Regulation of Phosphate Excretion by the Diseased Kidney: The Intrinsic Proximal Tubular Adaptation
The maintenance of phosphate homeostasis in chronic renal failure has been ascribed to PTH-dependent1–4 and PTH-independent mechanisms5–9. While the phosphaturic effect of elevated PTH levels undoubtedly plays an important role in modulating tubular phosphate reabsorption as nephrons are progressively destroyed, there is equally impressive evidence that intrinsic adaptations in tubular transport may occur independently of biologically active PTH levels. Such adaptations would include changes in the basal rate of phosphate transport and in the sensitivity and responsiveness of the renal tubule to PTH.
KeywordsPhosphate Excretion Dibutyryl cAMP Remnant Kidney Proximal Straight Tubule Phosphate Flux
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