Interactions between treatment with 1,25(OH)2D3 and glucocorticoids in uremic patients after kidney transplantation

3 patients undergoing maintenance hemodialysis and receiving 1,25(OH)2D3 for osteomalacic bone disease received cadaveric kidney grafts and concomitant glucocorticoid therapy. The administration of pharmacological doses of glucocorticoids increased the dosage of 1,25(OH)2D3 needed to maintain a normal serum calcium level 7- to 10-fold in 2 patients whose renal grafts failed to function, but there was no decrease in sensitivity to 1,25(OH)2D3 in 1 patient whose renal graft functioned normally. These data suggest that steroids given to a uremic patient may block certain effects normally produced by 1,25(OH)2D3. An end-organ defect due to the combined effects of steroids and uremia is possible.