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

  • Original Article
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Pediatric Nephrology Aims and scope Submit manuscript

Abstract

Background

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

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

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.

Disclosure

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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Authors and Affiliations

  1. Department of Pediatrics, David Geffen School of Medicine at UCLA, A2-383 MDCC, 650 Charles Young Drive, Los Angeles, 90095, CA, USA

    Katherine Wesseling-Perry, Renata C. Pereira, Eileen Tsai, Robert Ettenger & Isidro B. Salusky

  2. Endocrine Unit and Pediatric Nephrology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Harald Jüppner

Authors
  1. Katherine Wesseling-Perry
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  2. Renata C. Pereira
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  3. Eileen Tsai
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  4. Robert Ettenger
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  5. Harald Jüppner
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  6. Isidro B. Salusky
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Corresponding author

Correspondence to Katherine Wesseling-Perry.

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Wesseling-Perry, K., Pereira, R.C., Tsai, E. et al. FGF23 and mineral metabolism in the early post-renal transplantation period. Pediatr Nephrol 28, 2207–2215 (2013). https://doi.org/10.1007/s00467-013-2547-z

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  • DOI: https://doi.org/10.1007/s00467-013-2547-z

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