Bone and Mineral Research Unit, Instituto Reina Sofia de Investigación, REDinREN ISCIII, Hospital Universitario Central de Asturias, Universidad de Oviedo, Julián Clavería S/N, 33006 Asturias, Spain.
Pediatr Nephrol. 2010 Apr;25(4):609-16. doi: 10.1007/s00467-010-1462-9. Epub 2010 Feb 12.
At present, new compounds are available to treat secondary hyperparathyroidism, namely calcimimetics, novel phosphorus binders and also novel vitamin D receptor activators. Calcimimetics increase the sensitivity of the parathyroid gland to calcium through spatial configurational changes of the calcium-sensing receptor. In addition, experimental studies have demonstrated that calcimimetics also upregulate both the calcium-sensing receptor and the vitamin D receptor. They are efficacious in children, though the experience in paediatric chronic kidney disease is still limited. Sevelamer, lanthanum carbonate and magnesium iron hydroxycarbonate are novel phosphorus binders available on the market. Several studies have demonstrated their efficacy and safety up to 6 years, though costs are the main limitation for a wider use. Since almost all the experience available on the new phosphorus binders comes from its use in adults, studies on children are needed in order to confirm the efficacy and safety of these products. Other new salts and polymers are also being developed. New vitamin D receptor activators, such as paricalcitol, are as effective at suppressing parathyroid hormone (PTH) as the traditional vitamin D receptor activators used for the past two decades, but they have a better and safer profile, showing fewer calcaemic and phosphoraemic effects while preserving the desirable effects of the vitamin D receptor activators on the cardiovascular system, hypertension, inflammation and fibrosis. Their use in children with chronic kidney disease has revealed similar responses to those of adults. The novel compounds discussed in this review should facilitate and improve the management of mineral and bone disorders in children with chronic kidney disease.
目前，有新的化合物可用于治疗继发性甲状旁腺功能亢进症，即钙敏感受体激动剂、新型磷结合剂和新型维生素 D 受体激动剂。钙敏感受体激动剂通过钙敏感受体的空间构象变化增加甲状旁腺对钙的敏感性。此外，实验研究表明，钙敏感受体激动剂还可上调钙敏感受体和维生素 D 受体。它们在儿童中有效，尽管在儿童慢性肾脏病中的经验仍然有限。Sevelamer、碳酸镧和镁铁羟碳酸盐是市场上新型的磷结合剂。多项研究证明了它们在 6 年内的疗效和安全性，尽管成本是广泛应用的主要限制因素。由于几乎所有关于新型磷结合剂的经验都来自其在成人中的应用，因此需要对儿童进行研究以确认这些产品的疗效和安全性。其他新型盐类和聚合物也在开发中。新的维生素 D 受体激动剂，如帕立骨化醇，在抑制甲状旁腺激素 (PTH) 方面与过去 20 年使用的传统维生素 D 受体激动剂一样有效，但它们具有更好和更安全的特性，在保持维生素 D 受体激动剂对心血管系统、高血压、炎症和纤维化的理想作用的同时，减少钙和磷的影响。它们在慢性肾脏病儿童中的应用显示出与成人相似的反应。本文综述中讨论的新型化合物应有助于改善慢性肾脏病儿童矿物质和骨代谢紊乱的管理。
