Dysregulated Mineral Metabolism in AKI

Semin Nephrol. 2019 Jan;39(1):41-56. doi: 10.1016/j.semnephrol.2018.10.004.

Abstract

Dysregulated mineral metabolism is a nearly universal sequalae of acute kidney injury (AKI). Abnormalities in circulating mineral metabolites observed in patients with AKI include hypocalcemia, hyperparathyroidism, hyperphosphatemia, decreased vitamin D metabolite levels, and increased fibroblast growth factor 23 levels. We review the pathophysiology of dysregulated mineral metabolism in AKI with a focus on calcium, phosphate, parathyroid hormone, and vitamin D metabolites. We discuss how mineral metabolite levels can serve as novel prognostic markers for incident AKI and other related outcomes in various clinical settings. Finally, we discuss how vitamin D metabolites potentially could be used as novel therapeutic agents for AKI prevention and treatment.

Keywords: AKI; FGF23; PTH; acute kidney injury; calcium; mineral metabolism; phosphate; vitamin D.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Acute Kidney Injury / complications
  • Acute Kidney Injury / physiopathology*
  • Acute Kidney Injury / therapy
  • Animals
  • Fibroblast Growth Factors / metabolism
  • Humans
  • Hyperparathyroidism / blood
  • Hyperparathyroidism / etiology
  • Hyperphosphatemia / etiology
  • Hyperphosphatemia / therapy
  • Hypocalcemia / etiology
  • Hypocalcemia / physiopathology*
  • Membrane Proteins / metabolism
  • Minerals / metabolism*
  • Parathyroid Hormone / blood
  • Renal Replacement Therapy / adverse effects
  • Vitamin D / analogs & derivatives
  • Vitamin D / blood
  • Vitamin D / therapeutic use
  • Vitamin D Deficiency / blood
  • Vitamin D Deficiency / drug therapy*
  • Vitamin D Deficiency / etiology

Substances

  • KLB protein, human
  • Membrane Proteins
  • Minerals
  • Parathyroid Hormone
  • Vitamin D
  • Fibroblast Growth Factors
  • 1,25-dihydroxyvitamin D
  • fibroblast growth factor 23
  • 25-hydroxyvitamin D