Sorbonne Universités, UPMC Univ Paris 6, UMR S 1155, Paris, France; INSERM, UMR S 1155, Paris, France; Physiology Unit, AP-HP, Hôpital Tenon, Paris, France.
Sorbonne Universités, UPMC Univ Paris 6, UMR S 1155, Paris, France; INSERM, UMR S 1155, Paris, France; Urology Unit, AP-HP, Hôpital Saint-Louis, Paris, France.
Kidney Int. 2016 Oct;90(4):809-17. doi: 10.1016/j.kint.2016.05.027. Epub 2016 Jul 27.
Vitamin D supplementation in humans should be accompanied by calcium administration to avoid bone demineralization through vitamin D receptor signaling. Here we analyzed whether long-term exposure of rats to vitamin D supplementation, with or without a calcium-rich diet, would promote kidney stone formation. Four groups of rats received vitamin D alone (100,000 UI/kg/3 weeks), a calcium-enriched diet alone, both vitamin D supplementation and calcium-enriched diet, or a standard diet (controls) for 6 months. Serum and urine parameters and crystalluria were monitored. Kidney stones were assessed by 3-dimensional micro-computed tomography, infrared spectroscopy, von Kossa/Yasue staining, and field emission scanning electron microscopy. Although serum calcium levels were similar in the 4 groups, rats receiving vitamin D had a progressive increase in urinary calcium excretion over time, especially those receiving both calcium and vitamin D. However, oral calcium supplementation alone did not increase urinary calcium excretion. At 6 months, rats exposed to both calcium and vitamin D, but not rats exposed to calcium or vitamin D alone, developed significant apatite kidney calcifications (mean volume, 0.121 mm(3)). Thus, coadministration of vitamin D and increased calcium intake had a synergistic role in tubular calcifications or kidney stone formation in this rat model. Hence, one should be cautious about the cumulative risk of kidney stone formation in humans when exposed to both vitamin D supplementation and high calcium intake.
维生素 D 补充剂应与钙剂同时服用，以避免维生素 D 受体信号导致的骨质脱矿。在这里，我们分析了长期给予大鼠维生素 D 补充剂（同时或不给予高钙饮食）是否会促进肾结石形成。四组大鼠分别给予维生素 D（100,000 UI/kg/3 周）、高钙饮食、维生素 D 补充剂和高钙饮食或标准饮食（对照组）6 个月。监测血清和尿液参数及结晶尿情况。采用三维微计算机断层扫描、红外光谱、von Kossa/Yasue 染色和场发射扫描电子显微镜评估肾结石。尽管四组大鼠的血清钙水平相似，但给予维生素 D 的大鼠随着时间的推移其尿钙排泄逐渐增加，尤其是同时给予钙和维生素 D 的大鼠。然而，单独给予口服钙剂不会增加尿钙排泄。6 个月时，同时给予钙和维生素 D 的大鼠，而非单独给予钙或维生素 D 的大鼠，出现明显的磷灰石肾钙化（平均体积 0.121 mm3）。因此，在该大鼠模型中，维生素 D 和钙摄入增加的联合作用在管状钙化或肾结石形成中具有协同作用。因此，当人体同时暴露于维生素 D 补充剂和高钙摄入时，应警惕肾结石形成的累积风险。
