D Vitamini, Kalsiyum & Mineral Metabolizması, D Vitaminin İskelet Dışı Etkileri ve Kronik Böbrek Yetmezliğinde Nutrisyonel D Vitamini Kullanımı
Vitamin D, güneş ışığı ile temas sonucu deride üretilen, yağda çözünen, secosteroid yapıda bir prohormondur. Vücutta çeşitli metabolik değişikliklerle kalsitriol olarak bilinen, kalsiyum ve fosfor metabolizmasında önemli rol oynayan bir hormona dönüşür.Böbrek dokusu haricinde D vitaminine ait reseptörler; T lenfositler, beyin, prostat, pankreas, gonadlar, meme dokusu, kas ve kolon gibi birçok organ ve dokuda bulunmaktadır. D vitamininin etkinliği sadece kalsiyum homeostazisini düzenleyerek kemik sağlığını idame ettirmekle sınırlı olmayıp, aynı zamanda pro-apopitotik, antienflamatuar ve immün-modülatuar özelliklere sahip olduğu bildirilmektedir. Son yıllarda yapılan epidemiyolojik çalışmalarda, düşük D vitamini düzeyinin kanser insidansını ve kardiyovasiküler mortaliteyi arttırdığı, diyabet ve multipl skleroz gibi otoimmün hastalıklar ile birlikte olduğu bildirilmiştir.Kronik böbrek yetmezliğinin (KBY) gelişmesi ile 1,25 dihidroksi D vitamini üretiminde progresif azalma ile ilişkilidir. Düşük 25-hidroksi vitamin D seviyeleri kronik böbrek yetmezliğinin tüm evrelerinde gözlenmekte ve sekonder hiperparatiroidizme neden olmaktadır. KBY hastalarında bilinen D vitamini önemli biyolojik etkileri, 25 hidroksi vitamin D’nin 1-25 dihidroksi D vitaminine extrarenal dönüşümü sayesinde gerçekleşmektedir. Bu derleme D vitamini, kalsiyum-mineral metabolizması, D vitaminin iskelet dışı etkileri ve kronik böbrek yetmezliğinde nutrisyonel D vitamini kullanımı gözden geçirilmiştir.
Anahtar Kelimeler:
D Vitamini, Kalsiyum-Mineral Metabolizması, Kronik Böbrek Yetmezliği
Vitamin D, Calcium&Mineral Metabolism, Extraskeletal Effects of Vitamin D and the Use of Nutritional Vitamin D in Chronic Kidney Disease
Vitamin D is a liposoluble prohormon and and a secosteroid that is produced in the skin after exposure to sunlight. It is turned to calcitriol that has an important role in the calcium and phosphate metabolism by different metabolic pathways.Vitamin D receptors excluding kidney tissues are available in the following organs and tissues; T lenfosit, brain, prostate, pancreas, gonad, breast tissues, muscles and colon. It is known that function of Vitamin D is not only to maintain healthy bones through arranging calcium homeostasis but also has pro-apopitotic, anti-inflammatory and immune modulator characteristics. In recent epidemiologic studies, low level vitamin D increases cancer incidence and cardiovascular mortality, and comes along with diabetes mellitus, auto-immune diseases such as multiple skleroz.The development of Chronic Kidney Dissease (CKD) is accompained by a progressive reduce in ability to produce 1,25-dihydroxyvitamin D. Low 25-hydroxyvitamin D levels are common in patients with all stages of CKD and this stuation has been triggered secondary hyperparathyroidism in CKD patients. Extrarenal conversion of 25-hydroxyvitamin D to 1,5-dihydroxyvitamin D may have significant biological role beyond those traditionally ascribed to vitamin D. In this review, we check outed vitamin D, calcium-mineral metabolism, the extrarenal effect of vitamin D, and nutritional vitamin D replacement in CKD.
Keywords:
Vitamin D, calcium-mineral metabolism, chronic kidney disease,
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- Yazışma Adresi/Correspondence Dr. Demet Yavuz Samsun Eğitim Araştırma Hastanesi Nefroloji Kliniği, Samsun, Turkiye, e-mail: demetdolu@hotmail.com Telefon: +90 505 369 16 91 Faks: +90 362 277 90 82 Geliş Tarihi: 25.06.2014 Kabul Tarihi: 01.09.2014
- Başlangıç: 2014
- Yayıncı: Ankara Yıldırım Beyazıt Üniversitesi Tıp Fakültesi