Newman G H, Wade M, Hosking D J
Eur J Clin Pharmacol. 1984;27(1):41-6.
In hypoparathyroidism the absence of parathyroid hormone leads to a reduction in the absorption of calcium by renal tubular cells. In spite of treatment with vitamin D, hypercalciuria persists and normocalcaemia can only be maintained by providing the kidney with a large load of calcium. Thiazide diuretics enhance tubular calcium reabsorption and it has been suggested that they can be used as an alternative to vitamin D. Bendrofluazide in a dose of 10 mg daily was given to 9 patients with severe hypoparathyroidism in addition to their usual treatment with calcium and vitamin D. Following the introduction of Bendrofluazide the calculated renal threshold for calcium reabsorption (TmCa/GFR) increased by a mean value of 0.14 mmol/l, and the mean rise in serum calcium was 0.13 mmol/l. This increase was due to a direct effect of the drug and was not caused by salt restriction or changes in glomerular filtration rate. The rise in serum calcium is modest compared to the rise following the introduction of vitamin D and except for patients with mild hypoparathyroidism, thiazides are not an alternative to vitamin D. They may however reduce the oral calcium load required to maintain normocalcaemia.
在甲状旁腺功能减退症中，甲状旁腺激素的缺乏导致肾小管细胞对钙的吸收减少。尽管使用维生素D进行治疗，但高钙尿症仍然持续存在，只有通过给肾脏提供大量钙负荷才能维持血钙正常。噻嗪类利尿剂可增强肾小管对钙的重吸收，有人认为它们可作为维生素D的替代品。除了常规使用钙和维生素D治疗外，给9例严重甲状旁腺功能减退症患者每日服用10mg苄氟噻嗪。引入苄氟噻嗪后，计算得出的钙重吸收肾阈值（TmCa/GFR）平均升高0.14mmol/l，血清钙平均升高0.13mmol/l。这种升高是药物的直接作用所致，并非由限盐或肾小球滤过率变化引起。与引入维生素D后的升高相比，血清钙的升高幅度较小，除轻度甲状旁腺功能减退症患者外，噻嗪类药物不能替代维生素D。然而，它们可能会减少维持血钙正常所需的口服钙负荷。
