Yadav Ashok Kumar, Ramachandran Raja, Aggarwal Abhinav, Kumar Vinod, Gupta Krishan Lal, Jha Vivekanand
Department of Nephrology, Chandigarh, India.
Department of Internal Medicine and Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Nephrology (Carlton). 2018 Apr;23(4):362-365. doi: 10.1111/nep.13001.
Despite its importance in bone and cardiovascular disease in subjects with kidney disease, there are no data on fibroblast growth factor 23 (FGF23) perturbations in nephrotic syndrome. We evaluated FGF23 and markers of mineral bone metabolism in subjects with untreated NS.
In this cross-sectional study, we measured circulating levels of FGF23, 25-hydroxy vitamin D [25(OH)D], 1,25 di-hydroxy vitamin D [1,25(OH) D], serum albumin, serum calcium, phosphorus, creatinine and intact parathyroid hormone (iPTH) in 101 patients with adults onset NS and 40 healthy controls. We examined the correlation between FGF23 and markers of mineral bone metabolism.
Compared to healthy controls, subjects with NS showed reduced levels of 25(OH)D (21.76 ± 10.18 vs 35.74 ± 40.27 nmol/L, P = 0.001), 1,25(OH) D (median; 37.80 vs 73.13 pmol/L, P = 0.0001) and FGF23 (37.81 ± 20.42 vs 48.20 ± 11.60 pg/mL, P = 0.004) levels. Serum phosphorus levels were marginally, but significantly higher in subjects with nephrotic syndrome compared to healthy controls (P = 0.004). Serum iPTH levels were significantly higher in subjects with NS compared to healthy controls (52.24 ± 39.58 vs 37.90 ± 14.60 pg/mL, P = 0.028).
We conclude that FGF23 is reduced in subjects with NS compared to healthy controls. The reduced levels of Vitamin D, and urinary losses may contribute to lower levels of FGF23 in NS.
尽管成纤维细胞生长因子23（FGF23）在肾病患者的骨骼和心血管疾病中具有重要作用，但关于肾病综合征中FGF23紊乱的数据尚无报道。我们评估了未经治疗的肾病综合征患者的FGF23及矿物质骨代谢标志物。
在这项横断面研究中，我们测量了101例成人起病的肾病综合征患者和40例健康对照者的循环FGF23、25-羟基维生素D [25(OH)D]、1,25-二羟基维生素D [1,25(OH)₂D]、血清白蛋白、血清钙、磷、肌酐和完整甲状旁腺激素（iPTH）水平。我们检测了FGF23与矿物质骨代谢标志物之间的相关性。
与健康对照相比，肾病综合征患者的25(OH)D水平降低（21.76 ± 10.18 vs 35.74 ± 4 nmol/L，P = 0.001），1,25(OH)₂D水平降低（中位数；37.80 vs 73.13 pmol/L，P = 0.0001），FGF23水平降低（37.81 ± 20.42 vs 48.20 ± 11.60 pg/mL，P = 0.004）血清磷水平在肾病综合征患者中略高于健康对照，但差异有统计学意义（P = 0.004）。肾病综合征患者的血清iPTH水平显著高于健康对照（52.24 ± 39.58 vs 37.90 ± 14.60 pg/mL，P = 0.028）。
我们得出结论，与健康对照相比，肾病综合征患者的FGF23水平降低。维生素D水平降低和尿中丢失可能导致肾病综合征患者FGF23水平降低。
