OBJECTIVE: A novel assay was employed to study the free 1,25-dihydroxyvitamin D (1,25(OH)2D) concentrations in various populations with different levels of 1,25(OH)2D and vitamin D binding protein (DBP). DESIGN: In 12 healthy women before and after 3 months of oral estrogen/progestagen treatment, 10 pregnant women, and 16 patients with a nephrotic syndrome and normal renal function, the concentrations of total and free 1,25(OH)2D, DBP and albumin were assessed. METHODS: The total concentration of 1,25(OH)2D in serum was assessed using a radioreceptor assay. The free fraction of 1,25(OH)2D was measured using symmetric dialysis. DBP was assessed using single radial immunodiffusion. Serum albumin concentrations were measured on an automated analyzer. RESULTS: In healthy women, the concentrations of total 1,25(OH)2D, free 1,25(OH)2D and DBP were 132+/-19 pmol/l, 92+/-30 fmol/l and 5.59+/-0.43 micromol/l. After 3 months of estrogen/progestagen treatment, total 1,25(OH)2D and DBP levels rose significantly to 175+/-51 pmol/l and 8.32+/-1.59 micromol/l (P< or =0.05 and P< or =0.001); the free 1,25(OH)2D remained unchanged (105+/-39 fmol/l; not significant). Pregnant women had significantly higher levels of total 1,25(OH)2D and DBP (239+/-68 pmol/l and 11.32+/-1.77 micromol/l; both P</=0.001); the free 1,25(OH)2D level, however, was not different (104+/-27 fmol/l; not significant). Unexpectedly, in patients with nephrotic syndrome, no lower DBP levels were found (5.36+/-0.84 micromol/l) relative to that in controls. Despite this, levels of both total (69+/-26 pmol/l, P< or =0.001) and free 1,25(OH)2D (53+/-28 fmol/l; P< or =0.001) were significantly lower than in controls. Albumin levels were lowered from 628+/-38 micromol/l to 300+/-84 micromol/l (P < or = 0.001). CONCLUSIONS: Higher estrogen levels result in higher DBP levels, with a parallel rise in total 1,25(OH)2D levels but without a change in the biologically active free fraction. The results in patients with nephrotic syndrome show that, with increasing glomerular protein leakage, the free 1,25(OH)2D concentration cannot be maintained.