Vnitr Lek 2005, 51(3):327-335

Hyperphosphataemia as an important complication of chronic renal insufficiency and chronic renal failure, part 1 - etiopathogenesis, consequences and diagnostics

J. Smržová

Dialyzační a nefrologické oddělení Interní gastroenterologické kliniky Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Petr Dítě, DrSc.

Abnormalities of calcium-phosphate metabolism start developing as early as in mild to moderate renal insufficiency when the glomerular filtration rate drops to 1 ml/s. As a result, the abnormalities can be found in up to 5% of population. The tendency towards the phosphate retention initiates a complicated cascade of disorders that ends in secondary hyperparathyroidism, renal bone disease and calcium-phosphate metabolism disturbances. The whole process leads to extraosseal calcifications, accelerated atherosclerosis and rise in mortality. Understanding pathogenetic mechanisms of calcium-phosphate metabolism disturbances well is vital for successful treatment that should be carried out by nephrologists, medical doctors and general practitioners. The aim of this paper is to summarise the up-to-date information related to etiopathogenesis and clinical consequences of calcium-phosphate metabolism disturbances in renal insufficiency as well as possible diagnostic approaches. In the first part, the metabolism of phosphorus, calcium, vitamin D and parathormone in patients with normal renal function is briefly described. Further, the possible causes of hyperphosphataemia are analysed while special attention is paid to hyperphosphataemia in dialysed patients. A separate chapter is devoted to clinical consequences of hyperphosphataemia. Last, available diagnostic means are listed.

Keywords: hyperphosphataemia; renal bone disease; parathormone; renal insufficiency; haemodialysis; etiopathogenesis

Received: March 10, 2004; Accepted: May 19, 2004; Published: March 1, 2005  Show citation