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Calcitriol is a hormone and the active form of vitamin D, normally made in the kidney. [8] [9] [10] It is also known as 1,25-dihydroxycholecalciferol.It binds to and activates the vitamin D receptor in the nucleus of the cell, which then increases the expression of many genes. [11]
Renal osteodystrophy is usually diagnosed after treatment for end-stage kidney disease begins; however the CKD-MBD starts early in the course of CKD. [ 1 ] [ 6 ] In advanced stages, blood tests will indicate decreased calcium and calcitriol (vitamin D) and increased phosphate , and parathyroid hormone levels.
CKD–MBD broadens the "old" concept of "renal osteodystrophy", which now should be restricted to describing the bone pathology associated with CKD. [ 1 ] [ 2 ] Thus, renal osteodystrophy is currently considered one measure of the skeletal component of the systemic disorder of CKD–MBD that is quantifiable by histomorphometry of bone biopsy.
All people with a GFR <60 mL/min/1.73 m 2 for 3 months are defined as having chronic kidney disease. [59] Protein in the urine is regarded as an independent marker for worsening of kidney function and cardiovascular disease. Hence, British guidelines append the letter "P" to the stage of chronic kidney disease if protein loss is significant. [60]
The kidneys secrete a variety of hormones, including erythropoietin, calcitriol, and renin. Erythropoietin is released in response to hypoxia (low levels of oxygen at tissue level) in the renal circulation. It stimulates erythropoiesis (production of red blood cells) in the bone marrow.
Calcitriol plays a key role in regulating vitamin D levels through a negative feedback mechanism. [203] It strongly upregulates the expression of the enzyme CYP24A1 , which inactivates vitamin D. This activation happens through binding of the activated vitamin D receptor (VDR) to two vitamin D response elements (VDREs) in the in the CYP24A1 gene.
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