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Phosphate-induced PTH stimulation and calcitriol treatment in children with early chronic renal insufficiency

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Abstract

Seven children with early chronic renal insufficiency and without any evidence of abnormal bone metabolism, received an iv infusion of phosphate over 30 min. Serum concentrations of P, Ca, INS-PTH and 1,25(OH)2D3 were determined before and after the infusion for 3.5 hours. The patients underwent the same infusion test after a 3-month course with oral calcitriol. Before treatment, baseline calcium and phosphorus were within normal limits, INS-PTH level was slightly above the normal range while, although within normal limits, 1,25(OH)2D3 was significantly (p<0.05) lower than in normal controls. The same baseline biochemical findings were observed after treatment with calcitriol, except for a significant (p<0.05) increase in 1,25(OH)2D3 whose plasma concentrations had returned to the level of normal controls. The time course of phosphorus and calcium was similar both before and after calcitriol treatment. However, the INS-PTH response to phosphate load was significantly less pronounced after treatment, with peak levels of 41.9±9.4 pg/ml versus 35.7±7.6 respectively before and after treatment. During the infusion of phosphate, a significant drop in 1,25(OH)2D3 was also observed, but the decrease itself was significantly more important before than after calcitriol.

This study demonstrates that, in children with early chronic renal insufficiency, a 12-week course with low dose calcitriol significantly reduces phosphate-induced PTH secretion. This is more likely to be a direct effect of calcitriol on the parathyroid glands than an effect mediated by calcium. This suggests the possible usefulness of low dose calcitriol treatment in preventing the development of overt secondary hyperparathyroidism.

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References

  1. Memmos DE, Eastwood JB, Talner LB et al: Double-blind trial of oral 1,25-dihydroxy vitamin D versus placebo in asymptomatic hyperparathyroidism in patients receiving maintenance haemodialysis. Br Med J 282: 1919–1924, 1981

    CAS  Google Scholar 

  2. Baker L, Abrams L, Roe C et al.: 1,25 (OH)2H3 administration in moderate renal failure; a prospective double-blind trial. Kidney Int 35: 661–669, 1989

    CAS  PubMed  Google Scholar 

  3. Quarles LD, Davidai GA, Schwab SJ et al.: Oralcalcitriol and calcium: efficient therapy for uremic hyperparathyroidism. Kidney Int 34: 840–844, 1988

    CAS  PubMed  Google Scholar 

  4. Slatopolsky E, Lopez-Hilker S, Delmez J et al.: The parathyroid-calcitriol axis in health and chronic renal failure. Kidney Int 38 (suppl. 29): S41-S47, 1990

    Google Scholar 

  5. Feinfeld D and Sherwood L: Parathyroid hormone and 1,25 (OH)2D3 in chronic renal failure. Kidney Int 33: 1049–1058, 1988

    CAS  PubMed  Google Scholar 

  6. Silver J, Neveh-Many T, Mayer H et al.: Regulation by vitamin D metabolites of parathyroid hormone gene trascription in vivo in the rat. J Clin Invest Nov 78: 1296–1301, 1986

    CAS  Google Scholar 

  7. Cantley L, Russel J, Lettieri D et al.: 1,25-Dihydroxyvitamin D3 suppresses parathyroid hormone secretion from bovine parathyroid cells in tissue culture. Endocrinology 117 (5): 2114–2119, 1985

    CAS  PubMed  Google Scholar 

  8. Bettinelli A, Bianchi ML, Mazzucchi E et al.: Acute effects of calcitriol and phosphate salts on mineral metabolism in children with hypophosphatemic rickets. J Pediatr 118 (3): 372–376, 1991

    CAS  PubMed  Google Scholar 

  9. Rivkees S, El-Hajj-Fuleihan G, Brown E et al.: Tertiary hyperparathyroidism during high phosphate therapy of familial hypophosphatemic rickers. J Clin Endocrinol Metab; 75 (6): 1514–1518, 1992

    Article  CAS  PubMed  Google Scholar 

  10. Felsenfeld A, Llach F: Parathyroid gland function in chronic renal failure. Kidney Int 43: 771–789, 1993

    CAS  PubMed  Google Scholar 

  11. Grant F, Colin P and Brown E: Rate and concentration dependence of parathyroid hormone dynamics during stepwise changes in serum ionized calcium in normal humans. J Clin Endocrinol Metab 71 (2): 370–377, 1990

    CAS  PubMed  Google Scholar 

  12. Llach F, Massry S, Singer F et al.: Skeletal resistance to endogenous parathyroid hormone in patients with early renal failure. A possible cause for secondary hyperparathyroidism. J Clin Endocrinol Metab 41 (2): 339–345, 1975

