News on Biomarkers in CKD‐MBD☆
Section snippets
Parathyroid Hormone
Parathyroid hormone (PTH), the most accredited marker of secondary hyperparathyroidism, is a single-chain, 84–amino acid protein, physiologically produced by parathyroid chief cells in response to fluctuations of plasma concentrations of ionized calcium. Two identified G-protein–coupled receptors, expressed in tissues not necessarily involved with mineral metabolism, and that are sensitive to the N-term region of PTH, are responsible for its biologic effects.6 Circulating PTH includes not only
Noncollagenous Bone Proteins
Besides collagen, bone matrix includes a variety of proteins produced mostly by bone cells, whose functions can be highly specific and, for some of them, still incompletely understood. According to some characteristics, it is possible to tentatively group them into some categories, as shown in Table 1. Notably, some of these proteins now are considered bone hormones and are the subject of intense clinical investigation. Others have intriguing experimental evidence pointing to a potential role
Conclusions
With the new discoveries in bone physiology, the active role of bone disease in the appearance of CKD-MBD becomes more evident. The biochemical markers of mineral metabolism used to date require a complete re-evaluation to take into account the complexity of their metabolism, which generates parent compounds that affect their diagnostic value. Moreover, the endocrine role of bone in the field of mineral and energy metabolism awaits further developments. As a whole, we should regard the
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