Service de Néphrologie, Hôpital Tenon-Assistance Publique-Hôpitaux de Paris et Université Paris VI, Paris, France.
Transplantation. 2011 Jan 27;91(2):207-12. doi: 10.1097/TP.0b013e318200ba37.
Apart from their important role in mediating calcium homeostasis, vitamin D derivatives regulate numerous vitamin D receptor-mediated renoprotective cellular functions including cell differentiation, negative regulation of inflammation, and fibrosis. Renal models of chronic kidney injury and clinical observational studies have suggested that vitamin D analogues may protect against the epithelial-to-mesenchymal transition (EMT), interstitial inflammation, and fibrosis.
The aim of this retrospective study is to test whether oral supplementation with cholecalciferol (vitamin D3) between 3 and 12 months posttransplantation confers a structural and functional nephroprotection in a population of 64 renal transplant patients, using historical controls. We analyzed glomerular filtration rates using iohexol clearance, urinary procollagen III aminoterminal propeptide excretion, and epithelial phenotypic changes as markers of the EMT and Banff scores at 3 and 12 months after transplantation in 64 renal transplant recipients with or without cholecalciferol supplementation between months 3 and 12.
Cholecalciferol supplementation in stable renal transplant recipients did not prevent EMT, interstitial fibrosis, tubular atrophy, or renal function deterioration.
Our results challenge the experimental data, suggesting that vitamin D-analog supplementation confers nephroprotection. These findings should be confirmed by randomized prospective studies.
除了在调节钙稳态方面发挥重要作用外，维生素 D 衍生物还调节多种维生素 D 受体介导的肾保护细胞功能，包括细胞分化、炎症负调节和纤维化。慢性肾损伤的肾脏模型和临床观察性研究表明，维生素 D 类似物可能对上皮-间充质转化（EMT）、间质炎症和纤维化具有保护作用。
本回顾性研究的目的是在 64 名肾移植患者中，使用历史对照，检测在移植后 3 至 12 个月期间口服补充胆钙化醇（维生素 D3）是否能提供结构和功能的肾脏保护作用。我们使用 iohexol 清除率分析肾小球滤过率，用尿原胶原 III 氨基末端前肽排泄和上皮表型变化作为 EMT 的标志物，在移植后 3 和 12 个月用 Banff 评分分析，观察有无胆钙化醇补充的 64 例肾移植患者。
在稳定的肾移植受者中补充胆钙化醇不能预防 EMT、间质纤维化、肾小管萎缩或肾功能恶化。
我们的结果对实验数据提出了挑战，表明维生素 D 类似物补充具有肾脏保护作用。这些发现需要通过随机前瞻性研究来证实。
