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Skeletal Resistance to Parathyroid Hormone in Renal Failure
Studies in 105 Human Subjects
- SHAUL G. MASSRY, M.D., F.A.C.P.;
- JACK W. COBURN, M.D., F.A.C.P.;
- DAVID B. N. LEE, M.B.;
- JENIFER JOWSEY, D.Phil.; and
- CHARLES R. KLEEMAN, M.D., F.A.C.P.
Abstract
The effects of an infusion of parathyroid extract on serum calcium and urinary phosphate levels were evaluated in 105 individuals—normal persons, patients with renal failure, patients treated with hemodialysis, and renal transplant recipients; patients were also studied after subtotal parathyroidectomy. The calcemic response was significantly lower than normal in all patients and was unrelated to the initial serum calcium, phosphorus, or immunoreactive parathyroid hormone levels. The calcemic response in advanced uremia varied inversely with preexisting bone resorption measured by microradiography. The parathyroid extract induced phosphaturia only in normal persons and those with mild-to-moderate renal failure. The results are consistent with skeletal resistance to the calcemic action of parathyroid hormone; this abnormality is seen early in the course of renal failure and is not reversed by hemodialysis. This derangement may contribute to the hypocalcemia of renal failure and hence play a role in the pathogenesis of secondary hyperparathyroidism in these patients.
Article and Author Information
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▸From the Renal and Hypertension Service and Medical Research Institute, Cedars-Sinai Medical Center; the Departments of Medicine, Cedars-Sinai Medical Center, Veterans Administration, Wadsworth Hospital Center, and UCLA School of Medicine; Los Angeles, California; and the Section of Orthopedic Research, Mayo Clinic and Mayo Foundation, Rochester, Minnesota.
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Supported by contract 43-68-1040 from the U.S. Public Health Service, Washington, D.C. Dr. Massry is an Established Investigator of the American Heart Association, New York, New York.
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▸Requests for reprints should be addressed to Shaul G. Massry, M.D., Cedars-Sinai Medical Center, 8720 Beverly Blvd., Los Angeles, CA 90048.
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- Received August 28, 1972.
- Accepted December 1, 1972.
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