Evenepoel Pieter, Meijers Bjorn K I, de Jonge Hylke, Naesens Maarten, Bammens Bert, Claes Kathleen, Kuypers Dirk, Vanrenterghem Yves
Department of Medicine, Division of Nephrology, University Hospital Leuven, B-3000 Leuven, Belgium.
Clin J Am Soc Nephrol. 2008 Nov;3(6):1829-36. doi: 10.2215/CJN.01310308. Epub 2008 Oct 15.
In the first months after successful kidney transplantation, hypophosphatemia and renal phosphorus wasting are common and related to inappropriately high parathyroid hormone (PTH) and fibroblast growth factor-23 (FGF-23) levels. Little is known about the long-term natural history of renal phosphorus homeostasis in renal transplant recipients.
DESIGN, SETTING, PARTICIPANTS: We prospectively followed parameters of mineral metabolism (including full-length PTH and FGF-23) in 50 renal transplant recipients at the time of transplantation (Tx), at month 3 (M3) and at month 12 (M12). Transplant recipients were (1:1) matched for estimated GFR with chronic kidney disease (CKD) patients.
FGF-23 levels (Tx: 2816 [641 to 10665] versus M3: 73 [43 to 111] versus M12: 56 [34 to 78] ng/L, median [interquartile range]) and fractional phosphorus excretion (FE(phos); M3: 45 +/- 19% versus M12: 37 +/- 13%) significantly declined over time after renal transplantation. Levels 1 yr after transplantation were similar to those in CKD patients (FGF-23: 47 [34 to 77] ng/L; FE(phos) 35 +/- 16%). Calcium (9.1 +/- 0.5 versus 8.9 +/- 0.3 mg/dl) and PTH (27.2 [17.0 to 46.0] versus 17.5 [11.7 to 24.4] ng/L) levels were significantly higher, whereas phosphorus (3.0 +/- 0.6 versus 3.3 +/- 0.6 mg/dl) levels were significantly lower 1 yr after renal transplantation as compared with CKD patients.
Data indicate that hyperphosphatoninism and renal phosphorus wasting regress by 1 yr after successful renal transplantation.
在肾移植成功后的最初几个月，低磷血症和肾性磷消耗很常见，且与甲状旁腺激素（PTH）和成纤维细胞生长因子-23（FGF-23）水平异常升高有关。对于肾移植受者肾磷稳态的长期自然病程了解甚少。
设计、地点、参与者：我们前瞻性地跟踪了50名肾移植受者在移植时（Tx）、第3个月（M3）和第12个月（M12）的矿物质代谢参数（包括全长PTH和FGF-23）。移植受者与慢性肾脏病（CKD）患者按估计肾小球滤过率进行（1:1）匹配。
肾移植后，FGF-23水平（Tx：2816[641至10665]对比M3：73[43至111]对比M12：56[34至78]ng/L，中位数[四分位间距]）和磷排泄分数（FE(phos)；M3：45±19%对比M12：37±13%）随时间显著下降。移植后1年的水平与CKD患者相似（FGF-23：47[34至77]ng/L；FE(phos) 35±16%）。与CKD患者相比，肾移植后1年时钙（9.1±0.5对比8.9±0.3mg/dl）和PTH（27.2[17.0至46.0]对比17.5[11.7至24.4]ng/L）水平显著更高，而磷（3.0±0.6对比3.3±0.6mg/dl）水平显著更低。
数据表明，成功肾移植后1年，高磷血症和肾性磷消耗会消退。
