Hypophosphatemia: An evidence-based approach to its clinical consequences and management

Jamshid Amanzadeh, Robert F. Reilly

Research output: Contribution to journalArticle

173 Citations (Scopus)

Abstract

Optimal cellular function is dependent on maintenance of a normal serum phosphorus concentration. Serum phosphorus concentration is affected by several determinants, the most important of which is regulation of phosphorus reabsorption by the kidney. The majority of this reabsorption (80%) occurs in the proximal tubule and is mediated by an isoform of the sodium-phosphate cotransporter (NaPi-II). Parathyroid hormone, via a variety of intracellular signaling cascades leading to NaPi-IIa internalization and downregulation, is the main regulator of renal phosphate reabsorption. Shift of phosphorus from extracellular to intracellular compartments, decreased gastrointestinal absorption, and increased urinary losses, are the primary mechanisms of hypophosphatemia, which affects approximately 2% of hospitalized patients. Hypophosphatemia has been implicated as a cause of rhabdomyolysis, respiratory failure, hemolysis and left ventricular dysfunction. With the exception of ventilated patients, there is little evidence that moderate hypophosphatemia has significant clinical consequences in humans, and aggressive intravenous phosphate replacement is unnecessary. By contrast, patients with severe hypophosphatemia should be treated. Intravenous repletion may be considered, especially for patients who have clinical sequelae of hypophosphatemia.

Original languageEnglish (US)
Pages (from-to)136-148
Number of pages13
JournalNature Clinical Practice Nephrology
Volume2
Issue number3
DOIs
StatePublished - Mar 2006

Fingerprint

Hypophosphatemia
Phosphorus
Sodium-Phosphate Cotransporter Proteins
Phosphates
Rhabdomyolysis
Left Ventricular Dysfunction
Hemolysis
Parathyroid Hormone
Serum
Respiratory Insufficiency
Protein Isoforms
Down-Regulation
Maintenance
Kidney

Keywords

  • Hemolysis
  • Hypophosphatemia
  • Phosphorus
  • Refeeding
  • Rhabdomyolysis

ASJC Scopus subject areas

  • Nephrology

Cite this

Hypophosphatemia : An evidence-based approach to its clinical consequences and management. / Amanzadeh, Jamshid; Reilly, Robert F.

In: Nature Clinical Practice Nephrology, Vol. 2, No. 3, 03.2006, p. 136-148.

Research output: Contribution to journalArticle

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