Mineral Metabolism in Children with End Stage Renal Failure

  • Russell W. Chesney
Part of the Developments in Nephrology book series (DINE, volume 17)

Abstract

Abnormalities in calcium and phosphate balance which beset children with chronic renal insufficiency have been recognized for over a century (1). The intestinal malabsorption of calcium characteristic of uremic children results in severe secondary hyperparathyroidism and indicates dysfunction of the vitamin D endocrine system (2). The finding that these children are resistant to conventional doses of vitamin D can be explained by the discovery of Kodicek and Lawson, Norman and Haussler and DeLuca’s group that the kidney is an essential organ in the biotransformation of vitamin D to more active metabolites (3). This endocrine function of the kidney now excludes vitamin D as “a vitamin” since one of the renal synthesized metabolites — 1,25(OH)2 vitamin D (1,25(OH)2D)-acts at target tissues remote from the site of its production such as the intestine and bone (Fig. 1). The hormonally active form of vitamin D appears to be 1,25(OH)2D since it is responsible for active intestinal calcium and phosphate absorption, since it releases calcium from the greatest body depot of minerals — bone — and since it probably contributes to calcium and phosphate conservation by the kidney (4). Again, since many other vitamin D metabolites — among them 24,25(OH)2 vitamin D; 25,26(OH)2 vitamin D and 25(OH)D — 23,26— lactone — as well as 1,25(OH)2D, are produced by the kidney, it is to be anticipated that the blood levels of these metabolites would be reduced in uremic individuals. Indeed, at least 3 groups have reported that a significant reduction in the circulating values of 1,25(OH)2D occurs in children experiencing renal diseases and whose creatinine clearance is under 50 ml/min/1.73M2 (5–7) and a significant decline in 24,25(OH)2D has been reported as well (5) with end stage renal disease; the values of 1,25(OH)2D and 24,25(OH)2D fall even farther and many of the findings of vxtamin D deficiency develop (8). This chapter is an attempt to outline how changes in the circulating level of 1,25(OH)2D brought about by uremia result in malfunction of the vitamin D — endocrine system and how this influences overall mineral balance in the child with end-stage renal failure.

Keywords

Toxicity Phosphorus Creatinine Assure Oxalate 

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© Martinus Nijhoff Publishing, Boston 1987

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  • Russell W. Chesney

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