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- Title
FGF-23 in children with CKD: a new player in the development of CKD–mineral and bone disorder.
- Authors
Siomou, Ekaterini; Stefanidis, Constantinos J.
- Abstract
Disturbances in mineral and bone metabolism in children with chronic kidney disease (CKD) lead to specific abnormalities of skeletal homeostasis called CKD–mineral and bone disorder (CKD-MBD). These disturbances should be diagnosed and managed appropriately to prevent bone deformities and disturbed growth. Changes in the vitamin D and parathyroid hormone (PTH), and the subsequent alterations in calcium (Ca) and phosphate (P) homeostasis are considered responsible for the development of CKD-MBD. Recently, a phosphaturic hormone, the fibroblast growth factor-23 (FGF-23), has been reported as a key regulator of P and vitamin D metabolism. A number of recent studies in paediatric populations have documented that the FGF-23 levels are increased early in CKD, before any abnormalities in serum Ca, P or PTH are apparent. The elevated FGF-23 levels result in a negative P balance to maintain P homeostasis, inducing phosphaturia, independently of PTH, and suppressing vitamin D synthesis. Therefore, the bone–kidney–parathyroid endocrine axis mediated by FGF-23 should be a novel therapeutic target in clinical practice, even in early stages of CKD in children.
- Subjects
CHRONIC kidney failure in children; FIBROBLAST growth factors; BONE diseases; BONE density; BONE metabolism; HOMEOSTASIS; BONE abnormalities
- Publication
Nephrology Dialysis Transplantation, 2012, Vol 27, Issue 12, p4259
- ISSN
0931-0509
- Publication type
Article
- DOI
10.1093/ndt/gfs315