Direct tubular effect on calcium retention by hydrochlorothiazide
Tóm tắt
Previous studies with hydrochlorothiazide revealed a calcium retaining effect of this substance. The mechanism by what this is done is still matter of controverse discussion. Effects of hydrochlorothiazide on vitamin D metabolism have been reported as well as those on parathyroid function. To further clarify the calcium retaining potency of hydrochlorothiazide (HCTZ) we treated 10 healthy young volunteers for four weeks with × 50 mg HCTZ. In all volunteers we observed a marked decrease in urinary calcium excretion as well as in calcium clearance. Furthermore, we found a slight rise in ionized serum calcium (6.7%) and in intact PTH, as well as a 36% drop in 1,25-(OH)2D3-levels. These effects were reversible after discontinuation of the treatment. No change was observed in urinary cAMP, phosphate excretion, serum anorganic phosphate levels, serum calcitonin and magnesium levels. Data presented here suggest that treatment with HCTZ causes a persistent reduction in calcium excretion through direct tubular effects, inhibits hydroxylation of vitamin D, and does not affect parathyroid function.
Tài liệu tham khảo
Lamberg B.A., Kuhlbäck B. Effect of chlorothiazide and hydrochlorothiazide on the excretion of calcium in urine. Scand. J. Clin. Invest. 11: 351, 1959.
Seitz H., Jaworski Z.F. Effect of serum and urinary calcium and urinary citrate. Can. Med. Assoc. J. 90: 414, 1964.
Nassim J.R., Higgins B.A. Control of idiopathic hypercalciuria. Br. Med. J. 1: 675, 1965.
Yendt E.R., Gagne R.J.A., Cohanim M. The effects of thiazides in idiopathic hypercalciuria. Am. J. Med. Sci. 251: 449, 1966.
Duarte C.G., Bland J.H. Changes in metabolism of calcium and uric acid after oral administration of chlorothiazide. Metabolism 14: 899, 1965.
Duarte C.G., Bland J.H. Calcium, phosphorus and uric acid clearances after intravenous administration of chlorothiazide. Metabolism 14: 211, 1965.
Moens C., Wauters M. Hypocalciuric effect of benzothiazides. Acta Rheumatol. Scand. 12: 228, 1966.
Suki W.N., Hull A.E., Rector F.C. Mechanism of the effect of thiazide diuretics on calcium and uric acid (abstract). Clin. Res. 19: 194, 1971.
Parfitt A.M. Chlorothiazide induced hypercalcemia in juvenile osteoporosis and hyperparathyroidism. N. Engl. J. Med. 281: 55, 1969.
Brickman A.S., Coburn J.W., Koppel M.H., Peacock M., Massry S.G. The effect of hydrochlorothiazide administration on serum and urinary calcium in normal, hypoparathyroid and hyperparathyroid subjects: Studies on mechanisms. Isr. J. Med. Sci. 7: 518, 1971.
Paloyan E., Forland M., Pickleman J.R. Hyperparathyroidism coexisting with hypertension and prolonged thiazide administration. JAMA 210: 1243, 1969.
Pickleman J.R., Straus F.H. II, Forland M., Paloyan E. Triazide-induced parathyroid stimulation. Metabolism 18: 867, 1969.
Sakhaee K., Nicar M.J., Glass K., Pak C.Y.C. Postmenopausal osteoporosis: a manifestation of renal hypercalciuria with secondary hyperparathyroidism. J. Clin. Endocrinol. Metab. 61: 368, 1985.
Coe F.L., Canterbury J.M., Firpo J.J, Reiss E. Evidence for secondary hyperparathyroidism in idiopathic hypercalciuria. J. Clin. Invest. 52: 134, 1972.
Brickman A.S., Massry S.G., Coburn J.W. Changes in serum and urinary calcium during treatment with hydrochlorothiazide: Studies on mechanisms. J. Clin. Invest. 51: 945, 1972.
Suki W.N., Schwettmann R.S., Rector F.C., Seldin D.W. Effect of chronic mineralocorticoid administration on calcium excretion in the rat. Am. J. Physiol. 215: 71, 1968.
Schmidt-Gayk H., Schmitt-Fiebig M., Hitzler W., Armbruster F.P., Mayer E. Two homologous radioimmunoassays for parathyrin compared and applied to disorders of calcium metabolism. Clin. Chem. 32: 57, 1986.
Scharia S., Schmidt-Gayk H., Reichel H, Mayer E. A sensitive and simplified radioimmunoassay for 1,25-dihydroxyvitamin D3. Clin. Chim. Acta 142: 325, 1984.
Stote R.M., Smith L.H., Wilson D.M., Dube W.J., Goldsmith R.S., Arnaud C.D. Hydrochlorothiazide effects on serum calcium and immunoreactive parathyroid hormone concentrations. Ann. Intern. Med. 77: 587, 1972.
Pak C.Y.C., Nicar M., Northcutt C. The definition of the mechanism of hypercalciuria is necessary for the treatment of recurrent stone formers. Contrib. Nephrol. 33: 136, 1982.
Wasnich R.D., Benfante R.J., Yano K., Heilbrun L., Vogel J.M. Thiazide effect on the mineral content of the bone. N.Engl.J. Med. 309: 344, 1983.
Wasnich R.D., Ross P.D., Heilbrun L.K., Vogel J.M., Yano K., Benfante R.J. Differential effects of thiazide and estrogen upon bone mineral content and fracture prevalence. Obstet. Gynecol. 67: 457, 1986.
Sowers M.R., Wallace R.B., Lemke J, H. Correlates of mid-radius bone density among postmenopausal women: a community study. Am.J. Clin. Nutr. 41: 1045, 1985.
Lindsay R., Marshall B., Haboubi A., Herrington B.S., Tohme J. Increased axial bone mass in women with hypertension: role of thiazide therapy. J. Bone Miner. Res. 2 (Suppl. 1): S29, 1987 (Abstract).
Hunt I., Murphy N., Henderson C., Clark V., Coulson A. Bone mineral content in elderly women. Am. J. Epidemiol. 128: 903, 1988 (Abstract).
Hale W.R., Stewart R.B., Marks R.B. Central nervous system symptoms of elderly subjects using antihypertensive drugs. J. Am. Geriatr. Soc. 32: 5, 1984.
Ray W.A., Griffin M.R., Downey W., Melton L.J. Long-term use of thiazide diuretics and risk of hip fracture. Lancet 1: 687, 1989.