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Calciumstoffwechselstörungen bei Sarkoidose Inzidenz, Ausmass, Pathogenese und renale Folgeerkrankungen

Calcium metabolism in sarcoidosis frequency, pathogenesis, and consecutive renal diseases

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Summary

Determination of total and ionized serum calcium and of calcium/creatine ratio in urine collected over a 24 h period and in urine obtained in the morning after an overnight fast was performed in 38 patients with untreated sarcoidosis and a control-group of 33 healthy volunteers. In all patients with hypercalciuria abdominal x-ray in supine position was performed and in addition an intravenous urogram in those cases with a history of renal stone disease and/or renal colic. Mild hypercalcemia was only found in 3 (7.9%) of 38 patients with sarcoidosis. In 24 patients with repeated calcium determinations whole serum calcium was at times moderately elevated (>10.2 mg%) in 8 patients (33%). Elevation of ionized serum calcium was detected in 10 (27.8%) of 36 patients. In these patients mean ionized calcium concentration was significantly higher (p<0.05) than in normal controls (4.56±0.25 mg% vs. 4.45±0.13 mg%). 20 patients (52.6%) showed an elevated urinary calcium/creatinine ratio (>0.15). Calcium/creatinine ratios were significantly higher (p<0.001) in patients with sarcoidosis than in controls (0.15±0.05 vs. 0.10±0.04). Determination of calcium/creatinine ratio both in 24 h urine and in urine collected in the morning after an overnight fast showed that 12 patients were intestinal calcium hyperabsorbers, whereas 8 patients had increased mobilisation of bone calcium. Renal stone disease was found in only 3 patients (7.9%) with hypercalciuria. Our results indicate that increased calcium release from bone or intestinal hyperabsorption of calcium are responsible for the disturbed calcium metabolism in sarcoidosis. Since vitamin D metabolites have been reported to be normal in patients with sarcoidosis, intestinal calcium hyperabsorption and increased mobilisation of bone calcium may be explained by an increased and individually different sensitivity of the target organs bone and gut to vitamin D in sarcoidosis.

Zusammenfassung

Bei 38 Patienten mit unbehandelter Sarkoidose und 33 Kontrollpersonen erfolgte die Bestimmung von Gesamtcalcium und ionisiertem Calcium im Serum und des Calcium/Kreatinin-Quotienten im 24 h- und Morgenurin. Bei allen hypercalciurischen Patienten wurde eine Abdomenleeraufnahme, bei Patienten mit Stein- oder Kolikanamnese ein i.v.-Urogramm angefertigt. Bei Analyse der aktuellen Serumcalciumbestimmungen fand sich bei 3 (7,9%) von 38 Patienten eine Hypercalcämie. Bei Mitbeurteilung von Serumcalciumbestimmungen in der vorausgegangenen Kontrollperiode zeigten allerdings 8 (33%) von 24 untersuchten Patienten zuweilen eine geringgradige klinisch nicht relevante Erhöhung des Gesamtcalciums. Die ionisierte Calciumfraktion war bei 10 (27,8%) von 36 untersuchten Sarkoidosepatienten erhöht. Die mittlere Konzentration des ionisierten Serumcalciums lag bei den Sarkoidosepatienten signifikant höher (p<0,05) als in der Kontrollgruppe (4,56±0,25 mg-% vs 4,45±0,13 mg-%). Als häufigste Calciumstoffwechselstörung fand sich bei 20 Patienten (52,6%) eine Hypercalciurie (Calcium/Kreatinin-Quotient >0,15 im 24 h-Urin). Der Calcium/Kreatinin-Quotient war bei den Sarkoidosepatienten significant höher (p<0,001) als in der Kontrollgruppe (0,15±0,05 vs. 0,10±0,04). Anhand der Bestimmung des gleichen Quotienten im Morgenurin nach einer 10stündigen Fastenperiode erfolgte die pathogenetische Aufschlüsselung der Hypercalciurie: Bei 12 Patienten ist eine intestinal-absorptive Form und bei 8 Patienten eine ossär-resorptive Form der Hypercalciurie anzunehmen. Nur bei 3 Patienten (7,9%) mit Hypercalciurie fand sich eine Urolithiasis. Unsere Ergebnisse zeigen, daß eine vermehrte Calciumfreisetzung aus den Knochen oder eine intestinale Calcium-Hyperabsorption für den gestörten Calciumstoffwechsel bei Sarkoidose verantwortlich sind. Da die in der Literatur angegebenen Messwerte der Vitamin-D-Metaboliten bei Sarkoidosepatienten Normalwerte ergeben, muß eine individuell unterschiedliche Sensitivitätszunahme der Zielorgane des Vitamin D Darm und Knochen als Ursache der Calciumstoffwechselstörungen bei Sarkoidosepatienten postuliert werden.

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  1. Departement für Innere Medizin, Universitäts-Spital, Rämistr. 100, CH-8091, Zürich, Schweiz

    U. Kuhlmann, K. Finkel, U. Binswanger & W. Siegenthaler

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  1. U. Kuhlmann
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  2. K. Finkel
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  3. U. Binswanger
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  4. W. Siegenthaler
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Kuhlmann, U., Finkel, K., Binswanger, U. et al. Calciumstoffwechselstörungen bei Sarkoidose Inzidenz, Ausmass, Pathogenese und renale Folgeerkrankungen. Klin Wochenschr 58, 17–23 (1980). https://doi.org/10.1007/BF01477139

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