Tradeoff-in-the-Nephron: A Theory to Explain the Primacy of Phosphate in the Pathogenesis of Secondary Hyperparathyroidism.

ABSTRACT: Chronic kidney disease (CKD) causes secondary hyperparathyroidism (SHPT). The cardinal features of SHPT are persistence of normocalcemia as CKD progresses and dependence of the parathyroid hormone concentration ([PTH]) on phosphate influx (I_P). The tradeoff-in-the-nephron hypothesis integrates these features. It states that as the glomerular filtration rate (GFR) falls, the phosphate concentration ([P]_CDN) rises in the cortical distal nephron, the calcium concentration ([Ca]_CDN) in that segment falls, and [PTH] rises to maintain normal calcium reabsorption per volume of filtrate (TR_Ca/GFR). In a clinical study, we set GFR equal to creatinine clearance (C_cr) and I_P equal to the urinary excretion rate of phosphorus (E_P

SUBMITTER: Phelps KR 

PROVIDER: S-EPMC5452157 | biostudies-literature | 2017 Apr

REPOSITORIES: biostudies-literature