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Abnormal renal magnesium handling

R A Sutton1, S Domrongkitchaiporn

  • 1Department of Medicine, University of British Columbia, Vancouver, Canada.

Mineral and Electrolyte Metabolism
|January 1, 1993
PubMed
Summary
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The kidneys can reduce magnesium loss during deficiency through unknown mechanisms. Renal magnesium wasting is defined by excessive urinary excretion despite low plasma magnesium levels.

Area of Science:

  • Nephrology
  • Endocrinology
  • Biochemistry

Background:

  • Magnesium is crucial for physiological functions, with kidneys regulating its balance.
  • Normal fractional urinary excretion of filtered magnesium is approximately 5%.
  • The kidneys can conserve magnesium during deficiency via unknown mechanisms, initially without affecting plasma magnesium.

Purpose of the Study:

  • To define renal magnesium wasting.
  • To explore causes of congenital and acquired renal magnesium wasting.
  • To differentiate causes of hypermagnesemia.

Main Methods:

  • Review of physiological mechanisms of renal magnesium handling.
  • Analysis of conditions associated with renal magnesium wasting.
  • Comparison of hypermagnesemia causes.

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Main Results:

  • Renal magnesium wasting defined as urinary excretion >1 mmol/day with hypomagnesemia (<0.7 mmol/l).
  • Congenital causes include Bartter's and Gitelman's syndromes.
  • Acquired causes include diabetes mellitus, hypercalcemia, diuretics, and toxicities (cis-platinum, aminoglycosides).
  • Calcitriol deficiency and familial hypocalciuric hypercalcemia are also implicated.
  • Hypermagnesemia in chronic renal failure stems from reduced glomerular filtration.

Conclusions:

  • Renal magnesium wasting has diverse etiologies, including genetic syndromes, metabolic disorders, and drug toxicities.
  • Understanding these causes is vital for appropriate diagnosis and management.
  • Mechanisms of renal magnesium conservation and wasting are complex and multifactorial.