FGF-23 Regulation in Chronic Kidney Disease

骨疾病在患有慢性肾脏疾病（CKD）的儿科患者中普遍存在，并且导致不良反应。 结果包括生长不良、骨痛和骨折。此外，心血管疾病是 是CKD儿童和成人的主要死因，而骨骼和心血管疾病似乎是 在这个人群中。目前，钙、磷、PTH和维生素D代谢被用于 监测骨骼疾病并指导其治疗。然而，这些因素的纠正改善，但 不治愈，骨和血管病变的CKD。成纤维细胞生长因子23（FGF-23）是一种新发现的蛋白质， 23），已在患有骨病的肾功能正常的个体和动物中发现， 矿物质离子体内平衡紊乱在CKD患者中也发现高水平的蛋白质， 这些高水平与死亡率上升有关。FGF-23是在骨骼中产生的， CKD进展;然而，CKD个体中FGF-23的调节尚不清楚。因此，本研究 将评价： 1)CKD 2-4期患者FGF-23对磷酸盐结合剂治疗的反应 2)慢性肾脏病患者成纤维细胞生长因子-23及其他骨矿化相关因子的表达 阶段2-4 这些具体目标将通过评估队列中FGF-23与口服磷酸盐负荷的变化来研究 接受磷酸盐结合剂治疗的2-4期CKD患者。的关系 FGF-23和骨骼矿化将通过患者骨的免疫组织化学评价进行评估 接受骨活检的CKD患者。

Bone disease is prevalent in pediatric patients with chronic kidney disease (CKD) and leads to adverse outcomes such as poor growth, bone pain, and fractures. Furthermore, cardiovascular disease is the leading cause of death in children and adults with CKD while bone and cardiovascular disease appear to be linked in this population. Currently, calcium, phosphorus, PTH, and vitamin D metabolism are used to monitor bone disease and guide its treatment. However, correction of these factors ameliorates, but does not cure, bone and vascular lesions in CKD. A newly described protein, fibroblast growth factor 23 (FGF- 23), has been identified in individuals and animals with normal kidney function who have bone disease and disordered mineral ion homeostasis. High levels of the protein are also found in individuals with CKD and these high levels have been linked to an increased mortality rate. FGF-23 is made in bone and levels rise as CKD progresses; the regulation of FGF-23 in individuals with CKD is, however, unknown. Thus, this study will evaluate: 1) The response of FGF-23 to phosphate binder therapy in CKD stages 2-4 CKD 2) The bone expression of FGF-23 and other factors involved in skeletal mineralization in patients with CKD stages 2-4 These specific aims will be investigated by evaluating changes in FGF-23 to oral phosphate load in a cohort of patients with CKD stages 2-4 who are treated with phosphate binding agents. The relationship between FGF-23 and skeletal mineralization will be assessed by immunohistochemical evaluation of bone in patients with CKD who undergo bone biopsy.