HYPERPARATHYROIDISM AND 1,25-DIHYDROXYVITAMIN-D DEFICIENCY IN MILD, MODERATE, AND SEVERE RENAL-FAILURE
HYPERPARATHYROIDISM AND 1,25-DIHYDROXYVITAMIN-D DEFICIENCY IN MILD, MODERATE, AND SEVERE RENAL-FAILURE
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DOI：
10.1210/jcem-67-5-876
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发表时间：
1988-11-01
影响因子：
5.8
通讯作者：
PUSCHETT, JB
中科院分区：
文献类型：
--
作者：
PITTS, TO;PIRAINO, BH;PUSCHETT, JB
据推测，慢性肾功能衰竭的高甲状旁腺激素是由低钙血症引起的，部分原因是磷酸盐潴留和/或1，25-二羟基维生素D3 [1，25-（OH）2D 3]合成不足。然而，许多研究未能证明轻度肾衰竭患者的高磷酸盐血症或低1，25-（OH）2D水平。我们测定了21名正常受试者和51名肾功能衰竭患者的肌酐清除率（CCr）、磷排泄分数（FEP）、血清磷、离子钙、血浆N-末端PTH和1，25-（OH）2D浓度。轻度肾衰竭患者（CCr > 40 mL/min. 1.73 m2）的平均血清磷和离子钙水平正常，平均1，25-（OH）2D水平低于正常人。在中度肾功能衰竭（CCr 20-40）患者中，平均离子钙水平正常，血浆PTH水平和FEP升高，1，25-（OH）2D降低更为明显。平均离子钙水平仅在严重肾功能衰竭组（CCr < 20）中降低。1，25-（OH）2D值与Ccr呈正相关，与血浆PTH和血清磷浓度的对数呈负相关。血浆PTH的对数与CCr呈负相关，与FEP呈正相关。离子钙浓度与CCr和血浆PTH水平的对数相关性很弱。这些数据表明肾衰竭患者存在甲状旁腺功能亢进、血钙正常和1，25-（OH）2D缺乏，这与1，25-（OH）2D通过尚未确定的机制抑制甲状旁腺活性的作用一致。
It has been postulated that hyperparathyroidism in chronic renal failure results from hypocalcemia, occurring, in part, from phosphate retention and/or deficient 1,25-dihydroxy vitamin D3 [1,25-(OH)2D3] synthesis. However, many studies have failed to demonstrate hyperphosphatemia or low 1,25-(OH)2D levels in patients with mild renal failure. We measured creatinine clearance (CCr), fractional excretion of phosphorus (FEP), and serum phosphorus, ionized calcium, and plasma N-terminal PTH, and 1,25-(OH)2D concentrations in 21 normal subjects and 51 patients with renal failure. Patients with mild renal failure (CCr > 40 mL/min .cntdot. 1.73 m2) had normal mean serum phosphorus and ionized calcium and decreased mean 1,25-(OH)2D levels compared with those in normal subjects. In patients with moderate renal failure (CCr 20-40), the mean ionized calcium level was normal, plasma PTH levels and FEP were elevated, and the decrement in 1,25-(OH)2D was more pronounced. The mean ionized calcium level was decreased only in the group of patients with severe renal failure (CCr < 20). The 1,25-(OH)2D values correlated positively with Ccr and negatively with the log of plasma PTH and serum phosphorus concentrations. Log of plasma PTH correlated negatively with CCr and positively with FEP. The ionized calcium concentration correlated very weakly with CCr and the log of the plasma PTH level. These data demonstrate the presence of hyperparathyroidism, normocalcemia, and 1,25-(OH)2D deficiency in renal failure and are consistent with a role for 1,25-(OH)2D in the suppression of parathyroid activity through as yet unidentified mechanisms.