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Nephrol Dial Transplant (1999) 14: 2815-2818
© 1999 European Renal Association-European Dialysis and Transplant Association

Editorial Comments

Calcium sensitivity of the parathyroid in renal failure: another look with new methodology

Claus P. Schmitt and Franz Schaefer

Division of Pediatric Nephrology, University Children's Hospital, Heidelberg, Germany

Correspondence and offprint requests to: PD Dr. Franz Schaefer, Division of Pediatric Nephrology, University Children's Hospital, Im Neuenheimer Feld 150, D-69120 Heidelberg, Germany.

Abnormal calcium sensitivity in uraemia?

The parathyroid's sensitivity to changes in ionized calcium has been a matter of controversy for more than two decades. In 1978 Brown introduced the concept of a four-parameter sigmoidal model to characterize the calcium dependency of parathyroid hormone (PTH) release from parathyroid cells in vitro. He demonstrated an increased calcium `set-point', i.e. a decreased calcium sensitivity of cells derived from patients with primary and uraemic hyperparathyroidism [1]. Several clinical studies adapting the in-vitro model to the clinical setting are in line with a reduced sensing of the extracellular calcium level in patients with parathyroid adenoma [2,3]. The reduced expresFion of the calcium receptor on the parathyroid cell surface of patients with primary and uraemic hyperparathyroidism is also compatible with the notion of a calcium sensing deficiency [4]. On the other hand, many investigators failed to demonstrate a rightward shift of the . . . [Full Text of this Article]

A new methodological approach

The normal secretory pattern of PTH

The PTH secretory pattern in uraemia

Issues in interpretation

References


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