EFFECT OF DIETARY PHOSPHORUS ON CIRCULATING CONCENTRATIONS OF 1,25-DIHYDROXYVITAMIN-D AND IMMUNOREACTIVE PARATHYROID-HORMONE IN CHILDREN WITH MODERATE RENAL-INSUFFICIENCY
EFFECT OF DIETARY PHOSPHORUS ON CIRCULATING CONCENTRATIONS OF 1,25-DIHYDROXYVITAMIN-D AND IMMUNOREACTIVE PARATHYROID-HORMONE IN CHILDREN WITH MODERATE RENAL-INSUFFICIENCY
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DOI：
10.1172/jci111365
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发表时间：
1984-01-01
影响因子：
15.9
通讯作者：
MORRIS, RC
中科院分区：
文献类型：
--
作者：
PORTALE, AA;BOOTH, BE;MORRIS, RC
对以中度肾功能不全为特征的甲状旁腺功能亢进症的病因进行了探讨。测定短期(5天)限制和补充磷对大鼠血浆1，25-(OH)2D[1，25-二羟基维生素D]浓度、血清免疫反应性甲状旁腺激素(IPTH)和磷浓度以及肾脏磷排泄分数(FEPI)的影响。在中度肾功能不全的儿童中，正常的饮食磷摄入量伴随着循环中1，25-(OH)2D浓度的下降和iPTH浓度的上升，但在一天中的任何时候都不会出现血清磷浓度的反复上升。然而，膳食磷是1，25-(OH)2D和iPTH循环浓度的主要决定因素，它们分别与膳食磷摄入量成反比和正向变化，当磷限制5天时，它们分别增加和减少到正常值。限制和补充磷可引起血清iPTH浓度的变化，这种变化与1，25-(OH)2D的血浆浓度呈负相关(r=-0.88，P<；0.001)。肾小管对饲料磷变化的生理反应在很大程度上是完整的。这些数据支持了可逆的，磷介导的对肾脏25-羟基维生素D-1，α-羟基酶的抑制，这是控制血流中1，25-(OH)2D水平的机制。
The cause of hyperparathyroidism characteristic of moderate renal insufficiency was studied. The effect of short term (5-day) restriction and supplementation of dietary intake of phosphorus on the plasma concentration of 1,25-(OH)2D [1,25-dihydroxyvitamin D], the serum concentrations of immunoreactive parathyroid hormone (iPTH) and phosphorus, and the fractional renal excretion of phosphorus (FEPi) were determined. In children with moderate renal insufficiency a normal dietary intake of phosphorus is attended by a decreased circulating concentration of 1,25-(OH)2D and an increased concentration of iPTH, but not by recurring increases in the serum concentration of phosphorus at any time of the day. Dietary phosphorus is, however, a major determinant of the circulating concentrations of 1,25-(OH)2D and iPTH, which vary inversely and directly, respectively, with dietary intake of phosphorus, and increase and decrease, respectively, to normal values when phosphorus is restricted for 5 days. Restriction and supplementation of dietary phosphorus induces changes in the serum concentration of iPTH that correlate strongly but inversely with those induced in the plasma concentration of 1,25-(OH)2D (r = -0.88, P < 0.001). The physiologic responsiveness of the renal tubule to changes in dietary phosphorus is to a substantial extent intact. The data provide support for a reversible, phosphorus-mediated suppression of renal 25-hydroxyvitamin-D-1.alpha.-hydroxylase as the mechanism controlling 1,25-(OH)2D levels in the bloodstream.