Abstract
Fibroblast growth factor 23 (FGF23) is a bone-derived hormone regulating phosphate and vitamin D metabolism. FGF23 works by binding to Klotho-FGF receptor (FGFR) complex. FGF23 reduces serum phosphate level by suppressing the expression of type 2a and 2c sodium-phosphate cotransporters in the renal proximal tubules. In addition, FGF23 suppresses intestinal phosphate absorption by reducing 1,25-dihydroxyvitamin D (1,25(OH)2D) level. FGF23 also inhibits the production and secretion of parathyroid hormone. FGF23 starts to increase in the early phase of chronic kidney disease (CKD) and is considered to prevent the development of hyperphosphatemia. With the progression of CKD, the expression of Klotho decreases causing impaired actions of FGF23. It has been reported that FGF23 level is correlated with various adverse events including cardiovascular diseases especially in patients with CKD. It was also shown that FGF23 induces left ventricular hypertrophy by directly acting on cardiomyocytes in a Klotho-independent way. However, there still remain several unanswered questions concerning FGF23-Klotho axis. We hope that further studies elucidate unsolved problems and will be useful for more appropriate management of patients with CKD.
Highlights
Kidney is essential for maintaining mineral metabolism
Serum Fibroblast growth factor 23 (FGF23) level is high in patients of chronic kidney disease (CKD), suggesting that FGF23 has some role in the development of CKD-mineral and bone disorder (CKD-MBD) [14]
Klotho was identified as a gene whose expression was severely reduced in genetically engineered mice called Klotho [21]. Both FGF23 knockout and Klotho mice were shown to have hyperphosphatemia with increased renal proximal tubular phosphate reabsorption and high 1,25(OH)2D level [9, 12, 13, 22], indicating that FGF23-Klotho pathway is essential for maintaining phosphate and vitamin D metabolism
Summary
Kidney is essential for maintaining mineral metabolism. deranged mineral metabolism and abnormal serum concentrations of minerals including calcium (Ca) and phosphate can be observed in patients with chronic kidney disease (CKD). Serum FGF23 level is high in patients of CKD, suggesting that FGF23 has some role in the development of CKD-MBD [14]. FGF23 reduces serum phosphate level by suppressing the expression of type 2a and 2c sodium-phosphate cotransporters in the renal proximal tubules [8] (Fig. 2).
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
