What is the mechanism by which bone and mineral metabolism changes in the person with progressive kidney disease?
The earliest changes involve rising fibroblast growth factor (FGF)-23 levels, which increase phosphate excretion in the urine and suppress 1,25 vitamin D production.
Increased phosphorous and low 1,25-vitamin D lead to hypocalcemia, which stimulates PTH production (secondary hyperparathyroidism) to normalize serum calcium.
