NDT Advance Access originally published online on April 19, 2005
Nephrology Dialysis Transplantation 2005 20(7):1295-1298; doi:10.1093/ndt/gfh827
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Editorial Comment
With or without the kidney: the role of FGF23 in CKD
1 Division of Nephrology and Dialysis Center, Kobe University School of Medicine, Kobe and 2 Division of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medicine and Dental Sciences, Niigata, Japan
Correspondence and offprint requests to: Masafumi Fukagawa, MD, PhD, FJSIM, FASN, Division of Nephrology and Dialysis Center, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017 Japan. Email: fukagawa@med.kobe-u.ac.jp
Keywords: chronic kidney disease (CKD); FGF23; kidney; parathyroid hormone (PTH); phosphate; vitamin D
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Introduction |
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The systemic balance of phosphate is maintained mainly by three organs, i.e. the intestine, kidney and bone. Several factors including parathyroid hormone (PTH) and vitamin D play a critical role in this system. Fibroblast growth factor 23 (FGF23) is a recently identified phosphatonin which also is implicated [1,2].
It has been demonstrated in several diseases that excessive activity of FGF23 resulted in hypophosphataemia, low plasma 1,25-dihydroxyvitamin D (1,25D) levels and osteomalacia [3–5]. In animals, the administration of recombinant FGF23 led to the same results [6]. Furthermore, overexpression of FGF23 led to phosphate wasting [7] and rickets, while ablation of this gene led to hyperphosphatemia and high circulating 1,25D levels [8].
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Physiological role of FGF23 with a normal kidney |
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What are the physiological stimuli for FGF23 secretion? In normal rats, a dietary phosphate load leads to hyperphosphataemia and increased serum FGF23 levels [9]. Such an
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Role of FGF23 with a failing kidney |
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Role of FGF23 in the absence of a functioning kidney |
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Closed or open loop in the FGF23 system: with or without the kidney |
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Conclusion |
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