Abstract
Background
Fibroblast growth factor 23 (FGF23), a novel bone-derived hormone that inhibits phosphate reabsorption and calcitriol production by the kidney, has uncovered primary regulatory pathways and new systems biology governing bone mineralization, vitamin D metabolism, parathyroid gland function, and renal phosphate handling.
Aim of the work
The aim of the present prospective study was to investigate FGF23 levels in patients with end-stage renal disease before and after a successful renal transplant and their probable association with the markers of bone and mineral metabolism.
Patients and methods
A total of 40 patients were studied for 6 months and divided into two groups (hemodialysis vs. renal transplant patients). Serum FGF23, calcium, phosphorus, and intact parathyroid hormone (iPTH) were estimated for both groups. We compared the changes in serum FGF23, calcium, phosphorus, and iPTH in renal transplant patients 3 and 6 months after successful renal transplantation. Results
The serum FGF23 decreased significantly after renal transplantation. iPTH and P levels also decreased significantly after renal transplant, whereas Ca level increased.
Conclusion
FGF23 levels were markedly increased in patients with end-stage renal disease associated with an increase in phosphorous and iPTH levels. FGF23 levels decrease dramatically after successful renal transplantation and remain within the normal limits when graft function is good. iPTH and P levels also decrease significantly after renal transplantation, whereas Ca increases.
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References
Silver J, Naveh-Many T. FGF23 and the parathyroid glands. Pediatr Nephrol 2013; 25: 2241–2245.
Stubbs JR, He N, Idiculla A. Longitudinal evaluation of FGF23 changes and mineral metabolism abnormalities in a mouse model of chronic kidney disease. J Bone Miner Res 2012; 1: 38–46.
Wolf M. Update on fibroblast growth factor 23 in chronic kidney disease. Kidney Int 2012; 82: 737–747.
Evenepoel P, Viaene L, Meijers B. PTH, FGF23, and calcium: it takes three to tango? Kidney Int 2011; 80: 1377.
Baia LC, Heilberg IP, Navis G, de Borst MH; NIGRAM investigators. Phosphate and FGF-23 homeostasis after kidney transplantation. Nat Rev Nephrol 2015; 11: 656–666.
Cianciolo G, Capelli I, Angelini ML, Valentini C, Baraldi O, Scolari MP, Stefoni S. Importance of vascular calcification inkidney transplant recipients. Am J Nephrol 2014; 39: 418–426.
Torregrosa JV, Bover J, Cannata Andía J, Lorenzo V, de Francisco AL, Martínez I et al. Spanish Society of Nephrology recommendations for controlling mineral and bone disorder in chronic kidney disease patients (S.E.N.-M.B.D.). Nefrologia 2011; 31: (Suppl 1): 3–32.
Taweesedt PT, Disthabanchong S. Mineral and bone disorder after kidney transplantation. World J Transplant 2015; 5: 231–242.
Silver J, Naveh-Many T. FGF-23 and secondary hyperparathyroidism in chronic kidney disease. Nat Rev Nephrol 2013; 9: 641–649.
Economidou D, Dovas S, Papagianni A. FGF23 before and after renal transplantation. J Transplant 2009; 10: 1–5.
Krocker D, Perka C, Tuischer J. Effects of tacrolimus, cyclosporin A and sirolimus on MG63 cells. Transplant Int 2006; 19: 563–569.
Trombetti A, Richert L, Hadaya K, Graf JD, Herrmann FR, Ferrari SLet al. Early post-transplantation hypophosphatemia is associated with elevated FGF-23 levels. Eur J Endocrinol 2011; 164: 839–847.
Heaf JG. Bone disease after renal transplantation. Transplantation 2003; 75: 315.
Saji F, Shiizaki K, Shimada S. Regulation of fibroblast growth factor 23 production in bone in uremic rats. Nephron Physiol 2009; 111: 59–66.
Borchhardt K, Sulzbacher I, Benesch T. Low-turnover bone disease in hypercalcemic hyperparathyroidism after kidney transplantation. Am J Transplant 2007; 7: 2515.
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El-khatib, M.M., El-Shahaby, A.R., EEl-Khashab, S.O. et al. Fibroblast growth factor 23 levels before and after renal transplantation. Egypt J Intern Med 28, 52–59 (2016). https://doi.org/10.4103/1110-7782.193887
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DOI: https://doi.org/10.4103/1110-7782.193887