Vitamin D is tightly linked with renal tubular homeostasis: the mitochondria of proximal convoluted tubule cells are the production site of 1α,25-dihydroxyvitamin D3. Patients with renal impairment or tubular injury often suffer from chronic inflammation. This alteration comes from oxidative stress, acidosis, decreased clearance of inflammatory cytokines and stimulation of inflammatory factors. The challenge is to find the right formula for each patient to correctly modulate the landscape of treatment and preserve the essential functions of the organism without perturbating its homeostasis. The complexity of the counter-regulation mechanisms and the different axis involved in the Vitamin D equilibrium pose a major issue on Vitamin D as a potential effective anti-inflammatory drug. The therapeutic use of this compound should be able to inhibit the development of inflammation without interfering with normal homeostasis. Megalin-Cubilin-Amnionless and the FGF23-Klotho axis represent two Vitamin D-linked mechanisms that could modulate and ameliorate the damage response at the renal tubular level, balancing Vitamin D therapy with an effect potent enough to contrast the inflammatory cascades, but which avoids potential severe side effects.

中文翻译：

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维生素D在肾小管病变中的保护作用

维生素D与肾小管动态平衡紧密相关：近曲小管细胞的线粒体是1α，25-二羟基维生素D3的产生部位。肾功能不全或肾小管损伤的患者通常患有慢性炎症。这种改变来自氧化应激，酸中毒，炎性细胞因子清除率的降低和炎性因子的刺激。面临的挑战是为每位患者找到合适的配方，以正确调节治疗方案并保持有机体的基本功能，而又不影响其体内平衡。反调节机制的复杂性和维生素D平衡所涉及的不同轴对维生素D作为潜在的有效抗炎药构成了一个重大问题。该化合物的治疗用途应能够抑制炎症的发展而不会干扰正常的体内平衡。Megalin-Cubilin-Amnionless和FGF23-Klotho轴代表了两种维生素D相关的机制，可以调节和改善肾小管水平的损伤反应，平衡维生素D治疗的效果足以抵消炎症级联反应，但避免潜在的严重副作用。