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Disorders of plasma phosphate

The commonest cause of sustained hyperphosphataemia is renal impairment, because the kidney normally excretes phosphate (note that phosphate levels normally rise following meals and that there is significant diurnal variation). A considerable phosphate load may also be provided by some medications, in particular, those used for bowel preparation. Hypophosphataemia may arise from reduced intake or absorption, increased renal excretion, or intracellular redistribution, particularly in response to carbohydrate loads with refeeding after starvation. Excessive renal phosphate loss can reflect tubular damage or inherited phosphate-wasting nephropathies. This chapter reviews the causes of derangements of phosphate metabolism and the clinical consequences.