FGF-23 and sFRP-4 in chronic kidney disease and post-renal transplantation
FGF-23 and sFRP-4 in chronic kidney disease and post-renal transplantation
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DOI：
10.1159/000093277
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发表时间：
2006-01-01
影响因子：
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通讯作者：
Brown, Alex J.
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文献类型：
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作者：
Pande, Sangeeta;Ritter, Cynthia S.;Brown, Alex J.
背景：磷酸钙成纤维细胞生长因子-23 (FGF-23) 和 FRP-4 是肾小管磷酸盐重吸收的抑制剂，可能在与慢性肾病 (CKD) 相关的高磷血症或与肾移植相关的低磷血症中发挥作用。方法：测定CKD各阶段患者血浆FGF-23、FRP-4、磷和甲状旁腺激素。在使用或不使用治疗性磷酸盐结合剂的情况下，在终末期肾病患者中检查了 FGF-23 和分泌型卷曲相关蛋白 4 (sFRP-4) 的磷酸盐调节。在肾移植患者中，移植前和移植后4-5天测定血浆FGF-23、sFRP-4和磷浓度。结果：在 CKD 患者中，血浆 FGF-23 与肌酐清除率（r(2) = -0.584，p < 0.0001）和血浆磷（r(2) = 0.347，p < 0.001）相关，在终末期肾病患者中，血浆 FGF-23 与血浆磷（r(2) = 0.448，p < 0.001）相关。磷酸盐结合剂戒除增加了 FGF-23 水平。在肾移植患者中，移植后 4-5 天观察到 FGF-23 (-88.8 +/- 5.4%) 和磷 (-64 +/- 10.2%) 急剧下降。在移植后低磷血症患者中，FGF-23 水平与血浆磷呈负相关（r(2) = 0.661，p < 0.05）。在 CKD 或终末期肾病患者中，sFRP-4 水平不随肌酐清除率或高磷血症而变化，并且移植后 sFRP-4 水平与低磷血症之间没有关系。结论：在 CKD 中，FGF-23 水平随着肌酐清除率降低和血浆磷水平升高而升高，并在移植后迅速降低，表明 FGF-23 被肾脏清除。残留的 FGF-23 可能导致移植后患者出现低磷血症。
Background: The phosphatonins fibroblast growth factor-23 (FGF-23) and FRP-4 are inhibitors of tubular phosphate reabsorption that may play a role in the hyperphosphatemia associated with chronic kidney disease (CKD) or in the hypophosphatemia associated with renal transplants. Methods: Plasma FGF-23, FRP- 4, phosphorus and parathyroid hormone were measured in patients at all stages of CKD. Phosphate regulation of FGF-23 and secreted frizzled related protein-4 (sFRP-4) was examined in end-stage renal disease patients in the presence and absence of therapeutic phosphate binder usage. In renal transplant patients, plasma FGF-23, sFRP-4 and phosphorus concentrations were determined before and 4-5 days after transplantation. Results: Plasma FGF-23 correlated with creatinine clearance (r(2) = -0.584, p < 0.0001) and plasma phosphorus (r(2) = 0.347, p < 0.001) in CKD patients and with plasma phosphorus (r(2) = 0.448, p < 0.001) in end-stage renal disease patients. Phosphate binder withdrawal increased FGF-23 levels. In kidney transplant patients, dramatic decreases in FGF-23 (-88.8 +/- 5.4%) and phosphorus (-64 +/- 10.2%) were observed by 4-5 days post-transplantation. In patients with post-transplant hypophosphatemia, FGF-23 levels correlated inversely with plasma phosphorus (r(2) = 0.661, p < 0.05). sFRP-4 levels did not change with creatinine clearance or hyperphosphatemia in CKD or end-stage renal disease patients, and no relation was noted between post-transplant sFRP-4 levels and hypophosphatemia. Conclusions: In CKD, FGF-23 levels rose with decreasing creatinine clearance rates and increasing plasma phosphorus levels, and rapidly decreased post-transplantation suggesting FGF-23 is cleared by the kidney. Residual FGF-23 may contribute to the hypophosphatemia in post-transplant patients.