Phosphate And Vitamin D In Chronic Kidney Disease

The enormous progress made during the last decade has resulted in a better conceptual understanding of mineral ion metabolism in general. With regard to chronic kidney disease, the two most affected nutrients are phosphate and vitamin D. This book provides an overview of the physiological aspects of phosphate and vitamin D metabolism, and how their pathological dysregulation facilitates advancement of chronic kidney disease. It looks into the complex molecular and organ cross-talks during disease progression that range from the involvement of fibroblast growth factor (FGF23)-klotho system to impaired phosphate transport to hormonal dysfunctions of PTH and vitamin D. Each chapter clearly presents the clinically and biologically important problems and lists the key unsolved issues related to chronic kidney disease and beyond. Illustrations explaining multi-factorial and multi-organ interactions provide an easy outline for the reader to appreciate the complex biological pathways. For those without prior familiarity with the subject matter, this volume may serve as a quick reference to get updated information on phosphate and vitamin D metabolism.

Vitamin D deficiency, circulating levels lower than 15 ng/ml, is an epidemic disease worldwide with more than a billion people suffering of it in the beginning of the 21-century. Besides its impact on mineral and bone metabolism, these low vitamin D levels are also associated with a diversity of non-skeletal complications, among them cardiovascular disease, diabetes mellitus, multiple sclerosis, cancer, tuberculosis, and immune system dysfunction. Chronic Kidney Disease is also a very common disease, affecting more than 10% of the world population, ranging from stage 1 to stage 5 before dialysis. Approximately 1% of the population in industrialized countries is affected by end-stage renal disease (ESRD), needing a renal replacement therapy either hemodialysis or peritoneal dialysis, and ultimately by renal transplantation. Those CKD patients are more susceptible to exhibit reduced vitamin D stocks. Consequently, more than eighty percent of CKD patients have either insufficient or deficient vitamin D levels for multiple reasons.

The present book contains the Proceedings of a two day Symposium on Uremic Toxins organized at the University of Ghent in Belgium. A series of guest lectures, free communications and posters have been presented. An international audience of 163 scientists from 16 nationalities listened to and discussed extensively a spectrum of topics brought forward by colleagues and researchers who worked for many years in the field of Uremic Toxins. There is a striking contrast between all the new dialysis strategies available in the work to "clean" the uremic patients and the almost non-progression of our knowledge on uremic toxins in the past decade. In this sense the symposium was felt by all participants as a new start for the research in the biochemical field of the definition of uremia. If the present volume would stimulate new work in this field in order to define uremia, or identify the uremic toxins, the purpose of the organizers would be maximally fulfilled.

We present to our readers the proceedings of the Second International Workshop on Phosphate. A short account of the history of the effort led to the Phosphate Workshops is appro priate and can be of interest to the reader. The idea for Phosphate Workshops was born in the early days of November, 1974. One of us (S. G. M. ) suggested the thought to a group of scientists gathered for a luncheon in one of the attrac tive small restaurants in Weisbaden, Germany. The purpose of the workshop was to bring together interested scientists to discuss the newer developments and the recent advances in the field of phosphate metabolism and the other related minerals. An Organizing Committee made of Shaul G. Massry (USA), Louis V. Avioli (USA), Philippe Bordier (France), Herbert Fleisch (Switzerland), and Eduardo Slatopolsky (USA) was formed. The First Workshop was held in Paris during June 5-6, 1975 and was hosted by Dr. Philippe Bordier. Its proceeding was already published. The Second Workshop took place in Heidelberg during June 28-30, 1976 and was hosted by Dr. Eberhard Ritz. Both of these workshops were extremely successful scientific endeavors, and the need for them was demonstrated by the great interest they generated among the scientific community. The Or ganizing Committee, therefore, decided to continue with the tradi tion to hold additional Workshops annually or every other year.

Traditionally, endocrinology textbooks have been either short notes or multi-author, multi-volume monster, all of which present clinical material last and often only briefly. Endocrinology is different and used real cases to lead readers into the text and then describes the biochemistry, physiology, and anatomy they need to understand the case. The

When the kidney fails its intended mission to manage the body’s waste products, physicians must perform multi-level and simultaneous adjustments to replicate kidney function. The management of the body’s absorption, reabsorption, utilization and excretion of calcium and phosphate requires constant fine tuning. This book provides an overview of the state-of-the-art clinical and basic science aspects of abnormal calcium and phosphate metabolism and its management.