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Mechanisms of renal phosphate loss in liver resection-associated hypophosphatemia.
Ann Surg. 2009 May; 249(5):824-7.AnnS

Abstract

OBJECTIVE

To determine precisely the role of parathyroid hormone (PTH) and of phosphatonins in the genesis of posthepatectomy hypophosphatemia.

BACKGROUND

Posthepatectomy hypophosphatemia has recently been related to increased renal fractional excretion of phosphate (FE P). To address the cause of hypophosphatemia, we measured serum concentrations of PTH, various phosphatonins, and the number of removed hepatic segment in patients with this disorder.

METHODS

Serum phosphate (PO4), ionized calcium (Ca++), HCO3-, pH and FE P, intact PTH (I-PTH), carboxyl-terminal fibroblast growth factor 23 (C-FGF-23) and intact fibroblast growth factor 23 (I-FGF-23), FGF-7, and secreted frizzled related-protein-4 (sFRP-4) were measured before and on postoperative (po) days 1, 2, 3, 5, and 7, in 18 patients undergoing liver resection. The number of removed hepatic segments was also assessed.

RESULTS

Serum PO4 concentrations decreased within 24 hours, were lowest (0.66 +/- 0.03 mmol/L; P < 0.001) at 48 hours, and returned to normal within 5 days of the procedure. FE P peaked at 25.07% +/- 2.26% on po day 1 (P < 0.05). Decreased ionized calcium concentrations (1.10 +/- 0.01 mmol/L; P < 0.01) were observed on po day 1 and were negatively correlated with increased I-PTH concentrations (8.8 +/- 0.9 pmol/L; P < 0.01; correlation: r = -0.062, P = 0.016). FE P was positively related to I-PTH levels on po day 1 (r = 0.52, P = 0.047) and negatively related to PO4 concentrations (r = -0.56, P = 0.024). Severe hypophosphatemia and increased urinary phosphate excretion persisted for 72 hours even when I-PTH concentrations had returned to normal. I-FGF-23 decreased to its nadir of 7.8 +/- 6.9 pg/mL (P < 0.001) on po day 3 and was correlated with PO4 levels on po days 0, 3, 5, and 7 (P < 0.001). C-FGF-23, FGF-7 and sFRP-4 levels could not be related to either PO4 concentrations or FE P.

CONCLUSION

Posthepatectomy hypophosphatemia is associated with increased FE P unrelated to I-FGF-23 or C-FGF-23, FGF-7, or sFRP-4. I-PTH contributes to excessive FE P partially on po day 1 but not thereafter. Other yet defined factors should explain post hepatectomy hypophosphatemia.

Authors+Show Affiliations

Department of Surgery, Centre hospitalier de l'Université de Montréal, (CHUM)-Hôpital Saint-Luc, Montréal, Québec, Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19387319

Citation

Nafidi, Otmane, et al. "Mechanisms of Renal Phosphate Loss in Liver Resection-associated Hypophosphatemia." Annals of Surgery, vol. 249, no. 5, 2009, pp. 824-7.
Nafidi O, Lapointe RW, Lepage R, et al. Mechanisms of renal phosphate loss in liver resection-associated hypophosphatemia. Ann Surg. 2009;249(5):824-7.
Nafidi, O., Lapointe, R. W., Lepage, R., Kumar, R., & D'Amour, P. (2009). Mechanisms of renal phosphate loss in liver resection-associated hypophosphatemia. Annals of Surgery, 249(5), 824-7. https://doi.org/10.1097/SLA.0b013e3181a3e562
Nafidi O, et al. Mechanisms of Renal Phosphate Loss in Liver Resection-associated Hypophosphatemia. Ann Surg. 2009;249(5):824-7. PubMed PMID: 19387319.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mechanisms of renal phosphate loss in liver resection-associated hypophosphatemia. AU - Nafidi,Otmane, AU - Lapointe,Real W, AU - Lepage,Raymond, AU - Kumar,Rajiv, AU - D'Amour,Pierre, PY - 2009/4/24/entrez PY - 2009/4/24/pubmed PY - 2009/5/27/medline SP - 824 EP - 7 JF - Annals of surgery JO - Ann Surg VL - 249 IS - 5 N2 - OBJECTIVE: To determine precisely the role of parathyroid hormone (PTH) and of phosphatonins in the genesis of posthepatectomy hypophosphatemia. BACKGROUND: Posthepatectomy hypophosphatemia has recently been related to increased renal fractional excretion of phosphate (FE P). To address the cause of hypophosphatemia, we measured serum concentrations of PTH, various phosphatonins, and the number of removed hepatic segment in patients with this disorder. METHODS: Serum phosphate (PO4), ionized calcium (Ca++), HCO3-, pH and FE P, intact PTH (I-PTH), carboxyl-terminal fibroblast growth factor 23 (C-FGF-23) and intact fibroblast growth factor 23 (I-FGF-23), FGF-7, and secreted frizzled related-protein-4 (sFRP-4) were measured before and on postoperative (po) days 1, 2, 3, 5, and 7, in 18 patients undergoing liver resection. The number of removed hepatic segments was also assessed. RESULTS: Serum PO4 concentrations decreased within 24 hours, were lowest (0.66 +/- 0.03 mmol/L; P < 0.001) at 48 hours, and returned to normal within 5 days of the procedure. FE P peaked at 25.07% +/- 2.26% on po day 1 (P < 0.05). Decreased ionized calcium concentrations (1.10 +/- 0.01 mmol/L; P < 0.01) were observed on po day 1 and were negatively correlated with increased I-PTH concentrations (8.8 +/- 0.9 pmol/L; P < 0.01; correlation: r = -0.062, P = 0.016). FE P was positively related to I-PTH levels on po day 1 (r = 0.52, P = 0.047) and negatively related to PO4 concentrations (r = -0.56, P = 0.024). Severe hypophosphatemia and increased urinary phosphate excretion persisted for 72 hours even when I-PTH concentrations had returned to normal. I-FGF-23 decreased to its nadir of 7.8 +/- 6.9 pg/mL (P < 0.001) on po day 3 and was correlated with PO4 levels on po days 0, 3, 5, and 7 (P < 0.001). C-FGF-23, FGF-7 and sFRP-4 levels could not be related to either PO4 concentrations or FE P. CONCLUSION: Posthepatectomy hypophosphatemia is associated with increased FE P unrelated to I-FGF-23 or C-FGF-23, FGF-7, or sFRP-4. I-PTH contributes to excessive FE P partially on po day 1 but not thereafter. Other yet defined factors should explain post hepatectomy hypophosphatemia. SN - 1528-1140 UR - https://www.unboundmedicine.com/medline/citation/19387319/Mechanisms_of_renal_phosphate_loss_in_liver_resection_associated_hypophosphatemia_ L2 - https://Insights.ovid.com/pubmed?pmid=19387319 DB - PRIME DP - Unbound Medicine ER -