Altered Calcium and Vitamin D Homeostasis in First-Time Calcium Kidney Stone-Formers.

Hemamalini Ketha,Eric J. Bergstralh,John C. Lieske,Ravinder J. Singh,Rajiv Kumar,Andrew D. Rule,Stefan K. Grebe,Karen M. Tordjman

doi:10.1371/journal.pone.0137350

Hemamalini Ketha, Eric J. Bergstralh + Show 6 more

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https://doi.org/10.1371/journal.pone.0137350

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Journal: PloS one	Publication Date: Sep 2, 2015
Citations: 31	License type: CC BY 4.0

Affiliation: Mayo Clinic, Winneshiek Medical Center

Abstract

BackgroundElevated serum 1,25-dihydroxyvitamin D (1,25(OH)2D) concentrations have been reported among cohorts of recurrent calcium (Ca) kidney stone-formers and implicated in the pathogenesis of hypercalciuria. Variations in Ca and vitamin D metabolism, and excretion of urinary solutes among first-time male and female Ca stone-formers in the community, however, have not been defined.MethodsIn a 4-year community-based study we measured serum Ca, phosphorus (P), 25-hydroxyvitamin D (25(OH)D), 1,25(OH)2D, 24,25-dihydroxyvitamin D (24,25(OH)2D), parathyroid hormone (PTH), and fibroblast growth factor-23 (FGF-23) concentrations in first-time Ca stone-formers and age- and gender frequency-matched controls.ResultsSerum Ca and 1,25(OH)2D were increased in Ca stone-formers compared to controls (P = 0.01 and P = 0.001). Stone-formers had a lower serum 24,25(OH)2D/25(OH)D ratio compared to controls (P = 0.008). Serum PTH and FGF-23 concentrations were similar in the groups. Urine Ca excretion was similar in the two groups (P = 0.82). In controls, positive associations between serum 25(OH)D and 24,25(OH)2D, FGF-23 and fractional phosphate excretion, and negative associations between serum Ca and PTH, and FGF-23 and 1,25(OH)2D were observed. In SF associations between FGF-23 and fractional phosphate excretion, and FGF-23 and 1,25(OH)2D, were not observed. 1,25(OH)2D concentrations associated more weakly with FGF-23 in SF compared with C (P <0.05).ConclusionsQuantitative differences in serum Ca and 1,25(OH)2D and reductions in 24-hydroxylation of vitamin D metabolites are present in first-time SF and might contribute to first-time stone risk.

Highlights

Urinary stone disease is an increasingly common and recurrent metabolic disorder with an estimated lifetime risk in the United States of 6–12%, and a recurrence rate of up to 50%. [1,2,3,4]
Elevated serum 1,25-dihydroxyvitamin D (1,25(OH)2D) concentrations have been reported among cohorts of recurrent calcium (Ca) kidney stone-formers and implicated in the pathogenesis of hypercalciuria
Serum parathyroid hormone (PTH) and fibroblast growth factor-23 (FGF-23) concentrations were similar in the groups

Summary

Introduction

Urinary stone disease is an increasingly common and recurrent metabolic disorder with an estimated lifetime risk in the United States of 6–12%, and a recurrence rate of up to 50%. [1,2,3,4]. [1,2,3,4] Both dietary patterns and genetic factors influence urinary Ca excretion and are important in the pathogenesis of kidney stones [5,6,7,8,9,10]. A recent report of 356 male incident stone formers compared plasma concentrations of 25-hydroxyvitamin D, 24,25-dihydroxyvitamin D, parathyroid hormone, fibroblast growth factor 23, calcium, phosphate, and creatinine with those found in control subjects [18]. Elevated serum 1,25-dihydroxyvitamin D (1,25(OH)2D) concentrations have been reported among cohorts of recurrent calcium (Ca) kidney stone-formers and implicated in the pathogenesis of hypercalciuria. Variations in Ca and vitamin D metabolism, and excretion of urinary solutes among first-time male and female Ca stone-formers in the community, have not been defined

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