Vascular calcification and uremia: what do we know?
In the last decade, the nephrology community has focused its attention on the main cause of morbidity and mortality in chronic renal failure patients: cardiovascular disease. In addition, recent studies pointed out that vascular calcification (VC) is a major cause of cardiovascular disease in the dialysis population. Interestingly, the pathogenesis of VC and soft tissue calcification in chronic kidney disease (CKD) has been extensively investigated. Nowadays we know that VC is associated not only with passive calcium phosphate deposition, but also with an active, cell-mediated process. To better understand the pathogenesis of VC in CKD, numerous regulatory proteins have been studied, because of their ability to inhibit mineral deposition in the vessels. We here examine the state of the art of those substances recognized as regulatory key factors in preventing VC in uremic conditions, such as fetuin A (alpha2-Heremans-Schmid glycoprotein), matrix gamma-carboxyglutamic acid protein, pyrophosphate, osteoprotegerin and bone morphogenetic protein. We conclude that at present it is too early to introduce these novel markers into clinical practice.
Renal Division, S. Paolo Hospital, University of Milan, Milan, Italy. mariocozzolino@hotmail.com
Mario
M
Cozzolino
Sandro
S
Mazzaferro
Francesco
F
Pugliese
Diego
D
Brancaccio
D015055:1-Carboxyglutamic Acid / Q000378:metabolism; D055419:Bone Morphogenetic Protein 7; D019485:Bone Morphogenetic Proteins / Q000378:metabolism*; D002114:Calcinosis / Q000175:diagnosis* / Q000473:pathology; D011756:Diphosphates / Q000378:metabolism; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000473:pathology; D008954:Models, Biological; D053244:Osteoprotegerin / Q000378:metabolism; D012307:Risk Factors; D016212:Transforming Growth Factor beta / Q000378:metabolism*; D014511:Uremia / Q000175:diagnosis* / Q000473:pathology; D014652:Vascular Diseases / Q000175:diagnosis* / Q000473:pathology; D000509:alpha-Fetoproteins / Q000378:metabolism
C525819:BMP7 protein, human; D055419:Bone Morphogenetic Protein 7; D019485:Bone Morphogenetic Proteins; D011756:Diphosphates; D053244:Osteoprotegerin; D016212:Transforming Growth Factor beta; D000509:alpha-Fetoproteins; D015055:1-Carboxyglutamic Acid