Advertisement

The Indian Journal of Pediatrics

, Volume 86, Issue 6, pp 555–557 | Cite as

C-Terminal Fibroblast Growth Factor-23 Levels in Non-Nutritional Hypophosphatemic Rickets

  • Joyita Bharati
  • Divya Bhatia
  • Priyanka Khandelwal
  • Nandita Gupta
  • Aditi Sinha
  • Rajesh Khadgawat
  • Pankaj Hari
  • Arvind BaggaEmail author
Clinical Brief
  • 81 Downloads

Abstract

Fibroblast growth factor-23 (FGF23) is central to phosphate homeostasis. The author examined if blood levels of FGF23 allow discrimination of classic hypophosphatemic rickets from other causes of non-nutritional rickets with hypophosphatemia. Forty-two children (median age: 102 mo) with non-nutritional rickets and hypophosphatemia were clinically classified as having distal renal tubular acidosis (RTA, n = 12), Fanconi syndrome (n = 8), classic hypophosphatemic rickets (n = 11), vitamin D dependent rickets (n = 7) and Dent disease (n = 4). Median blood FGF23 (measured by C-terminal ELISA) concentrations were similar in all groups (P = 0.24). These levels did not correlate with phosphate, tubular maximum for phosphate, calcium, 25-hydroxyvitamin D, creatinine, and parathormone levels. Patients with distal RTA showed variable degree of proximal tubular dysfunction that resolved following alkali supplements. Blood FGF23 levels did not satisfactorily differentiate classic hypophosphatemic rickets from other causes of hypophosphatemic rickets.

Keywords

Hypophosphatemia Familial rickets Dent disease Renal tubular acidosis 

Notes

Authors’ Contributions

JB: Patient care, data collection and manuscript preparation; DB: Laboratory work for the study; PK: Patient care and manuscript preparation; NG: Patient care and laboratory work for the study; AS and PH: Patient care; RK: Patient care and data collection; AB: Study design, patient care and manuscript preparation. AB is the guarantor for this paper.

Compliance with Ethical Standards

Conflict of Interest

None.

References

  1. 1.
    Carpenter TO. The expanding family of hypophosphatemic syndromes. J Bone Miner Metab. 2012;30:1–9.CrossRefGoogle Scholar
  2. 2.
    McMillan JA. Oski’s pediatrics: principles & practice. Philadelphia: Lippincott Williams & Wilkins; 2006. p. 2623.Google Scholar
  3. 3.
    Walton RJ, Bijvoet OL. Nomogram for derivation of renal threshold phosphate concentration. Lancet. 1975;2:309–10.CrossRefGoogle Scholar
  4. 4.
    Jonsson KB, Zahradnik R, Larsson T, et al. Fibroblast growth factor 23 in oncogenic osteomalacia and X-linked hypophosphatemia. N Engl J Med. 2003;348:1656–63.CrossRefGoogle Scholar
  5. 5.
    Gifre L, Martínez de Osaba MJ, Monegal A, Guañabens N, Peris P. Clinical usefulness of the determination of fibroblast growth factor 23 in the evaluation of patients with osteomalacia. Med Clin (Barc). 2014;42:447–50.CrossRefGoogle Scholar
  6. 6.
    Endo I, Fukumoto S, Ozono K, et al. Clinical usefulness of measurement of fibroblast growth factor 23 (FGF23) in hypophosphatemic patients: proposal of diagnostic criteria using FGF23 measurement. Bone. 2008;42:1235–9.CrossRefGoogle Scholar
  7. 7.
    Braithwaite V, Jones KS, Assar S, Schoenmakers I, Prentice A. Predictors of intact and C-terminal fibroblast growth factor 23 in Gambian children. Endocr Connect. 2014;3:1–10.CrossRefGoogle Scholar
  8. 8.
    Prentice A, Ceesay M, Nigdikar S, Allen SJ, Pettifor JM. FGF23 is elevated in Gambian children with rickets. Bone. 2008;42:788–97.CrossRefGoogle Scholar
  9. 9.
    Braithwaite V, Jarjou LMA, Goldberg GR, Prentice A. Iron status and fibroblast growth factor-23 in Gambian children. Bone. 2012;50:1351–6.CrossRefGoogle Scholar
  10. 10.
    Tasic V, Korneti P, Gucev Z, Hoppe B, Blau N, Cheong HI. Atypical presentation of distal renal tubularacidosis in two siblings. Pediatr Nephrol. 2008;23:1177–81.CrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2019

Authors and Affiliations

  • Joyita Bharati
    • 1
  • Divya Bhatia
    • 1
  • Priyanka Khandelwal
    • 1
  • Nandita Gupta
    • 2
  • Aditi Sinha
    • 1
  • Rajesh Khadgawat
    • 2
  • Pankaj Hari
    • 1
  • Arvind Bagga
    • 1
    Email author
  1. 1.Division of Nephrology, Department of PediatricsAll India Institute of Medical SciencesNew DelhiIndia
  2. 2.Department of EndocrinologyAll India Institute of Medical SciencesNew DelhiIndia

Personalised recommendations