Koall W, Klette H, Kokot F, Hintner I, Mampel E
Z Gesamte Inn Med. 1982 Dec;37(23):805-9.
Under influence of the ultraviolet radiation the formerly lowered 25-hydroxycholecalciferol (25-OH-CC) level increases in persons with healthy kidneys. Such investigations were not yet carried out in patients undergoing dialysis. Since the insufficiency of active vitamin-D-metabolites plays an essential role in the development of the renal osteopathy, since 1978 in 13 patients undergoing dialysis a regular ultraviolet radiation has been performed, in order to stimulate the cutaneous vitamin-D-production. The time of observation was 31.7 +/- 14.3 months. Deionized water served for the production of dialysate. The calcium content was about 3.5 +/- 3.8 mval/l. The patients had very rarely bone and joint complaints. Severe clinical complications of renal osteopathy developed only in one female patient in the 3rd year of dialysis with a fracture of the neck of the femur as well as in a 2nd patient after transplantation of a kidney with permanently progressing demineralization and spondylitis. Controls of the courses showed only in 18.2% a progressing loss of the peripheral mineral content of the bones. The alkaline phosphatase was not increased, the alkaline bone phosphatase appeared with low and not provable activities. A suppression of the secondary hyperparathyroidism could not be proved. Parathormone was increased with 2.30 +/- 1.90 micrograms/l. The 25-OH-CC-levels were normal or slightly increased with 39.1 +/- 12.4 micrograms/l, whereas they were essentially lower in a comparative group without ultraviolet radiation. Therefore in connection with the very low rate of complications of the renal osteopathy with normalized 25-OH-CC-levels new therapeutic possibilities were the result in patients undergoing dialysis after ultraviolet radiation. The increasing importance consists also in the fact that 90% of the human vitamin-D-need are supplied via skin and it was proved by animal experiments that also after bilateral nephrectomy the formation of the active vitamin-D-metabolite 1,25-dihydroxycholecalciferol is possible by photosynthesis.
在紫外线辐射的影响下，肾脏健康者先前降低的25-羟胆钙化醇（25-OH-CC）水平会升高。尚未对接受透析的患者进行此类研究。由于活性维生素D代谢产物不足在肾性骨病的发展中起重要作用，自1978年以来，对13例接受透析的患者进行了定期紫外线照射，以刺激皮肤维生素D的生成。观察时间为31.7±14.3个月。用去离子水制备透析液。钙含量约为3.5±3.8mval/L。患者很少有骨骼和关节不适。肾性骨病的严重临床并发症仅在1例女性患者透析第3年时出现股骨颈骨折，以及在1例肾移植后患者中出现，伴有持续进展的脱矿质和脊柱炎。病程对照显示，仅18.2%的患者骨外周矿物质含量呈进行性丢失。碱性磷酸酶未升高，碱性骨磷酸酶活性低且无法检测到。继发性甲状旁腺功能亢进未得到抑制。甲状旁腺激素升高至2.30±1.90微克/升。25-OH-CC水平正常或略有升高，为39.1±12.4微克/升，而在无紫外线辐射的对照组中则显著降低。因此，鉴于肾性骨病并发症发生率极低且25-OH-CC水平正常化，紫外线照射后为接受透析的患者带来了新的治疗可能性。其重要性的增加还在于，人体90%的维生素D需求是通过皮肤提供的，动物实验证明，双侧肾切除术后，通过光合作用也可能形成活性维生素D代谢产物1,25-二羟胆钙化醇。
