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Title: Parathyroid hormone changes during phosphorus load in patients with chronic renal insufficiency with low serum parathyroid hormone or adynamic bone disease
Authors: Cuppari, Lilian [UNIFESP]
Carvalho, A. B.
Lobao, RRS
Martini, Lígia Araújo [UNIFESP]
Cendoroglo, Miguel [UNIFESP]
Ventura, RTP
Draibe, Sergio Antonio [UNIFESP]
Universidade Federal de São Paulo (UNIFESP)
Keywords: parathyroid hormone
adynamic bone
chronic renal insufficiency
relative hypoparathyroidism
Issue Date: 1-Jul-2001
Publisher: Dustri-verlag Dr Karl Feistle
Citation: Clinical Nephrology. Oberhaching: Dustri-verlag Dr Karl Feistle, v. 56, n. 1, p. 35-43, 2001.
Abstract: Adynamic bone disease (ABD) is frequently associated with low serum parathyroid hormone (PTH) concentrations. Many clinical and therapeutic conditions have been associated with ABD, and recently, a low phosphorus intake accompanied by low serum concentration of phosphorus and PTH has been described. Aim: To evaluate the parathyroid gland response of chronic renal insufficiency patients (CRI) with low serum PTH or ABD to a phosphorus load. Methods: We examined the effects of 0.5 and 1.0 g/d of phosphorus load over a period of 60 days in 18 patients with mild CRI with a bone biopsy showing ABD (n = 7) or with low serum PTH (serum intact PTH less than or equal to 40 ng/l) and serum phosphorus < 4.5 mg/dl (n = 11). Results: Serum intact PTH increased significantly only after I g of phosphorus (58.5 to 83 ng/l) with a median percent increase of 72%. PTH secretion increased more in patients with lower basal PTH levels (81%). Serum phosphorus did not change significantly and urinary phosphorus increased from 487 to 1062 mg/dl (p < 0.05). Significant decreases in serum ionized calcium (from 1.26 to 1.19 mmol/l) and calcitriol (from 34.5 to 24.9 pg/ml) were observed. Changes in PTH were inversely correlated with changes in serum ionized calcium (r = -0.54, p < 0.05) and the final PTH concentrations were positively correlated with changes in serum phosphorus (r = 0.52, p < 0.05). Conclusions: The parathyroid glands of chronic renal insufficiency patients with relative hypoparathyroidism or ABD responded to a phosphorus load with an increase in serum PTH levels. The decrease in serum ionized calcium and calcitriol as well as minimal changes in serum phosphorus appeared to be involved in this response.
ISSN: 0301-0430
Appears in Collections:Artigo

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