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Osteo-renal regulation of systemic phosphate metabolism.
IUBMB Life. 2011 Apr; 63(4):240-7.IL

Abstract

Impaired kidney function and subsequent skeletal responses play a critical role in disrupting phosphate balance in chronic kidney disease (CKD) patients with mineral and bone disorder (CKD-MBD). In patients with CKD-MBD, the inability of the kidney to maintain normal mineral ion balance affects bone remodeling to induce skeletal fracture and extraskeletal vascular calcification. In physiological conditions, bone-derived fibroblast growth factor 23 (FGF23) acts on the kidney to reduce serum phosphate and 1,25-dihydroxyvitamin D levels. In humans, increased bioactivity of FGF23 leads to increased urinary phosphate excretion, which induces hypophosphatemic diseases (e.g., rickets/osteomalacia). However, reduced FGF23 activity is associated with hyperphosphatemic diseases (e.g., tumoral calcinosis). In patients with CKD, high serum levels of FGF23 fail to reduce serum phosphate levels and lead to numerous complications, including vascular calcification, one of the important determinants of mortality of CKD-MBD patients. Of particular significance, molecular, biochemical and morphological changes in patients with CKD-MBD are mostly due to osteo-renal dysregulation of mineral ion metabolism. Furthermore, hyperphosphatemia can partly contribute to the development of secondary hyperparathyroidism in patients with CKD-MBD. Relatively new pharmacological agents including sevelamer hydrochloride, calcitriol analogs and cinacalcet hydrochloride are used either alone, or in combination, to minimize hyperphosphatemia and hyperparathyroidism associated complications to improve morbidity and mortality of CKD-MBD patients. This article will briefly summarize how osteo-renal miscommunication can induce phosphate toxicity, resulting in extensive tissue injuries.

Authors+Show Affiliations

Department of Oral Medicine, Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA. mrazzaque@hms.harvard.edu

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Review

Language

eng

PubMed ID

21438115

Citation

Razzaque, Mohammed Shawkat. "Osteo-renal Regulation of Systemic Phosphate Metabolism." IUBMB Life, vol. 63, no. 4, 2011, pp. 240-7.
Razzaque MS. Osteo-renal regulation of systemic phosphate metabolism. IUBMB Life. 2011;63(4):240-7.
Razzaque, M. S. (2011). Osteo-renal regulation of systemic phosphate metabolism. IUBMB Life, 63(4), 240-7. https://doi.org/10.1002/iub.437
Razzaque MS. Osteo-renal Regulation of Systemic Phosphate Metabolism. IUBMB Life. 2011;63(4):240-7. PubMed PMID: 21438115.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Osteo-renal regulation of systemic phosphate metabolism. A1 - Razzaque,Mohammed Shawkat, Y1 - 2011/03/24/ PY - 2010/12/10/received PY - 2011/01/29/accepted PY - 2011/3/26/entrez PY - 2011/3/26/pubmed PY - 2011/8/6/medline SP - 240 EP - 7 JF - IUBMB life JO - IUBMB Life VL - 63 IS - 4 N2 - Impaired kidney function and subsequent skeletal responses play a critical role in disrupting phosphate balance in chronic kidney disease (CKD) patients with mineral and bone disorder (CKD-MBD). In patients with CKD-MBD, the inability of the kidney to maintain normal mineral ion balance affects bone remodeling to induce skeletal fracture and extraskeletal vascular calcification. In physiological conditions, bone-derived fibroblast growth factor 23 (FGF23) acts on the kidney to reduce serum phosphate and 1,25-dihydroxyvitamin D levels. In humans, increased bioactivity of FGF23 leads to increased urinary phosphate excretion, which induces hypophosphatemic diseases (e.g., rickets/osteomalacia). However, reduced FGF23 activity is associated with hyperphosphatemic diseases (e.g., tumoral calcinosis). In patients with CKD, high serum levels of FGF23 fail to reduce serum phosphate levels and lead to numerous complications, including vascular calcification, one of the important determinants of mortality of CKD-MBD patients. Of particular significance, molecular, biochemical and morphological changes in patients with CKD-MBD are mostly due to osteo-renal dysregulation of mineral ion metabolism. Furthermore, hyperphosphatemia can partly contribute to the development of secondary hyperparathyroidism in patients with CKD-MBD. Relatively new pharmacological agents including sevelamer hydrochloride, calcitriol analogs and cinacalcet hydrochloride are used either alone, or in combination, to minimize hyperphosphatemia and hyperparathyroidism associated complications to improve morbidity and mortality of CKD-MBD patients. This article will briefly summarize how osteo-renal miscommunication can induce phosphate toxicity, resulting in extensive tissue injuries. SN - 1521-6551 UR - https://www.unboundmedicine.com/medline/citation/21438115/Osteo_renal_regulation_of_systemic_phosphate_metabolism_ L2 - https://doi.org/10.1002/iub.437 DB - PRIME DP - Unbound Medicine ER -