multiple proximal renal tubular dysfunction was detected in all subjects showing increased FE beta 2-m and FFua, generalized aminoaciduria and renal glucosuria. Reduced ability of tubular reabsorption of phosphate resulted in hypophosphatemia in 31% of the women. Despite decreased tubular reabsorption of calcium, the level of serum calcium remained normal in all subjects. Serum 1,25-dihydroxyvitamin-D [1,25(OH)2D], which is produced in the proximal tubules through 1 alpha-hydroxylation from 25-hydroxyvitamin-D [25OHD], was normal or increased to more than 60pg/ml. The serum level of 1,25(OH)2D was inversely related to creatinine clearance in both the men (p < 0.05) and women (p < 0.01). Serum iPTH was slightly increased to more than 0.9 mg/ml, whereas the levels of other hormones, including 25OHD, calcitonin, thyroxine (T4) and triiodothyronine (T3) were normal. The serum alkaline phosphatase activity and serum osteocalcin concentration were significantly increased compared to those of controls in both sexes. Bone loss detected by the measurement of bone density was prominent in female subjects. These results support the hypothesis that the serum phosphate concentration is more important than the serum concentration of 1,25(OH)2D for abnormalities of bone metabolism in cadmium-induced renal tubular dysfunction.