MOE: Phosphorus or Phosphate
π PROXIMAL Tubule: Main site for regulation of phosphate (some is reabsorbed with Na and H20; most is regulated by change in FGF23)
π DISTAL Tubule: Main site for regulation of calcium and potassium #NKFClinicals#Nephpearls#CKDMBD
Active Intestinal Phosphate Transport and Passive Intestinal Phosphate (Paracellular) Transport
π Note that in these tight junctions, there are 5 groups of proteins that regulate this: occludens, claudins, JAMA, E-cadherin, desmosomes #NKFClinicals#Nephpearls
WOLFE: Tenapanor (NHE3 inhibitor) causes an "intracellular acidemia" which leads to clamping down of the intracellular tight junction between 2 adjacent enterocytes so that phosphate is unable to readily pass paracellularly
PRO: BID dosing only; β¬οΈFGF23 #NKFClinicals#Nephpearls
β’ β’ β’
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CONFIRM: In this trial involving adults w/ cirrhosis and HRS-1, terlipressin was more effective than placebo in improving renal function but was associated with serious adverse events, including respiratory failure (ca. 2021) #Hepatorenal#Nephpearls nejm.org/doi/full/10.10β¦