Pediatric Nephrology

, Volume 28, Issue 11, pp 2207–2215 | Cite as

FGF23 and mineral metabolism in the early post-renal transplantation period

  • Katherine Wesseling-Perry
  • Renata C. Pereira
  • Eileen Tsai
  • Robert Ettenger
  • Harald Jüppner
  • Isidro B. Salusky
Original Article



The relationship between fibroblast growth factor 23 (FGF23) and vitamin D production and catabolism post-renal transplantation has not been characterized.


Circulating creatinine, calcium, phosphorus, albumin, parathyroid hormone, FGF23, and 1,25(OH)2 vitamin D (calcitriol) values were obtained pre-transplantation, daily post-operatively for 5 days, and at 6 months post-transplantation in 44 patients aged 16.4 ± 0.4 years undergoing renal transplantation at UCLA from 1 August 2005 through to 30 April 2007. 25(OH) Vitamin D and 24,25(OH)2 vitamin D concentrations were obtained at baseline and on post-operative days 5 and 180, and urinary concentrations of creatinine, phosphorus, and FGF23 were measured on post-operative days 1, 3, 5, and 180.


Circulating phosphate concentrations declined more rapidly and the fractional excretion of phosphorus was higher in the first week post-transplantation in subjects with higher FGF23 values. Fractional excretion of FGF23 was low at all time-points. Circulating 1,25(OH)2 vitamin D levels rose more rapidly and were consistently higher in patients with lower FGF23 values; however, 25(OH) vitamin D and 24,25(OH)2 vitamin D values were unrelated to FGF23 concentrations.


Inhibition of renal 1α-hydroxylase, rather than stimulation of 24-hydroxylase, may primarily contribute to the relationship between FGF23 values and calcitriol. The rapid decline in FGF23 levels post-transplantation in our patient cohort was not mediated solely by the filtration of intact FGF23 by the new kidney.


FGF23 PTH Vitamin D Renal transplantation Phosphorus 



This work was supported in part by USPHS grants DK-67563, DK-35423, DK-51081, DK-073039, DK-080984, UL1 RR-033176 and UL1TR000124, PO1 DK11794, and by funds from the Casey Lee Ball Foundation. The authors would like to thank Barbara Gales and Georgina Ramos for their invaluable help in sample collection and storage for the current study.


H Jüppner is named on a patent describing the FGF-23 assay that was used in this study. None of the other authors of this paper have any financial interest in the information contained in this manuscript.


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Copyright information

© IPNA 2013

Authors and Affiliations

  • Katherine Wesseling-Perry
    • 1
  • Renata C. Pereira
    • 1
  • Eileen Tsai
    • 1
  • Robert Ettenger
    • 1
  • Harald Jüppner
    • 2
  • Isidro B. Salusky
    • 1
  1. 1.Department of PediatricsDavid Geffen School of Medicine at UCLALos AngelesUSA
  2. 2.Endocrine Unit and Pediatric Nephrology UnitMassachusetts General Hospital and Harvard Medical SchoolBostonUSA

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