Calcio sérico y huesos: efectos de la hormona paratiroidea, del fosfato, de la vitamina D y de la uremia
Serum calcium and bone: effect of PTH, phosphate, vitamin D and uremia
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La disminución de la respuesta calcémica a la hormona paratiroidea (PTH) contribuye al desarrollo de hiperparatiroidismo y es probable que se deba a una reducción de la emisión de calcio de los huesos. Entre los factores que contribuyen a la disminución de la respuesta calcémica a la PTH en la ERC se encuentran: 1) la hiperfosfatemia; 2) la disminución del calcitriol sérico; 3) la desensibilización del receptor PTHR1; 4) la presencia de fragmentos de gran tamaño de los extremos aminoterminales de la hormona paratiroidea que actúan en el receptor carboxi-PTH y 5) las toxinas urémicas. Asimismo, la administración prolongada de una dosis elevada de calcitriol podría disminuir la reserva intercambiable de calcio independiente de la hormona paratiroidea. El objetivo de esta revisión es facilitar la comprensión de cómo afectan los factores mencionados anteriormente a la emisión de calcio procedente del hueso en la ERC. Como conclusión, aún queda mucho por aprender acerca del papel de los huesos en la regulación del calcio sérico.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara">Hyperparathyroidism develops in chronic kidney disease (CKD). A decreased calcemic response to parathyroid hormone (PTH) contributes to the development of hyperparathyroidism and is presumed due to reduced calcium efflux from bone. Contributing factors to the decreased calcemic response to PTH in CKD include: 1) hyperphosphatemia; 2) decreased serum calcitriol; 3) downregulation of the PTH1 receptor; 4) large, truncated amino-terminal PTH fragments acting at the carboxy-PTH receptor; and 5) uremic toxins. Also, prolonged high dose calcitriol administration may decrease the exchangeable pool of bone calcium independent of PTH. The goal of the review is to provide a better understanding of how the above cited factors affect calcium efflux from bone in CKD. In conclusion, much remains to be learned about the role of bone in the regulation of serum calcium.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:88 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Massry SG, Coburn JW, Lee DBW, Jowsey J, Kleeman CR. Skeletal resistance to parathyroid hormone in renal failure. Studies in 105 human subjects. Ann Intern Med 1973;78:357-64. <a href="http://www.ncbi.nlm.nih.gov/pubmed/4571863" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Wesseling-Perry K, Harkins GC, Wang HJ, Elashoff R, Gales B, Horwitz MJ, et al. 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| año/Mes | Html | Total | |
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| 2017 Marzo | 62 | 23 | 85 |
| 2017 Febrero | 60 | 15 | 75 |
| 2017 Enero | 33 | 14 | 47 |
| 2016 Diciembre | 107 | 12 | 119 |
| 2016 Noviembre | 138 | 16 | 154 |
| 2016 Octubre | 153 | 19 | 172 |
| 2016 Septiembre | 275 | 7 | 282 |
| 2016 Agosto | 348 | 3 | 351 |
| 2016 Julio | 295 | 21 | 316 |
| 2016 Junio | 169 | 0 | 169 |
| 2016 Mayo | 186 | 0 | 186 |
| 2016 Abril | 178 | 0 | 178 |
| 2016 Marzo | 143 | 0 | 143 |
| 2016 Febrero | 183 | 0 | 183 |
| 2016 Enero | 155 | 0 | 155 |
| 2015 Diciembre | 157 | 0 | 157 |
| 2015 Noviembre | 183 | 0 | 183 |
| 2015 Octubre | 177 | 0 | 177 |
| 2015 Septiembre | 165 | 0 | 165 |
| 2015 Agosto | 150 | 0 | 150 |
| 2015 Julio | 185 | 0 | 185 |
| 2015 Junio | 172 | 0 | 172 |
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