Abstract
Post-transplant hypophosphatemia is a highly prevalent problem, and fibroblast growth factor 23, a newly discovered phosphatonin, has recently been reported to be involved in its pathogenesis. We report a 52-year-old Japanese woman who received a living-related kidney transplant and showed severe hypophosphatemia immediately after transplantation. We suspected that fibroblast growth factor 23 was the main cause of this hypophosphatemia and investigated its levels longitudinally after the transplantation. The patient showed persistently high levels of fibroblast growth factor 23, with suppressed 1,25-dihydroxyvitamin D and parathyroid hormone. She recovered from the hypophosphatemia when fibroblast growth factor returned to its reference level half a year after the transplantation. We conclude that a persistently high level of fibroblast growth factor 23 is an important cause of post-transplant hypophosphatemia, other than hyperparathyroidism, a previously noted cause.
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References
M Levi (2001) ArticleTitlePost-transplant hypophosphatemia Kidney Int 59 2377–87 Occurrence Handle1:STN:280:DC%2BD3M3ps1SitQ%3D%3D Occurrence Handle10.1046/j.1523-1755.2001.00755.x Occurrence Handle11380848
H Ghanekar BJ Welch OW Moe K Sakhae (2006) ArticleTitlePost-renal transplantation hypophosphatemia: a review and novel insights Curr Opin Nephrol Hypertens 15 97–104 Occurrence Handle1:CAS:528:DC%2BD28XjsVyjurc%3D Occurrence Handle10.1097/01.mnh.0000203187.49890.cc Occurrence Handle16481873
J Green H Debby E Lederer M Levi HK Zajicek T Bick (2001) ArticleTitleEvidence for a PTH-independent humoral mechanism in post-transplant hypophosphatemia and phosphaturia Kidney Int 60 1182–96 Occurrence Handle1:CAS:528:DC%2BD3MXmvFKjtbY%3D Occurrence Handle10.1046/j.1523-1755.2001.0600031182.x Occurrence Handle11532115
I Bhan A Shah J Holmes T Isakova O Gutierrez SA Burnett et al. (2006) ArticleTitlePost-transplant hypophosphatemia: tertiary “hyperphosphatoninism Kidney Int 70 1486–94 Occurrence Handle1:CAS:528:DC%2BD28XhtVCntLvK Occurrence Handle10.1038/sj.ki.5001788 Occurrence Handle16941023
S Pande CS Ritter M Rothstein K Wiesen J Vassiliadis R Kumor et al. (2006) ArticleTitleFGF-23 and sFRP-4 in chronic kidney disease and post-renal transplantation Nephron Physiol 104 23–32 Occurrence Handle10.1159/000093277
P Messa C Sindici G Cannella V Miotti A Risaliti M Gropuzzo et al. (1998) ArticleTitlePersistent secondary hyperparathyroidism after renal transplantation Kidney Int 54 1704–13 Occurrence Handle1:STN:280:DyaK1M%2Fmt1aktQ%3D%3D Occurrence Handle10.1046/j.1523-1755.1998.00142.x Occurrence Handle9844148
P Evenepoel M Naesens K Claes D Kuypers Y Vanrenterghem (2007) ArticleTitleTertiary “hyperphosphatoninism” accentuates hypophosphatemia and suppresses calcitriol levels in renal transplant recipients Am J Transplant 7 1–8 Occurrence Handle10.1111/j.1600-6143.2007.01753.x
Y Yamazaki R Okazaki M Shibata Y Hasegawa K Satoh T Tajima et al. (2002) ArticleTitleIncreased circulatory level of biologically active full-length FGF-23 in patients with hypophosphatemic rickets/osteomalacia J Clin Endocrinol Metab 87 4957–60 Occurrence Handle1:CAS:528:DC%2BD38Xos1ynsLk%3D Occurrence Handle10.1210/jc.2002-021105 Occurrence Handle12414858
TJ Berndt S Schiavi R Kumar (2005) ArticleTitle“Phosphatonins” and the regulation of phosphorus homeostasis Am J Physiol Renal Physiol 289 1170–82 Occurrence Handle10.1152/ajprenal.00072.2005
S Fukumoto T Yamashita (2007) ArticleTitleFGF23 is a hormone regulating phosphate metabolism–unique biological characteristics of FGF23 Bone 40 1190–5 Occurrence Handle1:CAS:528:DC%2BD2sXktF2nsrw%3D Occurrence Handle10.1016/j.bone.2006.12.062 Occurrence Handle17276744
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Kawarazaki, H., Shibagaki, Y., Shimizu, H. et al. Persistent high level of fibroblast growth factor 23 as a cause of post-renal transplant hypophosphatemia. Clin Exp Nephrol 11, 255–257 (2007). https://doi.org/10.1007/s10157-007-0489-0
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DOI: https://doi.org/10.1007/s10157-007-0489-0