Disturbances in mineral metabolism after successful renal transplantation

K. Sakhaee, K. Brinker, J. H. Helderman, J. L. Bengfort, M. J. Nicar, A. R. Hull, C. Y. Pak

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Abstract

Abnormalities of mineral metabolism remain a clinical problem after successful renal transplantation. These disturbances may be the result of derangements in divalent ion, parathyroid hormone (PTH) and/or vitamin D metabolism. We therefore measured serum Ca, phosphorus, PTH and 1,25-dihydroxyvitamin D [1,25(OH)2D] levels and fractional intestinal Ca absorption (α) in 6 patients befor and after successful transplantation (early, ≤6 months). 3 were reexamined later (late, ≥24 months after transplantation). The patients exhibited decreased serum levels of 1,25(OH)2D and α before the renal transplantation. In the early stages, renal transplantation reduced serum phosphorus from 5.55±(SD)1.96 to 2.96±0.95 mg/dl (p<0.02); this was accompanied by a rise in serum 1,25(OH)2D from 8.7±1.5 to 26.3±8.4 pg/ml (p<0.005). The calcemic response to PTH infusion became normal, since the increment in serum Ca rose from 0.45±0.21 mg/dl before transplantation to 1.03±0.18 mg/dl early after transplantation. Although the mean value for α increased significantly from 0.263±0.048 to 0.402±0.175 (p<0.05), α was subnormal in 3 patients (α<0.37). Urinary Ca was high in 3 patients, and it exceeded absorbed Ca (from intestines) in 4 patients (indicative of negative Ca balance). Serum PTH fell significantly but remained above normal. It was hoped that late after transplantation, when patients were maintained on smaller doses of oral glucocorticoids, these abnormalities would be ameliorated. However, hypercalciuria was found in 2 of 3 patients. Serum PTH remained elevated in all 3 patients despite adequate creatinine clearance. Moreover, fasting hypercalciuria (>0.1 mg/100 ml glomerular filtration) was encountered in 2 of 3 patients. We conclude that parathyroid stimulation, hypercalciuria and subnormal intestinal Ca absorption may persist in some patients after successful renal transplantation in the face of a rise in serum 1,25(OH)2D and improved skeletal responsiveness to PTH. The exact cause of these disturbances remains to be elucidated.

Original languageEnglish (US)
Pages (from-to)167-172
Number of pages6
JournalMineral and Electrolyte Metabolism
Volume11
Issue number3
StatePublished - Nov 6 1985

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ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry

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Sakhaee, K., Brinker, K., Helderman, J. H., Bengfort, J. L., Nicar, M. J., Hull, A. R., & Pak, C. Y. (1985). Disturbances in mineral metabolism after successful renal transplantation. Mineral and Electrolyte Metabolism, 11(3), 167-172.