Disturbances in phosphate handling include diseases with hypophosphatemia and hyperphosphatemia. The former is caused by excessive renal phosphate wastage and results in bone disorders, such as rickets, osteomalacia, osteoporosis, and osteoglophonia. Hyperphosphatemia on the other hand is caused by renal phosphate Retention and results in excessive bone ossification (osteopetrosis, subperiostal bone formation and calcinosis.
The flowchart below shows normal phosphate metabolism as it is designed to stabilize body phosphate content (homeostasis). With our normal diet, we consume phosphate in excess. Excess phosphate is excreted renally. By the amount of reabsorbed phosphate homeostasis is controlled. As with a normal diet 80% of the filtrated phosphate is reabsorbed, this leaves enough room to regulate homeostasis through a wide range of phosphate intake.
As renal reabsorption is the key player in phosphate homeostasis, it is there where most control is excreted. The control mechanisms that down-regulate reabsorption and by that up-regulate excretion are marked red. Disturbances of these control mechanisms eventually lead to phosphate wastage or phosphate retention, two sides of the same coin, disturbances of phosphate metabolism.
As hyper- and hypophosphatemia are managed differently the specific recommendations can be found there.
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