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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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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DOI: https://doi.org/10.1007/BF02375683