The roles of the skeleton and phosphorus in the CKD mineral bone disorder.
The roles of the skeleton and phosphorus in the CKD mineral bone disorder.
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DOI：
10.1053/j.ackd.2011.01.001
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发表时间：
2011-03
影响因子：
2.9
通讯作者：
Mathew S
中科院分区：
文献类型：
--
作者：
Hruska KA;Mathew S
CKD矿物质骨疾病是一个新术语，用于描述多器官系统衰竭，这是导致肾功能下降的心血管死亡率和发病率过高的主要原因。这种综合症体现了器官与器官通讯的新发现，包括骨骼激素成纤维细胞生长因子-23（FGF-23），它可以发出骨骼矿物质沉积到肾脏的状态信号。CKD矿物质骨疾病开始于影响骨骼的肾功能的轻度降低（阶段2 CKD），如通过增加的FGF-23分泌所标记的。在这个阶段，心血管风险的刺激已经开始，FGF-23水平的增加强烈预测心血管事件。在CKD后期，当FGF-23和高甲状旁腺素不再足以维持磷酸盐排泄时，高磷酸盐血症加重。高磷酸盐血症已被证明是一种直接刺激几种细胞类型，包括血管平滑肌细胞迁移到动脉粥样硬化斑块的新生内膜。磷刺激成骨细胞分泌FGF-23和成骨细胞转录组的表达，从而增加动脉粥样硬化斑块、肥大软骨和骨骼成骨细胞表面的细胞外基质矿化。因此，通过磷、FGF-23和其他新发现的骨骼激素如骨钙素的作用，骨骼在CKD心血管发病率的发生中起重要作用。
The CKD mineral bone disorder is a new term coined to describe the multiorgan system failure that is a major component of the excess cardiovascular mortality and morbidity complicating decreased kidney function. This syndrome embodies new discoveries of organ-to-organ communication including the skeletal hormone fibroblast growth factor-23 (FGF-23), which signals the status of skeletal mineral deposition to the kidney. The CKD mineral bone disorder begins with mild decreases in kidney function (stage 2 CKD) affecting the skeleton, as marked by increased FGF-23 secretion. At this stage, the stimulation of cardiovascular risk has begun and the increases in FGF-23 levels are strongly predictive of cardiovascular events. Later in CKD, hyperphosphatemia ensues when FGF-23 and hyperparathyroidism are no longer sufficient to maintain phosphate excretion. Hyperphosphatemia has been shown to be a direct stimulus to several cell types including vascular smooth muscle cells migrating to the neointima of atherosclerotic plaques. Phosphorus stimulates FGF-23 secretion by osteocytes and expression of the osteoblastic transcriptome, thereby increasing extracellular matrix mineralization in atherosclerotic plaques, hypertrophic cartilage, and skeletal osteoblast surfaces.In CKD, the skeleton positively contributes to hyperphosphatemia through excess bone resorption and inhibition of matrix mineralization. Thus, through the action of phosphorus, FGF-23, and other newly discovered skeletal hormones, such as osteocalcin, the skeleton plays an important role in the occurrence of cardiovascular morbidity in CKD.
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DOI：
10.1056/nejmoa0706130
发表时间：
2008-08-07
期刊：
The New England journal of medicine
影响因子：
--
作者：
Gutiérrez OM;Mannstadt M;Isakova T;Rauh-Hain JA;Tamez H;Shah A;Smith K;Lee H;Thadhani R;Jüppner H;Wolf M
通讯作者：
Wolf M
影响因子：
15.9
作者：
Gupta, A;Guo, XL;Hruska, KA
通讯作者：
Hruska, KA
影响因子：
13.2
作者：
Ahmed, S;O'Neill, KD;Moe, SM
通讯作者：
Moe, SM
影响因子：
64.8
作者：
BROWN, EM;GAMBA, G;HEBERT, SC
通讯作者：
HEBERT, SC
影响因子：
4
作者：
Beck, GR
通讯作者：
Beck, GR