| Objective: Calcium and phosphorus metabolism and vitamin D3deficiency arecommon in patients of advanced chronic kidney disease(CKD). Fibroblast growth factor23(FGF23) participates in regulation of phosphorus and1,25dihydroxyvitamin D3[1,25-(OH)2D3] with the aid of Klotho protein in patients of CKD. Compared with thehealthy subjects, patients of CKD have lower level of1,25-(OH)2D3and elevatedFGF23level. We aim to study the relationship of levels of serum1,25-(OH)2D3, FGF23and Klotho protein with proteinuria. We tried to find out whether the disorder of the1,25-(OH)2D3-FGF23-Klotho system has effects on the onset and progress of patients ofearly stage CKD with primary glomerulonephritis.Method: We enrolled patients admmited in Department of Nephrology, the firstAffiliated Hospital of Dalian Medical University from January2013to January2014.There are totally76cases, including40females and36males between the age of16-76years old. All patients had persistent proteinuria and were diagnosed as primaryglomerulonephritis without application of corticosteroids, immunosuppressive agents,calcium and vitamin D3. Patients of econdary and hereditary glomerulonephritis wereexcluded. According to the24h urinary protein level, patients were divided into threegroups: group A included28patients with24h urinary protein <1.0g; group B included24patients with1.0g≤24h urinary protein <3.5g; group C included24patients with24h urinary protein≥3.5g. Serum1,25-(OH)2D3, FGF23and Klotho proteinconcentration were tested through enzyme linked immunosorbent assay(ELISA). The other factors such as24h urinary protein, the concentration of serum albumin, creatinine,urea nitrogen, calcium, phosphorus and serum PTH were also measured. SPSS version19.0was used to analyze the data. We used ANOVA, LSD test and Pearson correlation.The results of the P value <0.05was considered to have statistical significance.Results:1.The means of the calcium concentration of three groups were significantlydifferent (P<0.01). The level of serum calcium of group C was much lower comparedwith group A and group B. The differences between group C and the other two groupshad statistical significance (P<0.01). But the mean levels of serum calcium of group Aand group B had no significant difference (P>0.05). Serum phosphorus and serum PTHhad no statistical defference between the3groups (P>0.05).2.The mean levels of serum FGF23in3groups are not equal (P<0.05). SerumFGF23in group C was elevated significantly. The differences between group C andgroup A, group B had statistical significance (P<0.05). But serum FGF23had nostatistical defference between groupAand group B (P>0.05).3.Serum1,25-(OH)2D3of the three groups are not all equal (P<0.05). The level ofserum1,25-(OH)2D3decrease with the increase of urinary protein excretion. Group Chad a higher degree of serum1,25-(OH)2D3than group A and group B. The differenceshad statistical significance (P<0.05). But the difference of serum1,25-(OH)2D3betweengroupAand group B was not statistically significant (P>0.05).4. While the24h urinary protein increased, serum Klotho protein was reduced.Group C had the lowest level of serum Klotho protein in the3groups. Compared withgroup A and group B respectively, the differences were statistically significant (P<0.05).But the levels of serum Klotho protein of group A and group B were not statisticallydifferent (P>0.05).5.Pearson correlation analysis showed that the24h urinary protein excretion wasnagatively correlated with serum calcium (P <0.01), serum1,25-(OH)2D3(P <0.05) andserum Klotho protein (P <0.05), and positively correlated with serum FGF23(P<0.01 Conclusion: In the early stage of CKD, with the increase of proteinuria, serum1,25-(OH)2D3and Klotho protein gradually decreased. But the level of serum FGF23concentration tended to increase on the contrary. The imbalance of the1,25-(OH)2D3-FGF23-Klotho system was involved in the occurrence and developmentof proteinuria. The disorder of calcium and phosphorus metabolism could be found inpatients of early stage of CKD. |
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