    CAS  PubMed  Google Scholar 

  13. Wilson L, Felsenfeld A, Drezner M et al.: Altered divalent ion metabolism in early renal failure: role of 1,25(OH)2D. Kidney Int 27: 565–573, 1985

    CAS  PubMed  Google Scholar 

  14. Llach F and Massry S: On the mechanism of secondary hyperparathyroidism in moderate renal insufficiency. J Clin Endocrinol Metab 61 (4): 601–605, 1985

    CAS  PubMed  Google Scholar 

  15. Cohn DV, MacGregor RR: The biosynthesis, intracellular processing and secretion of parathormone. Endocr Rev 2: 1–26, 1981

    CAS  PubMed  Google Scholar 

  16. Brown EM, LeBoff MS, Oetting M et al.: Secretory control in normal and abnormal parathyroid tissue. Recent Prog Horm Res 43: 337–382, 1987

    PubMed  Google Scholar 

  17. Hanley DA, Takatsuki K, Sultan JM et al.: Direct release of parathyroid fragments from functioning bovine parathyroid glands in vitro. J Clin Invest 62: 1247–1254, 1978

    CAS  PubMed  Google Scholar 

  18. Hanley DA, Ayer LM: Calcium-dependent release of carboxylterminal fragments of parathyroid hormone by hyperplastic human parathyroid tissue in vitro. J Clin Endocrinol Metab 63: 1075–1079, 1986

    CAS  PubMed  Google Scholar 

  19. Rodriguez M, Felsenfeld AJ, Llach F: Calcemic response to parathyroid hormone in renal failure: role of calcitriol and the effect of parathyroidectomy. Kidney Int 40: 1063–1068, 1991

    CAS  PubMed  Google Scholar 

  20. Hughes MR, Maussler MR: 1,25-dihydroxycholecalciferol receptors in parathyroid glands. J Biol Chem 253: 1065–1069, 1978

    CAS  PubMed  Google Scholar 

  21. Wecksler WR, Ross FP, Mason RS et al.: Biochemical properties of the 1,25-dihydroxy-vitamin D cytoplasmic receptors from human and chick para-t hyroid glands. Arch Biochem Biophys 201: 95–102, 1980

    Article  CAS  PubMed  Google Scholar 

  22. Delmez J, Tindira C, Grooms P et al.: Parathyroid hormone suppression by intravenous 1,25-Dihydroxyvitamin D. A role for increased sensitivity to calcium. J Clin Invest 83: 1349–1355, 1989

    CAS  PubMed  Google Scholar 

  23. Chesney RW, Hamstra AJ, Mazess RB et al.: Circulating vitamin D metabolite concentrations in childhood renal disease. Kidney Int 21: 65–69, 1982

    CAS  PubMed  Google Scholar 

  24. Rosen JF and Chesney RW: Circulating calcitriol concentrations in health and disease. J Pediatr 103: 1–17, 1983

    CAS  PubMed  Google Scholar 

  25. Portale A, Booth BE, Tsai HC et al.: Reduced plasma concentration of 1,25-dihydroxyvitamin D in children with moderate renal insufficiency. Kidney Int 21: 627–632, 1982

    CAS  PubMed  Google Scholar 

  26. Mehls O, Salusky IB: Recent advances and controversies in childhood renal osteodystrophy. Pediatr Nephrol 1: 212–223, 1987

    Article  CAS  PubMed  Google Scholar 

  27. Portale AA, Halloran BP and Curtis Morris R: Physiologic regulation of the serum concentration of 1,25-dihydroxyvitamin D by phosphorus in normal men. J Clin Invest 83: 1494–1499, 1989

    CAS  PubMed  Google Scholar 

  28. Portale AA, Halloran BP, Murphy MM et al.: Oral intake of phosphorus can determine the serum concentration of 1,25-dihydroxyvitamin D by determining its production rate in humans. J Clin Invest 77: 7–12, 1986

    CAS  PubMed  Google Scholar 

  29. Portale AA, Booth BE, Halloran BP et al.: Effect of dietary phosphorus on circulating concentrations of 1,25-dihydroxyvitamin D and immunoreactive parathyroid hormone in children with moderate renal insufficiency. J Clin Invest 73: 1580–1589, 1984

    CAS  PubMed  Google Scholar 

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Claris-Appiani, A., Ardissino, G., Porcellini, G. et al. Phosphate-induced PTH stimulation and calcitriol treatment in children with early chronic renal insufficiency. J Bone Miner Metab 12 (Suppl 1), S91–S97 (1994). https://doi.org/10.1007/BF02375683

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