Vitamin D and the Immune System from the Nephrologist's Viewpoint

Abstract

Vitamin D and its analogues are widely used as treatments by clinical nephrologists, especially when treating chronic kidney disease (CKD) patients with secondary hyperparathyroidism. As CKD progresses, the ability to compensate for elevations in parathyroid hormone (PTH) and fibroblast growth factor-23 and for decreases in 1,25(OH)2D3 becomes inadequate, which results in hyperphosphatemia, abnormal bone disorders, and extra-skeletal calcification. In addition to its calciotropic effect on the regulation of calcium, phosphate, and parathyroid hormone, vitamin D has many other noncalciotropic effects, including controlling cell differentiation/proliferation and having immunomodulatory effects. There are several immune dysregulations that can be noted when renal function declines. Physicians need to know well both the classical and nonclassical functions of vitamin D. This review is an analysis from the nephrologist's viewpoint and focuses on the relationship between the vitamin D and the immune system, together with vitamin's clinical use to treat kidney diseases.

Vitamin D3 Adjuvant Treatment Stimulate Interleukin-10 Expression in Children with Nephrotic Syndrome Without Affecting to Clinical Outcome and Glucocorticoid Receptor Expression

“…1,25(OH)2D3 proven has antiproteinuria effect and inhibit renin angiotensin aldosterone system (RAAS). 1,25(OH)2D3 has a beneficial effect in preserve podocyte structural integrity and functional and also suppress renin expression directly at transcriptional level [31].…”

“…T can also influence T cell behavior, promote tolerance through Th2 and Treg activity induction and Th1 and Th17 cell activity suppression [31].…”

The Correlation of Regulatory T (TReg) and Vitamin D3 in Pediatric Nephrotic Syndrome

“…Vitamin D administration could induce and stimulate T Reg directly through antigen presenting cells or dendritic cells also indirectly through endocrine or intracrinal conversion of 25(OH)D becoming 1,25(OH)2 D3 [18]. Furthermore, vitamin D administration was correlated with elevation of T Reg Foxp3 + population [9,19].…”

“…Reduction of T Reg population and its dysfunction in nephrotic syndrome would lead to disability to suppress effector T cells [15] that is associated to proteinuria [16,17]. T Reg also acts as anti-inflammatory T cells through secretion of several anti-inflammatory cytokines such as IL-10 and TGF-β [18].…”

Pengaruh Pemberian 1,25 Dihydroxyvitamin D (Calcitriol) Terhadap Kadar Fibroblast Growth Factor-23 Dan Albuminuria Pada Pasien Penyakit Ginjal Kronik Stadium v Yang Menjalani Hemodialisis

“…Peran vitamin D sebagai anti inflamasi melalui penekanan pada jalur Nuclear Factor kB (NF-ĸB), dimana jalur Nuclear Factor kB ini sangat berperan penting dalam progresivitas penyakit ginjal, karena jalur tersebut akan memicu inflamasi dan fibrogenesis melalui pelepasan sitokin pro inflamasi (Lang, 2014). Peran vitamin D aktif dalam mengatasi fibrosis ginjal dan disfungsi ginjal pada beberapa jalur patogen berkorelasi antara menurunnya vitamin D aktif pada ginjal dan rendahnya kadar serum 1,25(OH)2D3 atau Calcitriol sering dikaitkan dengan penurunan fungsi ginjal (Llach dan Yudd, 1998).…”