Pflügers Archiv - European Journal of Physiology

, Volume 471, Issue 1, pp 137–148 | Cite as

Clinical aspects of the phosphate transporters NaPi-IIa and NaPi-IIb: mutations and disease associations

  • Eleanor LedererEmail author
  • Carsten A. Wagner
Invited Review


The Na+-dependent phosphate transporter NaPi-IIa (SLC34A1) is mostly expressed in kidney, whereas NaPi-IIb (SLC34A2) has a wider tissue distribution with prominent expression in the lung and small intestine. NaPi-IIa is involved in renal reabsorption of inorganic phosphate (Pi) from urine, and patients with biallelic inactivating mutations in SLC34A1 develop hypophosphatemia, hypercalcemia, hypercalciuria and nephrocalcinosis, and nephrolithiasis in early childhood. Monoallelic mutations are frequent in the general population and may impact on the risk to develop kidney stones in adulthood. SNPs in close vicinity to the SLC34A1 locus associate with the risk to develop CKD. NaPi-IIb mediates high-affinity transport of Pi from the diet and appears to be mostly important during low Pi availability. Biallelic inactivating SLC34A2 mutations are found in patients with pulmonary alveolar microlithiasis, a lung disease characterized by the deposition of microcrystals. In contrast, no evidence for disturbed systemic Pi homeostasis has been reported in these patients to date. Nevertheless, NaPi-IIb-mediated intestinal Pi absorption may be a target for pharmaceutical interventions in patients with chronic kidney disease and Pi overload.


Phosphate metabolism Hypophosphatemia Hyperphosphatemia Nephrolithiasis Pulmonary alveolar microlithiasis 



Research in the laboratories of the authors has been supported by the Department of Veterans Affairs and the University of Louisville School of Medicine to E. Lederer and by the Swiss National Science Foundation (SNSF) (NCCR Kidney.CH and 31003A_176125).


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of Nephrology and HypertensionUniversity of Louisville School of MedicineLouisvilleUSA
  2. 2.Robley Rex VA Medical CenterLouisvilleUSA
  3. 3.Kidney Disease ProgramLouisvilleUSA
  4. 4.Institute of PhysiologyUniversity of ZurichZurichSwitzerland
  5. 5.National Center of Competence in Research NCCR Kidney.CHZurichSwitzerland

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