title: [Frontiers in vitamin D; basic research and clinical application. Vitamin D and secondary hyperparathyroidism].
abstract: In chronic kidney disease (CKD) , phosphate retention and low 1, 25-dihydroxyvitamin D [1, 25 (OH) ₂D] due to a decrease in the number of functioning nephrons had long been considered to contribute to the pathogenesis of secondary hyperparathyroidism (SHPT) . The discovery of fibroblast growth factor 23 (FGF23) drastically changed our understanding and provided new implication of the development of SHPT. In addition, CKD impairs the maintenance of normal 25-hydoxyvitamin D [25 (OH) D] levels which can act directly on the parathyroid glands to repress PTH synthesis. Active vitamin D therapy is widely used for the treatment of SHPT. However, the active form of vitamin D, 1, 25 (OH) ₂D and its analogs increase the calcium and phosphate levels by increasing the intestinal calcium and phosphate absorption. To suppress PTH secretion without these potential complications, several vitamin D analogs including paricalcitol, maxacalcitol and doxercalciferol are already in clinical use. A novel therapeutic concept in new vitamin D therapies are expected to improve patient outcome.
authors: Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Japan.
authors: Hisae
authors: H
authors: Tanaka
authors: Hirotaka
authors: H
authors: Komaba
authors: Masafumi
authors: M
authors: Fukagawa
mesh_terms: D002118:Calcium / Q000378:metabolism; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000188:drug therapy* / Q000209:etiology* / Q000378:metabolism; D007408:Intestinal Absorption; D007676:Kidney Failure, Chronic / Q000150:complications / Q000378:metabolism; D010281:Parathyroid Hormone / Q000378:metabolism; D010710:Phosphates / Q000378:metabolism; D014807:Vitamin D / Q000031:analogs & derivatives / Q000378:metabolism / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: C000717427:FGF23 protein, human; D010281:Parathyroid Hormone; D010710:Phosphates; D014807:Vitamin D; D005346:Fibroblast Growth Factors; C097949:1,25-dihydroxyvitamin D; D000089703:Fibroblast Growth Factor-23; D002118:Calcium