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Vitamin D Increases Plasma Renin Activity Independently of Plasma Ca2+ via Hypovolemia and {beta}-Adrenergic Activity

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Renal Physiology

Published online on

Abstract

1, 25-dihydroxycholechalciferol (calcitriol) and 19-nor-1, 25-dihydroxyvitamin D2 (paricalcitol) are vitamin-D receptor (VDR) agonists. Previous data suggest VDR agonists may actually increase renin-angiotensin activity, and this has always been assumed to be mediated by hypercalcemia. We hypothesized that calcitriol and paricalcitol would increase plasma renin activity (PRA) independently of plasma Ca2+ via hypercalciuria-mediated polyuria, hypovolemia and subsequent increased β-adrenergic sympathetic activity. We found that both calcitriol and paricalcitol increased PRA 3-fold, p<0.01). Calcitriol caused hypercalcemia, but paricalcitol did not. Both calcitriol and paricalcitol caused hypercalciuria (9 and 7-fold vs control, p<0.01) and polyuria (increasing 2.6 and 2.2-fold vs control, p<0.01). Paricalcitol increased renal calcium-sensing receptor (CaSR) expression, suggesting a potential cause of paricalcitol-mediated hypercalciuria and polyuria. Volume replacement completely normalized calcitriol-stimulated PRA and lowered plasma epinephrine by 43% (p<0.05). β-adrenergic blockade also normalized calcitriol-stimulated PRA. Cyclooxygenase-2 inhibition had no effect on calcitriol-stimulated PRA. Our data demonstrate that vitamin D increases PRA independently of plasma Ca2+ via hypercalciuria, polyuria, hypovolemia and increased β-adrenergic activity.