Oral sodium phosphate bowel purgatives and acute phosphate nephropathy

  • Glen S. Markowitz

Within both the kidney and the small intestine, phosphate absorption occurs mainly via sodium-dependent phosphate cotransporter proteins that are members of the SLC34 gene family [2-3]. NaPi-IIa (SLC34A1) and NaPi-IIc (SLC34A3) are expressed in the brush border of the proximal tubule and their expression is down regulated by increases in serum phosphate and parathyroid hormone (PTH). As such, NaPi-IIa knock-out mice have significant hyperphosphaturia and develop early and severe nephrocalcinosis [4]. NaPi-IIb (SLC34A2) has a broader distribution that includes the brush border of the small intestine and levels of this protein increase in response to hypophosphatemia and vitamin D. While expression of NaPi-IIa is acutely controlled over short time periods (i.e. minutes), NaPi-IIb expression in the intestine is slower, requiring days to respond to physiologic changes. Interestingly, recent studies have shown that there is a direct signaling axis by which intestinal phosphate absorption rapidly increases fractional phosphate excretion in the kidney. This effect is apparent within 10 minutes of phosphate ingestion and is independent of serum phosphate concentration or PTH [5].

In the usual state, between 60-80% of ingested phosphate is absorbed in the small intestine. In the kidney, phosphate is freely filtered at the level of the glomerulus. Approximately 80% of phosphate is reabsorbed in the proximal tubule, with smaller amounts reabsorbed in the distal tubule and collecting duct [6-7]. Oral phosphate ingestion has the potential to increase serum levels when the intake is at higher than usual levels or occurs over short periods of time. Similarly hyperphosphatemia may follow phosphate ingestion when it occurs in the setting of impaired gastrointestinal motility leading to increased absorption or with renal dysfunction leading to decreased excretion. Hyperphosphatemia may also result from massive intracellular phosphate release in the setting of tumor lysis syndrome or rhabdomyolysis.


Acute Kidney Injury Renal Biopsy Angiotensin Converting Enzyme Inhibitor Calcium Phosphate Bowel Preparation 


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© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Glen S. Markowitz
    • 1
  1. 1.College of Physicians and Surgeons, Department of PathologyColumbia UniversityNew YorkUSA

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