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Nephrol Dial Transplant. 1996;11 Suppl 3:22-8.

A deficit of calcitriol synthesis may not be the initial factor in the pathogenesis of secondary hyperparathyroidism.

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  • 1Servicio Nefrologia, Hospital de Galdakao, Vizcaya, Spain.


Secondary hyperparathyroidism (HPT) develops early in chronic renal failure (CRF) at a time when plasma calcitriol levels are normal. At this time, PTH are higher than normal controls and serum phosphorous levels are lower. A decrement in total serum Ca is noted, after an oral phosphate load, only in patients with ERF. These data suggest that factors, other than a decrease in calcitriol synthesis, may be involved in the pathogenesis of HPT. A hypothesis is forwarded suggesting that an alteration in the newly cloned calcium sensor receptor may be the earliest abnormality in the HPT, preceding a decrease in plasma calcitriol levels.

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