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Insulin-like growth factor system components in hyperparathyroidism and renal osteodystrophy
P M Jehle1, A Ostertag, K Schulten
1Division of Nephrology and Endocrinology, Department of Internal Medicine, University of Ulm, Germany. peter.jehle@medizin.uni-ulm.de
Kidney International
|January 29, 2000
Summary
Serum levels of insulin-like growth factor binding proteins (IGFBPs) change with chronic kidney disease and hyperparathyroidism. IGFBP-5 may serve as a marker for bone formation and low bone turnover in dialysis patients.
Area of Science:
- Endocrinology
- Nephrology
- Bone Metabolism
Background:
- The insulin-like growth factor (IGF) system is crucial for bone formation.
- Elevated IGF binding proteins (IGFBPs) are noted in renal osteodystrophy, but comprehensive analysis is lacking.
Purpose of the Study:
- To measure serum levels of IGF-I, IGF-II, and IGFBP-1 to -6 in various forms of renal osteodystrophy and hyperparathyroidism.
- To correlate IGF system components with bone histology and biochemical markers.
Main Methods:
- Cross-sectional study of 319 patients with varying degrees of renal failure and 25 with primary hyperparathyroidism (pHPT).
- Included healthy controls (N=87).
- Measured serum IGF-I, IGF-II, IGFBP-1 to -6, PTH, B-ALP, and OSC using immunometric assays.
Main Results:
- Declining renal function increased IGFBP-1, -2, -3, -4, and -6, while IGFBP-5 decreased.
- IGF-I and IGF-II levels remained relatively constant.
- pHPT patients showed lower IGFBP elevations compared to renal failure patients.
- IGFBP-5 correlated positively with bone formation markers; IGFBP-2 and -4 correlated with bone loss.
- Dialysis patients with low bone turnover had lower IGFBP-5 levels.
Conclusions:
- Primary and secondary hyperparathyroidism alter IGFBP profiles differently than chronic kidney disease.
- Elevated IGFBP-4 is characteristic of chronic renal failure.
- IGFBP-5 is a potential serological marker for osteopenia and low bone turnover in dialysis patients.