Studies on the Renal Clearance of Phosphate and the Role of the Parathyroid Glands in Its Regulation

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Abstract
Studies on the renal clearance of phosphate were carried out in normal subjects with experimental alterations in diet and circulating parathyroid hormone, and in patients with hypoparathyroidism and hyperparathyroidism. The effect of these states on the endogenous clearance of phosphate and the latter's response to a 4-hr infusion of calcium and to administration of beef and human parathyroid extract in various stages of purification were observed. The endogenous clearance of phosphate in normal subjects on low phosphorus diets and in states of physiologic hypoparathyroidism did not exceed 5 % of the filtered load. The rising serum calcium that accompanied the 4-hr infusion of this ion in normal subjects caused a progressive rise in the level of inorganic phosphate in the serum. The rate and the magnitude of this rise were related inversely to the probable level of circulating parathyroid hormone. As a result of the findings in the present study, it is apparent that the pattern of rise and fall in the clearance of phosphate during and after the infusion of calcium reflected the simultaneous effects of filtered load, circulating parathyroid hormone and dietary phosphorus on the nephron. The proper interpretation of random clearances of phosphate in clinical or physiologic studies depends upon an appreciation of these variables.

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