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C-Terminal Fibroblast Growth Factor-23 Levels in Non-Nutritional Hypophosphatemic Rickets

Joyita Bharati1, Divya Bhatia1, Priyanka Khandelwal1

  • 1Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.

Indian Journal of Pediatrics
|March 6, 2019
PubMed

Insights

Blood Fibroblast Growth Factor-23 (FGF23) levels did not distinguish classic hypophosphatemic rickets from other hypophosphatemic conditions in children. FGF23 concentrations were similar across various rickets types, indicating limited diagnostic utility.

Area of Science:

  • Pediatric Endocrinology
  • Nephrology
  • Metabolic Bone Disease

Background:

  • Fibroblast growth factor-23 (FGF23) plays a crucial role in phosphate and vitamin D metabolism.
  • Distinguishing classic hypophosphatemic rickets from other causes of hypophosphatemia is clinically important for appropriate management.

Purpose of the Study:

  • To investigate whether serum FGF23 levels can differentiate classic hypophosphatemic rickets from other non-nutritional rickets with hypophosphatemia in children.
  • To assess the correlation of FGF23 levels with biochemical parameters in these conditions.

Main Methods:

  • A cohort of 42 children with non-nutritional rickets and hypophosphatemia were clinically classified into five groups: distal renal tubular acidosis (RTA), Fanconi syndrome, classic hypophosphatemic rickets, vitamin D dependent rickets, and Dent disease.
  • Serum FGF23 concentrations were measured using a C-terminal ELISA.
  • Correlations between FGF23 levels and phosphate, tubular maximum for phosphate, calcium, 25-hydroxyvitamin D, creatinine, and parathormone were analyzed.

Main Results:

  • Median serum FGF23 concentrations were similar across all studied groups (P=0.24).
  • FGF23 levels did not show significant correlations with phosphate, tubular maximum for phosphate, calcium, 25-hydroxyvitamin D, creatinine, or parathormone.
  • Patients with distal RTA exhibited transient proximal tubular dysfunction that resolved with alkali supplementation.

Conclusions:

  • Serum FGF23 levels are not a reliable biomarker for differentiating classic hypophosphatemic rickets from other causes of hypophosphatemic rickets in children.
  • The diagnostic utility of FGF23 in the context of various hypophosphatemic rickets is limited.

Keywords:
Dent diseaseFamilial ricketsHypophosphatemiaRenal tubular acidosis

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