Figure 4. The Pathogenesis of Secondary Hyperparathyroidism (SHPT) in Chronic Kidney Disease (CKD)
The new perspective of SHPT in CKD emphasizes the degree of phosphate intake relative to the degree of kidney dysfunction and de-emphasizes the need for overt hypophosphatemia or hypocalcemia. Early FGF23 excess may be a key upstream event of increasing PTH in CKD. Note also the early 1,25-D deficiency.
Abbreviations: SHPT, secondary hyperparathyroidism; PTH, parathyroid hormone; CaR, calcium-sensing receptor; VDR, vitamin D receptor.
Adapted from Figure 3 of Wahl and Wolf201 with the kind permission of the author and of Springer Science and Business Media (copyright 2012, Springer and Advances in Experimental Medicine and Biology).