Volume 56, Pages S31-S37 (December 1999) Hyperphosphatemia in end-stage renal disease patients: Pathophysiological consequences  Francisco Llach  Kidney International  Volume 56, Pages S31-S37 (December 1999) DOI: 10.1046/j.1523-1755.1999.07316.x Copyright © 1999 International Society of Nephrology Terms and Conditions

Figure 1 Schematic representation of the deleterious effects of hyperphosphatemia. Kidney International 1999 56, S31-S37DOI: (10.1046/j.1523-1755.1999.07316.x) Copyright © 1999 International Society of Nephrology Terms and Conditions

Figure 2 Sigmoidal PTH-Ca2+ relationship in five patients with various levels of serum P. The closed square represents the PTH-Ca2+ curve in the presence of severe hyperphosphatemia (serum P, 8.5 mg/dl). The closed diamonds represent the PTH-Ca2+ later after lowering serum P to 7.0 mg/dl. The closed circle displays the curve days later at serum P of 5.4 mg/dl. Kidney International 1999 56, S31-S37DOI: (10.1046/j.1523-1755.1999.07316.x) Copyright © 1999 International Society of Nephrology Terms and Conditions

Figure 3 A patient with secondary HPTH treated with intravenous calcitriol for 42 weeks. (A) Serum Ca2+ and P during this period. (B) Serum PTH. Note that although the patient developed severe hyperphosphatemia due to dietary noncompliance, and despite appropriate intravenous calcitriol treatment and serum Ca2+ in the upper limit of normal, PTH progressively increased after the fifth week. Kidney International 1999 56, S31-S37DOI: (10.1046/j.1523-1755.1999.07316.x) Copyright © 1999 International Society of Nephrology Terms and Conditions

Figure 4 Schematic representation of the major factors affecting a parathyroid cell in the synthesis of PTH. Question mark (?) represents a hypothetical mechanism by which P↑ may interfere with VDR. Kidney International 1999 56, S31-S37DOI: (10.1046/j.1523-1755.1999.07316.x) Copyright © 1999 International Society of Nephrology Terms and Conditions