The effect of 1α-hydroxyvitamin D3 on renal function in normal subjects

Compston, J.E.; Dutt, Meenu; Mitchell, W. D.; Nunan, T O; Woodhead, J. S.

doi:10.1016/0221-8747(81)90012-6

Cited by 5 publications

(1 citation statement)

References 14 publications

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“…One study has reported impaired renal function [41], but this has not been confirmed. When hypercalcaemia was avoided one study reported a small and reversible decrease in glomerular filtration rate [42] not shown by others [43]. On the other hand, serum creatinine may rise for other reasons [44].…”

Section: Side Effectsmentioning

confidence: 99%

Treatment of osteoporosis with vitamin D

et al. 1997

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There are probably few more controversial areas in the pathophysiology and therapeutics of osteoporosis than that concerning the role of vitamin D and its derivatives. It has been argued that osteoporosis is in part related to defective production of calcitriol, and low values for calcitriol have been reported in postmenopausal women [1]. It is suggested that this gives rise to intestinal malabsorption of calcium, secondary hyperparathyroidism which accelerates bone turnover and thereby induces skeletal losses. Since oestrogens may stimulate the synthesis of calcitriol, at least in vitro, oestrogen withdrawal has been considered to be the signal for decreased production of calcitriol. This is, however, not the sole merchanism that could account for calcium malabsorption. It is equally plausible that oestrogen deficiency directly causes bone loss which in turn infuses the extracellular fluid with calcium, and that this in turn decreases the secretion of parathyroid hormone (PTH) and the synthesis of calcitriol. Thus, the intestinal malabsorption is a consequence of bone loss and not its cause [2].A more convincing role of disturbed metabolism of vitamin D arises in the elderly. With advancing years low values for calcitriol and increased secretion of PTH are consistently reported [1,3]. The administration of physiologically appropriate doses of parent vitamin D reverses these abnormalities [3,4]. For this reason it is probable that hyperparathyroidism is in part due to inadequacies in the nutriitional status of the elderly. Although florid osteomalacia due to vitamin D deficiency is rare [5], milder vitamin D insufficiency may be common, particularly in the institutionalized elderly. Over and above there is circumstantial evidence that abnormalities in the production of calcitriol occur due to the decline in renal function that occurs with age, which would also induce secondary hyperparathyroidism [6].In view of these uncertainties, the role of vitamin D, its analogues and metabolites in therapeutics cannot be argued from considerations of pathophysiology, but must Correspondence and offprint requsts to: Professor J. A. Kanis, WHO be judged from a pharmacodynamic perspective. From this viewpoint the principal action of vitamin D and related compounds is to increase intestinal absorption of calcium irrespective of the underlying pathophysiology and thereby to increase serum calcium, suppress PTH, suppress the turnover of bone and thus to decrease the rate of bone loss in bone-losing states [2]. Whether vitamin D has additional anabolic effects on the formation of bone is uncertain. Even if not, vitamin D treatment could be viewed as a means for the sustained delivery of calcium.The agents most widely used are the parent vitamins, calcitriol and alfacalcidol. Alfacalcidol is a synthetic .analogue of calcitriol that is metabolized to calcitriol by its 25-hydroxylation in the liver. Dihydrotachysterol (DHT) has a similar structural configuration with a pseudo-Iz-hydroxyl in the 3ß position ot the A ring. Like alfacalc...

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Section: Side Effectsmentioning

confidence: 99%

Treatment of osteoporosis with vitamin D

et al. 1997

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Star volume of marrow space and trabeculae in iliac crest: Sampling procedure and correlation to star volume of first lumbar vertebra

Vesterby¹

1990

Bone

102

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Hypoparathyroidism—a long‐term follow‐up experience with 1α‐vitamin D₃ therapy

Halabe

Arle

Mimran

et al. 1994

Clinical Endocrinology

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OBJECTIVE Previous studies have suggested that aipha-DI therapy can cause deterloration In renal functlon. We have, therefore, examlned the long-term effect of l ahydroxyvitamin D, (alpha-D,) administration upon renal function In hypoparathyroid patients. DESIGN This Is a prospective long-term foliow-up study of alpha-D, admlnlstratlon on hypoparathyroid patients at a mean dally dose of 1 pg (range 05-25 pg) durlng a total of 2040 patient-months. PATIENTS Seventeen unselected patients (14 females and 3 males), two wlth primary and 15 wlth post-surgical hypoparathyroidism. RESULTS The rlgnlflcant effect of alpha-D, on serum and urinary calcium was achieved during the first week of treatment and remained stable at the same range during the close follow-up of 2040 patlent-months. No slgniflcant Change was observed In the serum creatlnlne durlng the whole follow-up perlod. Durlng follow-up, five women developed hypercalcluria and one patient developed hypercaicaemla that disappeared when the dose of the drug was reduced or dllcontlnued. CONCLUSIONS From our study we concluded that alpha-DI Is a safe and effective drug in the long-term therapy of hypoparathyroid patients.Hypocalcaemia, hyperphosphataemia and reduced serum immunoreactive parathyroid hormone (imH) and 1.25dihydroxyvitamin D (I,25(OH)zD) concentrations are the main biochemical features of hypoparathyroidism (Balsam ef al.. 1975; Rosen ef d., 1977;Breslau & Pak, 1979).Parathyroid hormone stimulates the conversion of 25hydroxyvitamin D to 1.

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The effect of 1α-hydroxyvitamin D3 on renal function in normal subjects

Cited by 5 publications

References 14 publications

Treatment of osteoporosis with vitamin D

Treatment of osteoporosis with vitamin D

Star volume of marrow space and trabeculae in iliac crest: Sampling procedure and correlation to star volume of first lumbar vertebra

Hypoparathyroidism—a long‐term follow‐up experience with 1α‐vitamin D₃ therapy

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The effect of 1α-hydroxyvitamin D3 on renal function in normal subjects

Cited by 5 publications

References 14 publications

Treatment of osteoporosis with vitamin D

Treatment of osteoporosis with vitamin D

Star volume of marrow space and trabeculae in iliac crest: Sampling procedure and correlation to star volume of first lumbar vertebra

Hypoparathyroidism—a long‐term follow‐up experience with 1α‐vitamin D3 therapy

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Hypoparathyroidism—a long‐term follow‐up experience with 1α‐vitamin D₃ therapy