| Theme |
The new horizon of phosphate control in kidney disease |
| Title |
Phosphorus in pathogenesis of secondary hyperparathyroidism |
| Author |
Hirotaka Komaba |
Division of Nephrology and Kidney Center, Kobe University School of Medicine |
| Author |
Masafumi Fukagawa |
Division of Nephrology and Kidney Center, Kobe University School of Medicine |
| [ Summary ] |
Phosphate retention is an important factor in the pathogenesis of secondary hyperparathyroidism. It was originally thought that phosphate retention would indirectly cause an increase in parathyroid hormone (PTH) secretion under the influence of decreased calcium levels and / or 1.25 (OH)2D3 levels. Conversely, recent in vivo and in vitro studies have shown that a high phosphate concentration directly stimulates PTH secretion. It has also been demonstrated that enhancement of TGF-α is aggravated by high-phosphate intake, and constitutes the main pathogenic mechanism for severe parathyroid hyperplasia. More recently, α-Klotho and fibroblast growth factor 23 have been identified as novel factors involved in the regulation of phosphate and calcium homeostasis, which findings have also stimulated much interest in the nephrology community. Further understanding of these novel regula-tors may help shed light on the pathogenesis of secondary hyperparathyroidism. |